摘要
目的与传统解剖单束(single-bundle,SB)重建比较,探讨越顶位(over-the-top,OTT)重建前交叉韧带(anterior cruciate ligament,ACL)术后早期移植物愈合情况。方法回顾性分析2021年6月—2022年10月收治且符合选择标准的40例ACL重建患者临床资料,其中20例采用OTT重建(OTT组),20例采用SB重建(SB组)。两组患者性别、年龄、损伤侧别、病程、半月板损伤程度、身体质量指数以及术前国际膝关节文献委员会(IKDC)评分、Lysholm评分、疼痛视觉模拟评分(VAS)、KT-2000测量值等基线资料比较,差异均无统计学意义(P>0.05)。术后3、6、12个月,MRI检查测量两组移植物近端、中段、远端以及OTT组移植物与股骨外侧髁拐角处、移植物股骨固定点周围1 cm处核磁信噪比(signal noise quotient,SNQ),观察移植物愈合程度;术前及术后3、6、12个月,通过IKDC评分、Lysholm评分、VAS评分评估膝关节功能及疼痛程度;术前及术后12个月,KT-2000关节测量仪评价膝关节稳定性。结果两组手术均顺利完成,切口均Ⅰ期愈合。患者均获随访,随访时间12~15个月,平均12.9个月;组间差异无统计学意义(P>0.05)。术后两组IKDC评分、VAS评分、Lysholm评分均随时间延长逐渐改善,各时间点间差异均有统计学意义(P<0.05);但术后3、6、12个月组间差异均无统计学意义(P>0.05)。术后12个月两组膝关节前后稳定性均有显著改善,KT-2000测量值与术前比较差异有统计学意义(P<0.05),但手术前后差值组间差异无统计学意义(P>0.05)。MRI随访示,术后3、6、12个月两组移植物近端及中段SNQ差异均无统计学意义(P>0.05),SB组远端SNQ大于OTT组(P<0.05)。OTT组各时间点移植物拐角处SNQ最高、固定点周围1 cm处最小,与其余部位比较差异均有统计学意义(P<0.05)。两组内除固定点周围1 cm处,其余各部位移植物术后6个月SNQ最高、术后12个月最低,差异均有统计学意义(P<0.05)。两组内移植物不同部位SNQ差异均有统计学意义(P<0.05),移植物近端SNQ最低、远端最高。末次随访时两组患者膝关节移植物形态良好,未见移植物坏死及内固定物松动发生。结论单纯OTT重建ACL术后膝关节功能评分、移植物愈合与SB重建相似,需注意移植物拐角处愈合较慢。
Objective To compare early graft healing between over-the-top(OTT)and anatomic single-bundle(SB)anterior cruciate ligament(ACL)reconstruction.Methods A clinical data of 40 patients underwent ACL reconstruction,who admitted between June 2021 and October 2022 and met the selective criteria,was retrospectively analyzed.Among them,20 patients were treated with OTT reconstruction(OTT group)and 20 with SB reconstruction(SB group).There was no significant difference between groups(P>0.05)in the gender,age,affected side,disease duration,degree of meniscus injury,body mass index,and preoperative International Knee Documentation Committee(IKDC)score,Lysholm score,pain visual analogue scale(VAS)score,and KT-2000 measurement.At 3,6,and 12 months,MRI was performed to measure the signal noise quotient(SNQ)of the proximal end,middle,and distal end of the graft in the two groups,as well as at the corner of the graft with lateral femoral condyle and 1 cm around the femoral fixation point in the OTT group,to observe the degree of graft healing.Before operation and at 3,6,and 12 months,the knee function and pain were evaluated by IKDC score,Lysholm score,and VAS score.Before operation and at 12 months after operation,the KT-2000 measurement was taken to evaluation the knee joint stability.Results All operations were successfully completed in both groups and the incisions healed by first intention.All patients were followed up 12-15 months(mean,12.9 months),with no significant difference in the follow-up time between groups(P>0.05).After operation,the IKDC score,VAS score,and Lysholm score improved gradually over time in both groups,with significant differences between different time points(P<0.05).The differences between groups at 3,6,and 12 months after operation were not significant(P>0.05).The anterior and posterior stability of the knee joint improved significantly in both groups at 12 months after operation,and the difference in KT-2000 measurements was significant when compared with the preoperative value(P<0.05),but the difference of pre-and post-operation between groups was not significant(P>0.05).At 3,6,and 12 months after operation,MRI showed that the differences in the SNQ of the proximal end and middle of the grafts between the two groups were not significant(P>0.05),and the SNQ of distal end was significantly higher in the SB group than in the OTT group(P<0.05).At each time point,grafts in the OTT group had the highest SNQ at the corner and the lowest at the fixation point,and the differences were significant compared to the other sites(P<0.05).In the two groups,except for the fixation point,the SNQ of the remaining sites were highest at 6 months and lowest at 12 months(P<0.05).In addition,there were significant differences in SNQ between the different sites of grafts(P<0.05),and the SNQ was lowest at proximal end and highest at distal end.At last follow-up,the knee grafts in both groups were in good shape and no graft necrosis or loosening of the internal fixation was observed.Conclusion The knee joint function and graft healing after OTT reconstruction of ACL are similar to those of SB reconstruction,but it should be noted that the healing at the corner of the graft is slower.
作者
弓爵
魏志亨
贾梦阳
王卫明
向先祥
GONG Jue;WEI Zhiheng;JIA Mengyang;WANG Weiming;XIANG Xianxiang(Department of Sports Medicine,Xinhua Hospital Affiliated to Dalian University,Institute of Sports Medicine,Dalian University,Dalian Liaoning,116021,P.R.China)
出处
《中国修复重建外科杂志》
北大核心
2025年第3期307-313,共7页
Chinese Journal of Reparative and Reconstructive Surgery
基金
大连市医学科学研究计划(2311038)。
关键词
前交叉韧带重建
越顶位重建
移植物愈合
信噪比
Anterior cruciate ligament reconstruction
over-the-top reconstruction
graft healing
signal noise quotient
