前交叉韧带股骨侧移植物的止点和角度对术后膝关节功能的影响

目的:探讨前交叉韧带重建术股骨止点定位和隧道角度与术后膝关节功能的相关性。方法:分析自2006年1月至2009年5月行前交叉韧带单束重建术的47例患者,男32例,女15例;年龄19～51岁,平均35.3岁。在末次随访时摄膝关节正侧位X线片并记录以下指标:移植物在股骨止点上的位置,股骨隧道在冠状面与内、外髁连线及矢状面与股骨干轴线的夹角。根据IKDC评分,38例>90分,9例<90分。通过对两组的比较,分析各项指标与膝关节功能的相关性。结果:IKDC评分>90分的38例股骨止点位于Blumensaat线后16.21%～53.82%,平均(29.73±4.31)%;<90分的9例股骨止点位于Blumensaat线后27.18%～72.34%,平均(46.61±3.43)%,两组差异有统计学意义。>90分的38例股骨隧道中心线与膝关节线夹角33°～67°,平均(49.5±4.72)°;<90分的9例41°～81°,平均(67.6±3.09)°,两组差异有统计学意义。>90分的患者股骨隧道中心线与股骨干长轴的夹角11°～45°,平均(31.3±5.12)°;<90分的9例为23°～56°,平均(41.2±5.69)°,两组差异有统计学意义。结论:前交叉韧带重建术股骨止点定位和隧道角度与术后膝关节功能关系密切,故在前交叉韧带重建时应尽量选择前内侧入路解剖重建。

Clinical study on the effects of the femoral attachment site of grafts and the tunnel angle on the function of knee joint after anterior cruciate ligament reconstruction

Objective:To investigate the effects of the attachment site of grafts and the tunnel angle on the function of knee joint after anterior cruciate ligament reconstruction. Methods:From January 2006 to May 2009,47 patients(32 males and 15 females,ranging in age from 19 to 51 years old,with an average of 35.3 years old) were treated with single-bundle reconstruction of anterior cruciate ligament. Several indexes were measured at the latest follow-up as follow:attachment sites of graft on the femoral condyle were recorded,the femoral tunnel angles on coronal and sagittal planes were measured on postoperative X-ray films. According to the IKDC score,these patients were divided into two groups. In the first group,38 patients were found the IKDC score more than 90 at the latest follow-up,and in the second group 9 patients were found IKDC score less than 90. By comparing the two groups,the relation of the indexes and postoperative function of knee was analyzed. Results:The IKDC which was more than 90 at the latest follow-up was found in 38 patients,whose femoral attachments site of ACL was positioned at(29.73±4.31)%(ranged from 16.21% to 53.82%) from the posterior end of Blumensaat's line. IKDC which was less than 90 was found in 9 patients,whose femoral attachments site of ACL was positioned at(46.61±3.43)%(ranged from 27.18% to 72.34%). There was significant difference between the two groups(P=0.000 7). The IKDC more than 90 at the latest follow-up was found in 38 patients,whose femoral tunnel angle on coronal plane was(49.5±4.72)°(ranged from 33° to 67°)and on sagittal plane was (31.3±5.12)°(ranged from 11° to 45°) were significantly less than those whose IKDC less than 90 at the latest follow-up on coronal plane was(67.6±3.09)°(ranged from 41° to 81°) and on sagittal plane was(41.2±5.69)°(ranged from 23° to 56°)(P=0.000 7,P=0.000 8). Conclusion:There is close relation between the attachment site of grafts and the tunnel angle with the function of knee,so in anterior cruciate ligament should be anatomic reconstructed with the anterior medial approach.