【作者】 原福贞；

【导师】 严世贵；

【作者基本信息】 浙江大学 ， 外科学， 2012， 硕士

【摘要】 目的本研究通过术后磁共振(MRI)定量分析,以及临床随访结果,对比分析前内侧孔入路技术(AM技术)和经胫骨隧道技术(TT技术)行ACL单束重建术后骨隧道的扩大情况。方法本研究收集2007年10月至2010年2月间共60例行关节镜下ACL单束重建病例,按AM技术和TT技术,分为AM组和TT组,其中AM组28例,TT组32例。术后对其进行临床评估(Lysholm评分和Lachman试验)、MRI检查测术后及术后约2年矢状位股骨隧道和胫骨隧道宽度,测量股骨隧道远端(A1靠近关节面)、中间(A2)、近端(A3远离关节面)和胫骨隧道近端(B1靠近关节面)、中间(B2)、远端(B3远离关节面)的直径,计算出术后骨隧道变化率(%)。比较两者临床效果以及骨隧道的扩大情况。结果用AM技术重建ACL临床评估显示,术后六个月Lysholm评分为87.8±2.9,而TT组仅为83.5±2.8(P=0.048),并且Lachman试验AM组显著小于TT组(P=0.023)。结果显示TT组出现更明显的骨隧道扩大,A1位点(30.8%v21.5%p=0.006),A2位点(25.6%v18.5%p=0.009),B1位点(22.8%v19.5%p=0.043),B2位点(22.6%v18.2%p=0.035),B3位点(22.3%v18.0%p=0.041)。且股骨隧道多为锥形扩大,胫骨隧道多为线性扩大。结论相对于TT技术,AM技术可以减小骨隧道扩大的发生,术后早期临床效果较好。更多还原

【Abstract】 Objective The aims of this study were to compare the tunnel enlargement between transtibial and anteromedial portal techniques after single-bundle anterior cruciate ligament (ACL) reconstruction.using postoperative magnetic resonance imaging (MRI) and the clinical results.Methods Between October2007and February2010,60consecutive patients, followed by an arthroscopically assisted ACL reconstruction with either an AM technique or TT technique, were enrolled in this study. The patients were divided into two groups:AM group (28patients) and the TT group (32patients). All the patients including both groups in this study underwent postoperative MRI and clinical evaluation (Lysholm score and Lachman test). The diameter was measured perpendicular to the axis of the tunnel at proximal, middle, and distal. Tunnel enlargement was determined by comparing the diameter of the tunnel on the radiograph obtained after about24months and the radiograph obtained instantly after the operation.Results Postoperatively Lysholm score were87.8±2.9in the AM group and83.5±2.8in the TT group after six months(P=0.048), and the Lachman test was significantly different from each other after two years (P=0.023) with a better outcome in AM group. On lateral radiographs, the TT group has a higher rate of tunnel enlargement, Al (30.8%v21.5%p=0.006), A2(25.6%v18.5%p=0.009), B1(22.8%v19.5%p=0.043), B2(22.6%v18.2%p=0.035),B3(22.3%v18.0%p=0.041), and there is no difference at the point of A3between TT group and AM group.Conclusion Drilling the femoral tunnel through the anteromedial arthroscopy portal rather than using a transtibial drilling technique diminishes the enlargement of bone tunnel and provides better clinical outcomes in the early phase after operation.更多还原