关节镜下标尺定位在解剖重建前交叉韧带中的应用

目的探讨应用关节镜下标尺定位方法辅助解剖重建前交叉韧带的可行性及疗效。方法对36例前交叉韧带损伤患者行关节镜下前交叉韧带重建术。据镜下标尺测量前交叉韧带胫骨印迹长径将患者分为双束重建组（21例）和单束重建组（15例），采用标尺测量前交叉韧带胫骨、股骨解剖印迹中心结合局部解剖标志及钟表法确定重建位置后，取自体胭绳肌腱解剖重建损伤前交叉韧带，术后随访23．26个月，采用IKDC评分、Lysholm评分和Tegner评分方法评价术后疗效。结果双束重建组术后IKDC评分优良率90．4％（19／21），术前、术后Lysholm评分分别为（62．5±6．5）、（93．8±9．9）分，Tegner评分分别为（4．2±1．3）、（6．6±1．9）分；单束重建组术后IKDC评分优良率86．7％（13／15），术前、术后Lysholm评分分别为（61．7±7．1）、（94．2±9．6）分，Tegner评分分别为（4．1±1．5）、（6．5±1．7）分。两组组内术前、术后各项指标比较差异均有统计学意义（Z值分别为7．82、6．33，t值分别为2．31、5．60，3．55、7．09，P均〈0．05），两组组间术前、术后各项指标比较差异均无统计学意义（z值分别为1．35、2．04，t值分别为0．64、1．23，0．48、0．09，P均〉0．05）。结论采用关节镜下标尺测量结合其他传统方法定位解剖重建损伤前交叉韧带，简便、直观、有效，可个体化调整韧带的重建位置，值得临床推广应用。

Measurement with a scale in arthroscopic anatomic anterior cruciate ligament reconstruction

Objective To evaluate the value of the measurement with a scale in arthroscopic anatomic anterior cruciate ligament （ACL） reconstruction. Methods Thirty-six patients with unilateral ACL-deficient knees were divided into single bundle group and double bundle group based on the length of the major axis of the native ACL footprint measured with a scale. Consistent with the International Knee Documentation Committee （ IKDC ） scoring systems, Lysholm knee scoring scale and Tegner activity rating were used to evaluate the clinical results, and data from 23 to 26 months follow-up were gathered and analyzed statistically. Results In terms of IKDC evaluation,19 patients（90.4% ） in the double band group and 13 patients（ 86. 7% ）in the single band group were graded as normal or nearly normal （ Z = 7.82,6. 33 ; P 〈 0. 05 ）. The mean Lysholm scores were 93.8 ± 9. 9 and 94.2 ± 9. 6 and the mean Tegner scores were 6. 6 ±1.9 and 6. 5 ± 1.7 for the double and single band groups, respectively （ t = 2. 31,5.60,3.55,7. 09 ; P 〈 0. 05 ）. Conclusion Arthroscopic measurement with a scale combined with other traditional methods to determine the tunnel location is easy to conduct and intuitional to understand. It could be useful in anatomic ACL reconstruction.