固定袢和可调节袢在粗骨道中的长度对股骨骨道增宽及膝关节功能的影响

doi:10.19723/j.issn.1671-167X.2021.05.012

摘要/Abstract

摘要：

目的: 评估两种不同的股骨皮质悬吊装置(固定袢和可调节袢)重建前交叉韧带术后12个月患者的股骨骨道增宽情况及膝关节功能。方法: 共纳入60例行前交叉韧带重建术的患者,根据袢在粗骨道中长度(n)[n=袢的总长度-(股骨骨道总长度-粗骨道的总长度)]将患者分为A(可调节袢在粗骨道中长度为0 mm)、B(固定袢在粗骨道中长度为>0 mm、≤10 mm之间)、C(固定袢在粗骨道中长度>10 mm)三组,其中A组病例数为11例,B组病例数为27例,C组病例数为22例,比较三组患者在膝CT关节三维重建术后12个月与术后即刻股骨骨道增宽情况,同时比较三组患者的国际膝关节委员会(International Knee Documentation Committee,IKDC)评分、Lysholm评分及Tegner评分。结果: A、B、C三组的股骨骨道增宽程度存在差异,术后12个月和术后即刻股骨骨道增宽差值中位数:AP<0.05)。根据线性回归关系发现n值与骨道增宽差值存在线性关系,随着n值的增大,骨道增宽的差值逐渐变大。股骨中上骨道的增宽差值中位数出现负数,中下骨道的增宽差值中位数均为正数。随访时发现三组术后12个月的IKDC、Lysholm、Tegner评分差异无统计学意义(P>0.05)。结论: A组与B组、C组相比,其术后12个月的骨道增宽程度较小;在A、B、C三组中随着袢在粗骨道中的长度逐渐增大,骨道增宽程度越显著;前交叉韧带重建术后12个月患者,其股骨中下骨道较术后即刻骨道增宽明显,股骨中上骨道已逐渐开始发生重建肌腱和股骨愈合;在术后12个月的随访患者中,A、B、C三组膝关节功能评分差异无统计学意义。

关键词: 前交叉韧带重建, 固定袢, 可调节袢, 骨道增宽, 膝关节功能

Abstract:

Objective: To evaluate the effects of two different femoral cortical suspension devices (fixation loop and adjustable loop) on tunnel widening and knee function in patients following anterior cruciate ligament reconstruction for 12 months. Methods: A total of 60 patients who had undergone anterior cruciate ligament reconstruction were included in this study. According to the length of the loop(n)[n= total length of loop-(total length of femoral tunnel-total length of coarse tunnel)] in the rough bone tunnel, the patients were divided into A (adjustable loop was 0 mm in the coarse bone tunnel), B (fixation loop was greater than 0 mm and less than or equal to 10 mm in the coarse bone tunnel) and C (fixation loop was greater than 10 mm in the coarse bone tunnel) groups, of which 11 cases were in group A, 27 cases in group B and 22 cases in group C. In the three-dimensional reconstruction of the knee joint with multi-slice spiral CT, the widening of the bone tunnel in the three groups was compared. At the same time, IKDC, Lysholm and Tegner scores of the patients in the three groups were compared. Results: There were differences in the widening degree of the femoral canal among groups A, B and C, and the median difference of the widening degree of the femoral tunnel 12 months and immediately after the surgery was AP<0.05).According to the linear regression the relationship between the difference of the width of the femoral canal and the change of the length (n) of the loop in the coarse canal, it was found that there was a linear relationship between the value of n and the difference of the width of the bone canal. With the increase of the value of n, the difference of the width of the bone canal gradually became larger. The median difference of the width of the middle and superior tunnel was negative, while the median difference of the width of the middle and inferior tunnel was positive. During the follow-up, we found that there were no statistical differences in IKDC, Lysholm and Tegner scores among the three groups one year after surgery (P>0.05). Conclusion: Twelve months after surgery, compared with group B (fixed loop group) and group C (fixed loop group), group A (adjustable loop group) had less bone tunnel widening.In groups A, B and C, as the length of the loop in coarse bone tunnel gradually increased, the width of bone tunnel became more significant. At the end of 12 months follow-up after anterior cruciate ligament reconstruction, the medial and inferior femoral tunnel was significantly wider than immediately after surgery, and the medial and superior femoral tunnel had gradually begun to undergo tendon-bone healing. There was no significant difference in knee function scores among groups A, B, and C in the follow-up 12 months after surgery.

Key words: Anterior cruciate ligament reconstruction, Fixation loops, Adjustable loops, Bone tunnel widening, Knee function

中图分类号:

R686.5

印钰,梅宇,王泽刚,宋首一,刘鹏飞,何鹏峰,武文杰,谢兴. 固定袢和可调节袢在粗骨道中的长度对股骨骨道增宽及膝关节功能的影响[J]. 北京大学学报（医学版）, 2021, 53(5): 883-890.

Yu YIN,Yu MEI,Ze-gang WANG,Shou-yi SONG,Peng-fei LIU,Peng-feng HE,Wen-jie WU,Xing XIE. Lengths of the fixed loop and the adjustable loop in the coarse bone tunnel were compared to influence the widening of the femoral bone tunnel and the function of the knee joint[J]. Journal of Peking University (Health Sciences), 2021, 53(5): 883-890.

图/表 9

图1

图2

表1

表2

表3

A、B、C三组术后12个月膝关节功能评分的均值方差及P值相互比较"

Items	A	B	C	P
Items	A	B	C	A vs.B	A vs.C	B vs.C
Tegner score, $x ?$ ±s	4.18±0.75	4.44±0.75	4.54±1.01	0.341	0.394	0.973
Lysholm score, $x ?$ ±s	91.81±9.13	92.67±7.66	90.91±9.54	0.790	0.791	0.492
IKDC score, $x ?$ ±s	77.63±8.88	78.37±7.33	78.58±7.47	0.813	0.772	0.921

表3

图3

图4

图5

图6

参考文献 30

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Items	A	B	C
Age/year, M (Min, Max)	33 (25, 45)	31 (18, 58)	36 (24, 48)
BMI/(kg/m²), M (Min, Max)	25.7 (20.6, 28.7)	24.0 (18.2, 31.4)	24.1 (18.6, 29.7)
Lengths of the superior femoral tunnel/mm, M (Min, Max)	30.0 (29.0, 36.9)	34.2 (29.0, 43.0)	33.6 (25.8, 38.6)
Lengths of the coarse femoral tunnel/mm, M (Min, Max)	17.7 (15.5, 25.0)	25.2 (16.7, 29.4)	26.9 (22.0, 29.4)
T/mm, M (Min, Max)	8.000 (7.000, 9.000)	8.000 (7.000, 9.000)	8.000 (7.000, 9.000)
M1/mm, M (Min, Max)	9.300 (7.600, 11.800)	9.600 (7.900, 12.000)	10.950 (8.800, 15.100)
M2/mm M (Min, Max)	9.400 (7.200, 11.900)	9.500 (8.100, 13.000)	10.300 (8.400, 12.700)
M3/mm M (Min, Max)	7.600 (4.500, 9.900)	8.200 (6.000, 10.700)	7.700 (6.300, 12.200)
M4/mm M (Min, Max)	4.000 (1.600, 6.000)	5.100 (3.500, 8.000)	5.200 (4.200, 9.300)
M1-T/mm M (Min, Max)	1.000 (0.300, 3.800)	1.800 (0.700, 3.600)	3.100 (1.500, 7.100)
M2-T/mm M (Min, Max)	1.100 (-0.500, 3.900)	1.800 (0.300, 5.000)	2.300 (0.600, 5.200)
M3-T/mm M (Min, Max)	-0.400 (-4.500, 1.900)	0.250 (-1.700, 2.700)	0.350 (-1.300, 3.800)
M4-T/mm M (Min, Max)	-3.100 (-7.100, -2.100)	-2.700 (-4.500, -1.000)	-2.600 (-3.700, 1.300)
(M1-T)/T/% M (Min, Max)	0.125 (0.038, 0.475)	0.243 (0.088, 0.450)	0.401 (0.188, 0.888)
(M2-T)/T/% M (Min, Max)	0.157 (-0.056, 0.488)	0.238 (0.038, 0.625)	0.301 (0.075, 0.743)
(M3-T)/T/% M (Min, Max)	-0.050 (-0.500, 0.238)	0.016 (-0.213, 0.338)	0.019 (-0.162, 0.529)
(M4-T)/T/% M (Min, Max)	-0.443 (-0.800, -0.263)	-0.348 (-0.563, -0.111)	-0.346 (-0.463, 0.163)

Items	A vs.B	B vs.C	A vs.C
Age	0.420	0.243	0.863
BMI	0.910	0.185	0.073
Length of the superior femoral tunnel	0.022	0.278	0.089
Length of the coarse femoral tunnel	0.000	0.097	0.000
T	0.177	0.729	0.148
M1	0.375	0.003	0.003
M2	0.326	0.091	0.024
M3	0.097	0.960	0.187
M4	0.085	0.725	0.026
M1-T	0.005	0.000	0.000
M2-T	0.010	0.129	0.002
M3-T	0.031	0.936	0.037
M4-T	0.010	0.566	0.002
(M1-T)/T	0.004	0.000	0.000
(M2-T)/T	0.007	0.129	0.002
(M3-T)/T	0.031	0.912	0.041
(M4-T)/T	0.014	0.636	0.012