摘要
目的探讨关节镜下个性化原位解剖重建前交叉韧带(ACL)的技术与结果。方法该技术包括3部分内容,首先在术前进行膝关节三维CT与MRI扫描了解患者韧带足迹与排列特点,其次在术中对髁间窝和ACL在股骨与胫骨的足迹进行测量,以明确可以进行双束重建。最后,根据患者的体质情况进行个性化康复训练。手术前后采用KT2000、Lysholm评分、IKDC评分、拉赫曼与轴移试验进行手术效果评估。SPSS15.0统计软件进行统计分析。结果选择82例患者,男52例,女30例,评均年龄25.2岁。根据术前CT与MRI评估发现,股骨外侧髁3种形态:四边形、中间形、三角形3种,其中四边形髁最适合进行双束重建,三角形髁需要术中仔细测量;股骨与胫骨的ACL足迹均有2种排列:直行与斜行,术中可据此进行骨道钻制。本组术中将ACL足迹长度大于14mm,且髁间窝宽度大于12mm的患者入选进行双束重建。手术前后,ACL足迹测量结果完全相符者65例,髁间窝宽度相符者71例。82例均进行个性化双束重建。术后平均随访时间15个月。术后三维CT显示骨道与术前设计相符,Lysholm评分由(49.3±9.2)分到(93.7±8.0)分,IKDC正常者77例,占94%。77例显示前后与旋转稳定均良好,4例双侧KT200检查显示3～4mm前向松弛,但轴移阴性。1例失败需进行翻修。所有病例均对疗效满意。结论术前对股骨外髁形态、ACL股骨与胫骨足迹特点的判断对手术的设计至关重要,但手术中对髁间窝、ACL股骨与胫骨足迹的测量更具决定意义。采用个性化解剖位双束重建能较好地恢复患者膝关节稳定性。
Objective To discuss the outcomes of anterior cruciate ligament （ACL） reconstruction （ACLR） using the individualized in-situ double-bundle techniques by arthroscopy. Methods Preoperative MRI and 3D-CT scan were performed to obtain individual data of ligament foorprint. During the operation, the ACL insertions on the femoral condyles and tibial plateau, and the width of femoral intercondyle notch （WFIN） were precisely measured. ACL footprint over 14 mm and width of intercondylar fossa over 12 mm were taken as the inclusion criteria. 82 patients, 52 male, 30 female, mean age of 25.2 years, were selected to perform the double bundle ACLR procedure. All patients were followed up for 15 months in average. KT2000, Lysholm and IKDC Score, Lachman and Pivot Shift exams were adopted pre- and post-operatively. Statistical analysis was performed by SPSS software, version 15.0. Results According to pre-operative MR[ and CT scan, the shape of lateral femoral condyle had three kinds： Quadrilateral, intermediate shape, triangle. Among them, the quadrangle condyle is most suitable for double bundle ACLR, triangle condyle need intraoperative careful measurement, and the ACL insertion site had two kinds of arrangement on femoral and tibia sides ： straight and oblique. The pre- and intra- operative measurements of ACL footprint length were totally matched in 65 cases. The pre- and intra- operative WFIN were totally matched in 71 cases. The post-operative 3D-CT showed bone tunnels on both femoral and tibial sides were accordant with preoperative design in every case. Lysholm and IKDC scores showed good results. Lysholm scores increased from （49. 3±9. 2） to （93.7±8.0）, and IKDC scores became normal in 77 cases （94%）. 77 cases showed no rotation or anterior-posterior instability. Four cases showed 3 - d mm anterior-posterior displacement in KT2000 test; one case failed and needed revision. All cases were satisfactory in the final results. Conclusions Comparing to healthy knee, the shapes of lateral femoral condyle, the ACL insertion site arrangement on femoral and the tibial sides may have important value in pre-operative evaluation, but the final decision of performing double-bundle ACLR should better be made during the operation. The individualized arthroscopic in-situ double-bundle ACL anatomical reconstruction can maximally restore the rotation stability of knee.
出处
《中华关节外科杂志（电子版）》
CAS
2013年第1期12-16,共5页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
广东省卫生厅课题(2012B3180002)
关键词
关节镜
个性化
前交叉韧带
原位
解剖
重建
Arthroscopic
Individualized
Anatomy
Double bundle
Anterior cruciate ligament
Reconstruction.
