前交叉韧带直接止点不同股骨隧道定位解剖位置单束重建对髌股关节退变的影响

Effects of positioning of the femoral tunnel in single-bundle anterior cruciate ligament reconstruction on patellofemoral joint degeneration

摘要:

目的 对比前交叉韧带直接止点不同股骨隧道定位解剖位置单束重建对髌股关节退变的影响。方法 选取2016年2月—2021年3月蚌埠市第三人民医院收治的前交叉韧带损伤患者50例的临床资料。根据前交叉韧带重建术中单束重建的股骨隧道定位解剖位置不同分为研究组（在髁间窝外侧壁、原前交叉韧带足印中心方向置入克氏针）26例，对照组（在髁间窝外侧壁过顶点远端7 mm处置入克氏针）24例。自手术治疗起随访两组患者12个月。统计两组患者手术及恢复情况，比较两组患者手术前后疼痛、膝关节功能、膝关节稳定性、髌股关节退变情况，统计术后并发症。结果 两组患者手术时间、扶拐下地负重时间、弃拐完全下地负重时间比较，差异均无统计学意义（P >0.05）。研究组与对照组患者术前、术后3个月、术后6个月、术后12个月的疼痛视觉模拟评分（VAS）比较，采用重复测量设计的方差分析，结果 ①不同时间点VAS评分有差异（F =12.098，P =0.000）；②研究组与对照组VAS评分无差异（F =0.895，P =0.403）；③两组VAS评分变化趋势无差异（F =0.715，P =0.456）。研究组患者术前与术后12个月国际膝关节评分委员会（IKDC）评分、Lysholm评分的差值高于对照组（P <0.05）。研究组患者术前与术后12个月KT1000膝关节移动度的差值、轴移试验阳性减少率均高于对照组（P <0.05）。研究组与对照组患者术前髌股关节退变Recht分级比较，差异无统计学意义（P >0.05）；研究组患者术后12个月髌股关节退变Recht分级优于对照组（P <0.05）。对照组患者术后12个月的髌股关节退变Recht分级差于术前（P <0.05）。研究组患者术前与术后12个月的髌股关节退变Recht分级比较，差异无统计学意义（P >0.05）。两组患者总并发症发生率比较，差异无统计学意义（P >0.05）。结论 不同股骨隧道定位解剖位置的单束重建与髌股关节退变有关，在髁间窝外侧壁、原前交叉韧带足印中心方向置入克氏针的单束重建可使患者获得更佳的膝关节功能及膝关节稳定性，且术后髌股关节软骨退变程度更小。

Abstract:

Objective To compare the effects of different positioning of the femoral tunnel in single-bundle anterior cruciate ligament reconstruction on patellofemoral joint degeneration.Methods The clinical data of 50 patients with anterior cruciate ligament injury treated in our hospital from February 2016 to March 2021 were collected, and they were divided into the study group and control group according to the anatomical position of the femoral tunnel in single-bundle anterior cruciate ligament reconstruction, with 26 cases in each group. Specifically, K-wires were placed in the lateral wall of the intercondylar fossa and the center of the original anterior cruciate ligament footprint in the study group, while K-wires were placed 7 mm away from the apex of the lateral wall of the intercondylar fossa in the control group. Patients in both groups were followed up for 12 months since the surgical treatments. The operation and recovery of the two groups were recorded, and the pain, knee function, and knee stability of the two groups before and after the operation were analyzed. The degeneration of the patellofemoral joint before and after operation was compared between the two groups, and the postoperative complications were recorded.Results There was no significant difference between the two groups in the operative duration, duration of tolerance for weight bearing with crutches, or that for weight bearing without crutches (P > 0.05). The Visual Analogue Scale (VAS) scores before the operation, and 3 months, 6 months and 12 months after the operation in the study group and control group were compared via repeated measures ANOVA, and the results revealed that the VAS scores were different among the time points (F =12.098, P =0.000) but not between the study group and the control group (F = 0.895, P = 0.403). There was no significant difference in the change trends of the VAS scores between the study group and control group (F = 0.715, P = 0.456). The differences of the International Knee Documentation Committee (IKDC) scores and Lysholm scores before the operation and 12 months after the operation in the study group were higher than those in the control group (P < 0.05). The differences of knee laxity via KT1000 test and the proportion of patients with positive pivot shift test before the operation and 12 months after the operation in the study group were higher than those in the control group (P < 0.05). There was no difference in the Recht grade of the patellofemoral joint degeneration before operation (P > 0.05), whereas that at 12 months after operation was better in the study group compared with the control group (P < 0.05). The Recht grade of the patellofemoral joint degeneration 12 months after operation was worse than that before the operation in the control group (P < 0.05). There was no significant difference in the Recht grade of patellofemoral joint degeneration before operation and 12 months after operation in the study group (P > 0.05). There was no significant difference in the incidence of overall complications between the two groups (P > 0.05).Conclusions The positioning of the femoral tunnel in single-bundle anterior cruciate ligament reconstruction is related to patellofemoral joint degeneration. Placement of K-wires in the lateral wall of the intercondylar fossa and the center of the original anterior cruciate ligament footprint contributes to better knee function and stability, as well as milder postoperative patellofemoral cartilage degeneration.