两种镜下胫骨隧道定位后交叉韧带重建比较

Comparison of two arthroscopic tibial tunnel position techniques in posterior cruciate ligament reconstruction

摘要:

［目的］探讨 4 字位全前方高位双入路与常规三入路镜下胫骨隧道定位后交叉韧带重建的临床结果。［方法］回顾性分析 2018 年 4 月—2020 年 12 月在本院 PCL 重建 83 例患者的临床资料。依据术前医患沟通结果，29 例采用双入路，54 例采用三入路。比较两组围手术期、随访与影像资料。［结果］两组患者均顺利完成手术，术中均无血管、神经损伤。双入路组手术时间、切口总长度、术中失血量均显著优于三入路组 （P<0.05），但两组术中透视次数、下地行走时间、切口愈合等级和住院时间的差异无统计学意义 （P>0.05）。两组恢复完全负重活动时间差异无统计学意义 （P>0.05）。随时间推移，两组 VAS、 Lysholm 和 IKDC 评分均显著改善（P<0.05）；膝伸屈 ROM 无显著改变（P>0.05）。与术前相比，术后 6 个月和末次随访时，两组屈膝 90°位后抽屉试验稳定性显著改善 （P<0.05）。相应时间点，两组间 VAS、Lysholm、IKDC 评分、膝伸屈 ROM 和后抽屉试验结果的差异均无统计学意义（P>0.05）。影像方面，两组 PCL 胫骨隧道关节内口矢状位、冠状位及轴位测量位置数据的差异均无统计学意义 （P>0.05）。随时间推移，两组 Kellgren-Lawrence 影像评级无显著改变 （P>0.05）。［结论］ 4 字位全前方高位双入路重建后交叉韧带与传统三入路重建后交叉韧带胫骨骨道位置无明显区别，相比之下，前者手术创伤显著小于后者。

Abstract:

[Objective] To compare the clinical outcomes of all anterior 2 portals in figure-4 position versus conventional 3 portals for location of tibial tunnel in arthroscopic posterior cruciate ligament (PCL) reconstruction. [Methods] A retrospective study was conducted on a total of 83 patients who received arthroscopic PCL reconstruction in our hospital from April 2018 to December 2020. According to the re- sults of preoperative doctor-patient communication, 29 patients had the tibial tunnel located by the 2-portal technique, while the remaining 54 patients were by the conventional 3-portal technique. The documents regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All the patients in both groups had PCL reconstructed successfully without serious complica- tions, such as neurovascular injuries. The 2-portal group proved significantly superior to the 3-portal group in terms of operation time, total incision length and intraoperative blood loss (P<0.05) , although there was no significant difference in the times of fluoroscopy, postopera- tive walking time, incision healing and hospital stay between the two groups (P>0.05) . In addition, there was no a significant difference in the time to return to full weight-bearing activity between the two groups (P>0.05) . The VAS, Lysholm, and IKDC scores improved signifi- cantly (P<0.05) , whereas knee extension-flexion range of motion (ROM) remained unchanged over time in both groups (P>0.05) . The pos- terior stability revealed by posterior drawer test at 90° of knee flexion significantly improved in both groups at 6 months postoperatively and the latest follow-up compared with those preoperatively (P<0.05) . However, there were no significant differences in VAS, Lysholm, and IK- DC scores, as well as knee ROM and consequence of posterior drawer test between the two groups at the corresponding time points (P> 0.05) . Radiographically, there were no significant differences in sagittal, coronal and axial position data of the internal opening of the tibial tunnel between the two groups (P>0.05) . The Kellgren-Lawrence grade for osteoarthritis remained unchange over time in the two groups (P>0.05) . [Conclusion] There is no significant difference in the location of the tibial tunnel between all anterior 2-portal technique in fig- ure-4 position and conventional 3-portal method in posterior cruciate ligament reconstruction. By contrast, the former has considerably less iatrogenic trauma than the latter.