非接触性前十字韧带损伤初次重建术后失效的危险因素

目的探讨非接触性前十字韧带(anterior cruciate ligament,ACL)损伤初次重建术后失效的危险因素。方法2015年11月至2017年5月连续收治并随访2年以上的非接触性ACL损伤而行ACL初次重建的患者178例。随访2年内25例患者出现MRI证实的ACL移植物完全断裂或轴移试验阳性或KT-1000侧侧差值超过5 mm或MRI上静态胫骨前移超过5 mm判定为术后失效,纳入术后失效组;按照1∶2的比例匹配术后2年内未失效者50例,纳入术后未失效组。比较两组患者性别、年龄、体质指数(body mass index,BMI)、患侧分布、半月板损伤侧分布、受伤至手术时间、术前麻醉下KT-1000侧侧差值、轴移试验、随访时间、术前下肢负重位全长X线片上胫骨平台后倾角及胫骨前移的差异,采用多因素Logistic回归分析确定ACL损伤初次重建术后失效的危险因素。结果术后失效组的胫骨平台后倾角为17.21°±2.20°,大于术后未失效组的14.36°±2.72°,差异有统计学意义(t=4.395,P<0.001);术后失效组的术前胫骨前移为(8.29±3.42)mm,大于术后未失效组的(4.09±3.06)mm,差异有统计学意义(t=5.504,P<0.001)。两组性别、年龄、BMI、患侧分布、半月板损伤侧分布、受伤至手术时间、麻醉下KT-1000侧侧差值、轴移试验分度、随访时间的差异均无统计学意义(P>0.05)。多因素回归分析结果显示胫骨平台后倾角≥17°是ACL术后失效的独立危险因素(OR=15.62,P=0.002),胫骨前移≥6 mm是ACL术后失效的独立危险因素(OR=9.91,P=0.006);而性别、年龄、BMI、半月板是否损伤、轴移试验分度、KT-1000侧侧差值与术后失效无相关性(P>0.05)。结论术前下肢负重位全长X线片上胫骨平台后倾角≥17°和胫骨前移≥6 mm可增加ACL损伤初次重建术后失效的风险。

Risk factors for primary anterior cruciate ligament reconstruction failure

Objective To explore the risk factors of primary anterior cruciate ligament(ACL)reconstruction failure.Methods From November 2015 to May 2017,a total of 178 consecutive patients with clinically diagnosed non-contact ACL injury were treated and followed-up more than 2 years.Twenty-five patients(post-operative failure group)who underwent completely ruptured ACL graft confirmed by MRI,positive pivot-shift test,more than 5 mm side-to-side difference(SSD)measured by KT-1000 arthrometer,more than 5 mm static anterior tibial translation(ATT)measured on MRI were determined to be ACL reconstruction failure.They were matched in a 1∶2 fashion to 50 non-failure patients(post-operative non-failure group),who showed intact ACL graft 2 years after ACL reconstruction.The sex,age,body mass index(BMI),affected side,meniscal injury side,time from injury to surgery,KT-1000 SSD,pivot shift test under anesthesia,follow-up duration,posterior tibial slope(PTS)and ATT measured on the pre-operative weight-bearing whole leg radiographs between the two groups were compared using univariate analysis.Moreover,the predictors of ACL reconstruction failure were assessed by multivariable conditional Logistic regression analysis.Results Post-operative failure group had a significantly higher PTS and ATT values than those in the post-operative non-failure group(17.21°±2.20°vs 14.36°±2.72°,t=4.395,P<0.001;8.29±3.42 mm vs 4.09±3.06 mm,t=5.504,P<0.001).The sex,age,BMI,affected side,meniscal injury side,time from injury to surgery,KT-1000 SSD,pivot shift test under anesthesia,follow-up duration between the two groups showed no significant difference(P>0.05).Multivariable Logistic regressions indicated that PTS≥17°(OR=15.62,P=0.002)and ATT≥6 mm(OR=9.91,P=0.006)were independent risk factors for primary ACL reconstruction failure.However,sex,age,BMI,meniscal lesions,degree of pivot shift test,KT-1000 SSD were not the independent risk factors.Conclusion PTS≥17°and ATT≥6 mm could increase the risk of primary ACL reconstruction failure.