三入路技术对前交叉韧带重建术骨道、移植物等的影响

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1385 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探究关节镜下前交叉韧带重建术双入路技术(膝关节前内、前外入路)和三入路技术(膝关节前内上、前内下和前外入路)对骨道长度、移植物角度等的影响。方法对2017年10月至2018年7月在郑州市骨科医院运动医学科进行关节镜下前交叉韧带重建的患者进行随访，常规双入路组患者9例，男6例，女3例；年龄21~47岁，平均(31.33±7.47)岁；左膝5例，右膝4例。三入路组患者9例，男6例，女3例；年龄19~37岁，平均(24.78±6.61)岁；左膝4例，右膝5例。记录手术时间，测量前交叉韧带重建术后患者股骨骨道、胫骨骨道的长度以及重建后的韧带与股骨骨道的夹角，并进行统计学分析。结果三入路组与双入路组相比在年龄、左右侧别上差异无统计学意义。三入路组手术时间为(88.33±22.22)min，双入路组手术时间为(77.22±34.92)min，两组比较差异无统计学意义(P＞0.05)；三入路组股骨骨道长度(35.56±5.24)mm，双入路组股骨骨道长度(35.87±6.59)mm，两组比较差异无统计学意义(P＞0.05)；三入路组胫骨骨道长度(39.25±2.63)mm，双入路组胫骨骨道长度(33.36±3.50)mm，三入路组胫骨骨道长度明显长于双入路组(P＜0.05)；三入路组重建后韧带与股骨骨道的夹角为(150.57±8.16)°，双入路组重建后韧带与股骨骨道夹角为(153.10±6.49)°，两组比较差异无统计学意义(P＞0.05)。结论三入路组与常规双入路组相比在手术时间、股骨骨道长度、重建后韧带与股骨骨道夹角上并没有明显差异，但三入路组胫骨骨道长度明显长于双入路组胫骨骨道长度，且操作更为便捷，视野更为清晰，关节腔残留碎屑更少，同时可在镜下明确看到翻袢，降低了移植物固定失效风险。因此，在前交叉韧带重建术中更建议采用三入路技术。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	李明
	刘宁 *

关键词 ：关节镜, 前交叉韧带重建, 三入路

Abstract：Objective To explore the influence of arthroscopic anterior cruciate ligament reconstruction double-approach(anterior internal and external approaches of knee joint) and three-approach(anterior superior，anterior inferior and anterior external approaches of knee joint) on bone canal length and graft Angleandguide clinical practice.Methods Patients who underwent arthroscopic anterior cruciate ligament reconstruction in the Department of Sports Medicine of Zhengzhou Orthopaedics Hospital from October 2017 to July 2018 were followed up.There were 9 patients in the conventional double-access group，including 6 males and 3 females.The patientswere(31.33±7.47) years old(range：21~47 years old).There were 5 cases of left knee and 4 cases of right knee.There were 9 patients in the three access group，including 6 males and 3 females.The patients were(24.78±6.61) years old(range：19~37 years old).There were 4 cases of left knee and 5 cases of right knee.The length of femoral bone canal，the length of the tibia bone canal and the angle of the graft were measured after anterior cruciate ligament reconstruction and statistical analysis was performed.Results There was no statistically significant difference in age，left and right side between the three-way group and the two-way group.The operation time of the three-way group was(88.33±22.22)min，and the operation time of the double-entry group was(77.22±34.92)min.There was no significant difference between the two groups(P＞0.05).The length of the femoral bone canal in the three-way group was(35.56±5.24) mm，and the length of the femoral bone canal in the double-entry group was(35.87±6.59) mm.There was no significant difference between the two groups(P＞0.05).The length of the tibia bone canal in the three-way group was(39.25±2.63)mm，and the length of the tibia canal in the double-entry group was(33.36±3.50)mm.The length of the tibia canal in the three-way group was significantly longer than that in the double-entry group(P＜0.05).The graft angle of the three-way group was(150.57±8.16)°，and the graft angle of the two-way group was(153.10±6.49)°.There was no significant difference between the two groups(P＞0.05).Conclusion There are no significant difference in the operation time，the length of the femoral bone canal，and the graft angle between the three-way approach group and the conventional two-way approach group.However，the length of the tibia bone canal in the three-way group is significantly longer than the length of the tibia bone canal in the two-way group.The operation is more convenient，the field of view is clearer，and the residual debris in the joint cavity is less.At the same time，it can be clearly seen under the microscope to reduce the risk of graft fixation failure.Therefore，it is recommended to use a three-way approach in anterior cruciate ligament reconstruction.

Key words： arthroscopy anterior cruciate ligament reconstruction three approaches

通讯作者: 刘宁

作者简介: 李明(1989－ )，男，医师，郑州市骨科医院运动医学科，450052。

引用本文:

李明，刘宁 *. 三入路技术对前交叉韧带重建术骨道、移植物等的影响[J]. 实用骨科杂志, 2019, 25(8): 700-708.
Li Ming，Liu Ning *. The Effect of Anterior Cruciate Ligament Reconstruction Under Arthroscopy with Three Approaches on Bone Canal Length and Graft Angle. sygkzz, 2019, 25(8): 700-708.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I8/700

［1］van Eck CF，Morse KR，Fu FH.The anteromedial portal for anterior cruciate ligament reconstruction［J］.Arthroscopy，2009，25(10)：1062-1064；author reply 1064-1065.
［2］Bucher TA，Naim S，Mandalia V.The use of the 70 degrees arthroscope for anatomic femoral and tibial tunnel placement and tunnel viewing in anterior cruciate ligament reconstruction［J］.Arthrosc Tech，2014，3(1)：e79-81.
［3］Joseph SM，Karns MR，Knapik KDM，et al.Arthroscopic viewing position affects anterior cruciate ligament reconstruction femoral tunnel length measurements［J］.Front Surg，2018(5)：16.
［4］Dai X，Cai Y.Measurement of anterior cruciate ligament angles in single-bundle reconstruction using the anteromedial portal［J］.Am J Orthop(Belle Mead NJ)，2012，41(6)：268-272.
［5］Gupta R，Malhotra A，Kumar P，et al.Correlation of femoral tunnel length with body height，limb length，and thigh length in Indian patients undergoing anterior cruciate ligament reconstruction［J］.J Orthop Surg(Hong Kong)，2016，24(3)：286-288.
［6］Cohen SB，Fu FH.Three-portal technique for anterior cruciate ligament reconstruction：use of a central medial portal［J］.Arthroscopy，2007，23(3)：325；e1-5.
［7］Petretta R，Mandalia V.Bicruciate knee ligament reconstruction using 4 all-anterior arthroscopic portals［J］.Arthrosc Tech，2016，5(4)：e787-e792.
［8］Jaecker V，Zapf T，Naendrup JH，et al.High non-anatomic tunnel position rates in ACL reconstruction failure using both transtibial and anteromedial tunnel drilling techniques［J］.Arch Orthop Trauma Surg，2017，137(9)：1293-1299.
［9］Sonnery-Cottet B，Archbold P，Zayni R，et al.High lateral portal for sparing the infrapatellar fat-pad during ACL reconstruction［J］.Orthop Traumatol Surg Res，2011，97(8)：870-873.
［10］Budny J，Fox J，Rauh M，et al.Emerging trends in anterior cruciate ligament reconstruction［J］.J Knee Surg，2017，30(1)：63-69.
［11］Nishimori M，Deie M，Adachi N，et al.Simulated anterior cruciate ligament reconstruction using preoperative three-dimensional computed tomography［J］.Knee Surg Sports Traumatol Arthrosc，2014，22(5)：1175-1181.
［12］Luthringer TA，Blackmore SA，Singh BC，et al.The learning curve associated with anteromedial portal drilling in ACL reconstruction［J］.Phys Sportsmed，2016，44(2)：141-147.
［13］Bedi A，Altchek DW.The“footprint”anterior cruciate ligament technique：an anatomic approach to anterior cruciate ligament reconstruction［J］.Arthroscopy，2009，25(10)：1128-1138.
［14］Hensler D，Working ZM，Illingworth KD，et al.Correlation between femoral tunnel length and tunnel position in ACL reconstruction［J］.J Bone Joint Surg(Am)，2013，95(22)：2029-2034.
［15］Lopez-Vidriero E，Hugh JD.Evolving concepts in tunnel placement［J］.Sports Med Arthrosc Rev，2009，17(4)：210-216.
［16］Zhang C，Xu H，Li X，et al.Oblique femoral tunnel or oblique graft? A modified anteromedial portal technique to obtain vertical femoral tunnel and oblique graft in anatomic anterior cruciate ligament reconstruction［J］.Eur J Orthop Surg Traumatol，2013，23(6)：731-735.
［17］Chen L，Wu Y，Lin G，et al.Graft bending angle affects allograft tendon maturity early after anterior cruciate ligament reconstruction［J］.Knee Surg Sports Traumatol Arthrosc，2018，26(10)：3048-3054.
［18］Iriuchishima T，AUID-Oho，Fu FH，et al.Sagittal femoral condyle morphology correlates with femoral tunnel length in anatomical single bundle ACL reconstruction［J］.Knee Surg Sports Traumatol Arthrosc，2018，26(4)：1110-1116.
［19］Forsythe B，Collins MJ，Arns TA，et al.Optimization of anteromedial portal femoral tunnel drilling with flexible and straight reamers in anterior cruciate ligament reconstruction：A cadaveric 3-dimensional computed tomography analysis［J］.Arthroscopy，2017，33(5)：1036-1043.
［20］Patel KA，Chhabra A，Makovicka JL，et al.Anterior cruciate ligament tunnel placement using the pathfinder guide［J］.Arthrosc Tech，2017，6(4)：e1291-e1296.
［21］Song EK，Kim SK，Lim HA，et al.Comparisons of -tunnel-graft angle and tunnel length and position between transtibial and transportal techniques in anterior cruciate ligament reconstruction［J］.Int Orthop，2014，38(11)：2357-2362.
［22］Sim JA，Kim JM，Lee S，et al.Comparison of tunnel variability between trans-portal and outside-in techniques in ACL reconstruction［J］.Knee Surg Sports Traumatol Arthrosc，2017，25(4)：1227-1233.
［23］Robin BN，Lubowitz JH.Disadvantages and advantages of transtibial technique for creating the anterior cruciate ligament femoral socket［J］.J Knee Surg，2014，27(5)：327-330.
［24］蔡国栋，唐新元，王俊勤.关节镜下自体骨-髌腱-骨重建膝前交叉韧带［J］.实用骨科杂志，2009，15(5)：344-347.