中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (27): 4387-4392.doi: 10.3969/j.issn.2095-4344.0356

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

关节镜下单隧道单束与三隧道双束不同植入物重建前交叉韧带:膝关节稳定性及活动功能

王新民,刘 飞,赵海霞,王 巍,王健全   

  1. 秦皇岛市第一医院骨科二病区,河北省秦皇岛市 066000
  • 出版日期:2018-09-28 发布日期:2018-09-28
  • 通讯作者: 刘飞,教授,硕士研究生导师,秦皇岛市第一医院骨科二病区,河北省秦皇岛市 066000
  • 作者简介:王新民,男,1981年生,河北省秦皇岛市人,汉族,2008年河北医科大学毕业,硕士,主治医师,主要从事关节外科的研究。
  • 基金资助:

    2015年度河北省省级科技计划

Arthroscopic single-tunnel single-bundle versus three-tunnel double-bundle grafts for anterior cruciate ligament reconstruction: stability and movement of the knee joint  

Wang Xin-min, Liu Fei, Zhao Hai-xia, Wang Wei, Wang Jian-quan   

  1. Orthopedics and Arthroscopic Ward Two, First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
  • Online:2018-09-28 Published:2018-09-28
  • Contact: Liu Fei, Professor, Master’s supervisor, Orthopedics and Arthroscopic Ward Two, First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
  • About author:Wang Xin-min, Master, Attending physician, Orthopedics and Arthroscopic Ward Two, First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
  • Supported by:

    the Hebei Provincial Science and Technology Program in 2015

摘要:

文章快速阅读:

文题释义:

关节镜下传统单隧道单束重建前交叉韧带:采用关节镜下股骨端endobutton式纽扣悬吊固定,胫骨端采用Milagro界面螺钉单隧道挤压固定,单隧道单束重建前交叉韧带,手术简单,方便实用。
关节镜下Femoral-Intrafix固定三隧道双束解剖重建前交叉韧带:采用关节镜下股骨端Femoral Intrafix固定系统单隧道双束固定,胫骨端均采用双隧道Milagro界面螺钉挤压固定移植物,三隧道双束解剖重建前交叉韧带,最大限度的恢复前交叉韧带的功能。
 
摘要
背景:课题组设计关节镜下三隧道Femoral-Intrafix固定双束重建前交叉韧带,目的是恢复膝关节的旋转稳定性和前交叉韧带的功能,但是其临床效果尚未得到证实。
目的:评价关节镜下单隧道单束和三隧道Femoral-Intrafix固定双束重建后膝关节功能恢复的情况。
方法:回顾性分析2013年6月至2015年6月60例前交叉韧带损伤患者的临床资料,移植物均使用自体腘绳肌腱,其中30例采用单隧道单束重建,股骨端采用endobutton式纽扣悬吊固定,胫骨端采用Milagro界面螺钉挤压固定;30例采用三隧道Femoral-Intrafix固定双束重建,股骨端采用Femoral Intrafix 固定系统进行单隧道双束固定,胫骨端采用Milagro界面螺钉双隧道挤压固定。记录2组患者围手术期的指标;重建前及末次随访时进行前抽屉试验,Lachman征检查,轴移试验,Lysholm评分和IKDC评分以评估2组前交叉韧带功能恢复情况。

结果与结论:①所有患者均获得随访,单隧道单束重建及三隧道双束重建组随访时间分别为(25±4),(28±3)个月;②2组患者重建后均无螺钉脱落、深静脉血栓形成、重建韧带再断裂及关节内感染现象;③2组患者末次随访时关节活动达到正常范围,前抽屉试验阳性率、Lachman征阳性率、轴移试验阳性率较重建前均明显降低(P < 0.05);三隧道双束重建组末次随访时轴移试验阳性率显著低于单隧道单束重建组(P < 0.05);④2组患者末次随访时Lysholm评分和IKDC评分均较重建前明显提高(P < 0.05),且末次随访时2组间患者膝关节Lysholm评分、IKDC评分比较无显著性意义(P > 0.05);⑤结果提示,关节镜下前交叉韧带单隧道单束和三隧道Femoral-Intrafix固定双束重建前交叉韧带的近期临床疗效满意,均能显著改善患者膝关节的稳定性及活动功能,但三隧道Femoral-Intrafix固定双束重建前交叉韧带后能更好恢复膝关节的旋转稳定性。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID: 0000-0002-7867-2224(王新民)

关键词: 关节镜, 单隧道单束, 三隧道双束, 重建, 腘绳肌肌腱, 前交叉韧带, 前抽屉试验, Lachman征

Abstract:

BACKGROUND: Our group has designed the arthroscopic anterior cruciate ligament (ACL) reconstruction using Femoral-Intrafix system in order to restore the rotary stability of knee joint and function of ACL. But its clinical efficacy has not been confirmed.

OBJECTIVE: To retrospectively evaluate the functional recovery of knee joint after reconstructed using single-tunnel single-bundle versus three-tunnel double-bundle with Femoral-Intrafix system.
METHODS: Clinical data of 60 patients with ACL injury from June 2013 to June 2015 were analyzed retrospectively. Hamstring tendon autografts were used for all patients. Among them, 30 patients received single-tunnel single-bundle reconstruction, the Endobutton was performed at the femoral site and the Milagro interference screw was used for tibial tunnels (control group); another 30 patients adopted three-tunnel double-bundle reconstruction with Femoral-Intrafix system, the Femoral Intrafix System was used to fix the graft at the femoral site, and the Milagro interference screws were used for tibial tunnels (trial group). The perioperative indexes were recorded. The anterior drawer test, Lachman test, pivot shift test, Lysholm and International Knee Documentation Committee scores at baseline and last follow-up were detected to evaluate the functional recovery of ACL.
RESULTS AND CONCLUSION: (1) All patients were followed up with an average of (25±4) and (28±3) months in the control and trial groups, respectively. (2) No patients had screw exfoliation, deep vein thrombosis, ligament rerupture or articular infection. (3) The range of motion of the knee joint was restored. The positive rates of anterior drawer test, Lachman test and pivot shift test in the two groups were significantly lower than those before reconstruction (P < 0.05), and the positive rates in the trial group were significantly lower than those in the control group (P < 0.05). (4) The Lysholm and International Knee Documentation Committee scores at last follow-up in the two groups were significantly improved compared with the baseline (P < 0.05), and the scores showed no significant differences between two groups (P > 0.05). (5) These results indicate that both of the two methods can obtain satisfactory short-term outcomes in anterior cruciate ligament reconstruction, and can improve the stability and movement of the knee joint. But the three-tunnel double-bundle with Femoral-Intrafix system can obtain better rotary stability of knee joint after reconstruction.

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Anterior Cruciate Ligament, Bone-Patellar Tendon-Bone Graft, Arthroscopes, Tissue Engineering

中图分类号: