保留或非保留 ACL 残迹对自体腘肌腱重建 ACL 术后胫骨骨道影响的对比研究

目的：探讨保留或非保留 ACL 胫骨残迹对 ACL 重建术后胫骨骨道的影响以及与临床疗效的关系。方法65例孤立性 ACL 损伤病例行关节镜下自体半腱肌、股薄肌肌腱重建 ACL，其中 A 组27例，保留 ACL 胫骨残迹，B 组38例，采用非保留残迹进行 ACL 重建。术后进行 MRI 检查，测量胫骨矢状位骨道最宽处直径，以术后1周对应部位骨道直径为衡量基准，对骨道扩大率进行统计学分析。采用 Lysholm 评分评估各组临床疗效。结果 A组25例，B 组35例得以随访，其中 A 组平均随访12.4个月，B 组平均随访12.1个月。两组病例术后胫骨骨道均有不同程度增宽，以 B 组骨道扩大程度相对较高。结果表明胫骨骨道随时间延长逐步扩大，在术后6周即有明显的扩大，自术后3个月，骨隧道变化程度相对较小，并趋于稳定；两组资料胫骨骨隧道扩大程度在各个时间段上均无统计学意义。所有病例稳定性良好，术后 Lysholm 评分在随访过程中逐步提高，两组病例在各个时间段对比无统计学意义（P ＆gt;0.05）。结论是否保留 ACL 残迹对骨道扩大、术后疗效无相关性，但保留 ACL 残迹可以促进腱-骨愈合，降低骨道扩大的发生程度。

Comparative study of tibial tunnel enlargement after hamstring anterior cruciate ligament reconstruction by preservation of the remnants of ACL or not

Objective：To compare the changes and the outcome of the tibial bone tunnel after arthroscopically assisted hamstring ACL reconstruction by preservation of the remnents of ACL and evaluate the relation with clinical effect. Meth-ods：Sixty-five cases in two groups were included and underwent hamstring ACL reconstruction with endobutton and intrafix fixation system by preservation of the remnents of ACL or not for MRI evaluation. Twenty-seven cases in Group A received ACL reconstruction by preservation of the remnents of ACL,thirty-eight cases（Group B）by non-preservative remnents. Tibial bone tunnel diameters at the widest point on sagittal MRI were compared at one week postoperatively. Lysholm score was used to evaluate the clinical effect. Results：Twenty-five cases in Group A and thirty-five cases in Group B were fol-lowed up for average 12. 4 and 12. 1 months respectively. Tunnel enlargement after ACL surgery was noted in the two groups,and the extent of enlargement of ACL tunnel was larger in Group B comparatively. The changes of tibial tunnel ena-largement were distinct in six weeks postoperatively and stable in three months postoperatively. There was no difference be-tween groups A and B in the extent of tibial tunnel enlargement（P〉0. 05）. All the cases in the two groups had stable knee function. No significant difference was found by Lysholm score in follow-up time. Conclusion：No correlation of bone tunnel enlargement and clinical effect is found between the preservative and non-preservative ACL remnents. The preservation of ACL remnant can promote the healing of tendon and bone,and decrease the tunnel enlargement after ACL reconstruction.