后侧双与单入口镜下后交叉韧带重建的比较

Double versus single posterior portal for arthroscopic posterior cruciate ligament reconstruction

摘要:

[目的] 比较关节镜下后侧经双入口和单入口重建后交叉韧带 (posterior cruciate ligament, PCL) 的临床疗效。[方法]回顾性分析 2018 年 1 月—2019 年 10 月关节镜下 PCL 重建 74 例。依据术前医患沟通结果，36 例采用前侧双入口联合后侧双入口技术(双入口组)，38 例采用前侧双入口联合后侧单入口技术(单入口组)。比较两组围手术期、随访和影像资料。[结果]74 例患者均手术成功，未出现神经和血管损伤。双入口组手术时间、术中透视次数均显著优于单入口组 (P＜0.05)，两组术中失血量、下地行走时间、切口愈合等级、住院时间差异均无统计学意义(P＞0.05)。所有患者均获随访 18 月以上，两组完全负重活动时间的差异无统计学意义(P＞0.05)。随时间推移，两组 VAS 评分、Lysholm 评分、IKDC 评分、ROM 及后抽屉试验均显著改善(P＜0.05)。术后 6 个月及末次随访时，双入口组 Lysholm 评分、IKDC 评分均显著优于单入口组(P＜0.05)，但两组 VAS 评分、膝伸屈活动度、后抽屉试验的差异均无统计学意义 (P＞0.05)。影像学上，双入口组冠状面胫骨隧道偏移、斜坡位置百分比、垂直偏移均小于单入口组，但差异均无统计学意义(P＞0.05)。与术前相比，两组术后 6 个月及末次随访时 90°屈膝后向应力位测量胫骨后移距离显著减少 (P＜0.05)，相应时间点两组间应力下胫骨后移距离的差异均无统计学意义 (P＞0.05)。 [结论]镜下 PCL 重建经后双入路比单入口手术时间短，术中透视次数少、术后功能恢复好。

Abstract:

[Objective] To compare the clinical outcomes of arthroscopic reconstruction of the posterior cruciate ligament (PCL) through posterior double portals versus a single portal. [Methods] A retrospective study was performed on 74 patients who received ar- throscopic PCL reconstruction in our hospital between January 2018 and October 2019. According to the results of preoperative doctor-pa- tient communication, 36 patients had PCL reconstructed by double anterior portals combined with double posterior portal (the DP group) , while the remaining 38 patients were by double anterior portals combined with a single posterior portal (the SP group) . The documents re- garding perioperative period, follow-up and images were compared between the two groups. [Results] All the 74 patients had PCL recon- struction performed successfully without nerve or vascular injury. The DP group proved significantly superior to the SP group in terms of op- eration time and intraoperative fluoroscopy times (P＜0.05) , although there were no significant differences in total incision length, intraoper- ative blood loss, postoperative walking time, wound healing and hospital stay (P＞0.05) . All patients were followed up for more than 18 months, without a significant difference in the time of full weight-bearing activity between the two groups (P＞0.05) . The VAS, Lysholm, IK- DC scores, as well as knee extension-flexor range of motion (ROM) and posterior drawer test significantly improved in both groups over time (P＜0.05) . At 6 months and last follow-up, the DP group proved significantly superior to the SP group in terms of Lysholm and IKDC scores, regardless of the fact that there were no significant differences in VAS score, ROM, and posterior drawer test between them (P＞ 0.05) . Regarding imaging evaluation, the DP group was also better than the SP group in terms of coronal tibial tunnel deviation, the percent- age of slope tunnel position, and the vertical tibial tunnel deviation, whereas which were not statistically significant (P＞0.05) . The tibia pos- terior displacement distance measured at 90° flexion stress X-rays significantly reduced in both groups at 6 months after operation and at the last follow-up compared with those preoperatively (P＜0.05) , which was of no significant difference at any corresponding time points be- tween the two groups (P＞0.05) . [Conclusion] Arthroscopic PCL reconstruction through double posterior portals takes advantages of shorten- ing operation time, declining intraoperative fluoroscopy times and improving postoperative functional recovery over that through a single posterior portal.