由外向内法和前内侧入路法重建前交叉韧带对骨隧道扩大的影响

Observation of bone tunnel enlargement on the influence of anterior cruciate ligament reconstruction with outside-in technique and anteromedial tunnel drilling methods

摘要:

目的 使用由外向内和经髌骨下前内侧入路法行关节镜膝关节前交叉韧带重建术股骨隧道钻取，探讨该方法对术后骨隧道扩大的影响。方法 回顾性分析2018年2月－2019年6月就诊于新疆医科大学第一附属医院骨科中心并诊断为前交叉韧带损伤的患者50例，平均分为两组并行关节镜下前交叉韧带重建。其中，25例患者采用由外向内钻取股骨隧道法钻取股骨隧道（由外向内组），另25例使用传统的经前内侧入路法钻取股骨隧道（前内侧组），术后常规康复。比较两组术后１年股骨和胫骨隧道扩大直径和Lysholm评分。结果 两组共13例发生不同程度和不同部位的骨隧道扩大，由外向内组股骨隧道扩大（2.21±1.69）mm，前内侧组（1.54±1.14）mm，两组比较，差异有统计学意义（P < 0.05）；由外向内组胫骨隧道扩大（1.61±1.42）mm，前内侧组（1.70±1.22）mm，两组比较，差异无统计学意义（P > 0.05）。术后1年，由外向内组Lysholm评分为（96.73±3.92）分，前内侧组为（96.29±3.71）分，两组比较，差异无统计学意义（P > 0.05）；0级骨隧道扩大Lysholm评分为（96.51±3.89）分，1级扩大为（94.89±3.47）分，2级扩大为（92.21±0.59）分，差异无统计学意义（P > 0.05）。结论 术后1年两种股骨隧道钻取方式都可以引起骨隧道扩大，股骨隧道扩大直径与股骨隧道钻取方式明显相关，但隧道扩大与否对膝关节功能无明显影响。

Abstract:

Objective To compare the effects of arthroscopic anterior cruciate ligament reconstruction using outside-in technique and trans-inferior anteromedial approach in arthroscopic anterior cruciate ligament reconstruction on postoperative bone tunnel enlargement.Methods A retrospective analysis of 50 patients were diagnosed with anterior cruciate ligament injury from February 2018 to June 2019 were divided into two groups with anterior cruciate ligament reconstruction. 25 patients used the femoral tunnel from the outside-in technique to drill the femoral tunnel, and the remaining 25 patients used the traditional anteromedial approach, and routinely recovered after the operation. The enlarged diameter of femoral and tibial tunnels and Lysholm score were compared one year after operation.Results All the patients were followed up 1 year after surgery. The results of the postoperative follow-up showed that there were 13 patients with bone tunnel enlargement. The enlargement diameter of femoral tunnel from the outside-in group was (2.21 ± 1.69) mm, and the femoral tunnel for the anteromedial approach group. The enlargement diameter was (1.54 ± 1.14) mm, and the difference was statistically significant (P < 0.05). The enlargement diameter of the tibial tunnel from the outside to the inside group was (1.61 ± 1.42) mm, and the anteromedial approach group was (1.70 ± 1.22) mm, the difference was not statistically significant (P > 0.05). The Lysholm score from the outside-in group was (96.73 ± 3.92) and the anteromedial group was (96.29 ± 3.71) at 1 year after surgery, the difference was not significant (P > 0.05); The Lysholm score of grade 0 bone tunnel enlargement was (96.51 ± 3.89), grade 1 enlargement was (94.89 ± 3.47), grade 2 enlargement was (92.21 ± 0.59), and the difference was not significant (P > 0.05).Conclusion One year after operation , two kinds of femoral tunnel drilling methods can cause bone tunnel expansion, the diameter of femoral tunnel enlargement is significantly related to the femoral tunnel drilling method, and whether the tunnel expansion has no significant effect on knee function .