两种保留残迹后交叉韧带重建技术的比较

Comparison of two techniques of remnant preserved posterior cruciate ligament reconstruction

摘要:

［目的］比较两种不同通路保残重建后交叉韧带（posterior cruciate ligament, PCL）重建技术的临床疗效。［方法］回顾性分析本院 2012 年 3 月—2020 年 3 月保残重建后交叉韧带损伤 50 例患者的临床资料。根据术前医患沟通结果，28 例采用经 ACL 腋下通路定位胫骨骨道 （腋下组），另外 22 例采用经 ACL 与 PCL 残端间通路定位 （常规组）。比较两组围手术期、随访及影像资料。［结果］两组均顺利完成手术，术中均无血管、神经损伤等并发症发生。腋下组的术中出血量显著少于常规组 （P<0.05）。所有患者均获得 2 年以上随访，两组恢复完全负重活动时间差异无统计学意义（P>0.05）。随着术后时间推移， 两组 Lysholm 评分、IKDC 评分、膝关节屈伸 ROM 均显著增加 （P<0.05），而 VAS 疼痛评分和后抽屉试验分级均显著减少 （P< 0.05）；术后 6 个月和末次随访，腋下组 VAS 疼痛评分、Lysholm 评分、IKDC 评分、后抽屉试验均显著优于常规组 （P<0.05）。 影像方面，术后腋下组胫骨骨道内口 CT 测量冠状位（a/b）比值显著优于常规组 （P<0.05），而两组间胫骨骨道内口 CT 测量矢状位（c/d）比值的差异无统计学意义（P>0.05）。与术前相比，两组术后屈膝 90°后向应力位胫骨后移显著减少（P<0.05）；术后 6 个月和末次随访时腋下组显著优于常规组 （P<0.05）。［结论］ 关节镜下经 ACL 腋下定位胫骨隧道的 PCL 保残重建术，更有利于精确定位胫骨骨道内口，还可更有效地保留 PCL 残束，临床疗效更好。

Abstract:

[Objective] To compare the clinical efficacy of two remnant preserved posterior cruciate ligament (PCL) reconstruction. [Methods] A retrospective study was conducted on 50 patients who received remnant preserved PCL reconstruction for PCL tear in our hos- pital from March 2012 to March 2020. According to the preoperative doctor-patient communication, 28 patients had the tibial tunnel locat- ed through the path under the axillary part of the anterior cruciate ligament (ACL) (subaxillary group) , while the other 22 patients were posi- tioned through the upper ACL and PCL gap path (conventional group). The perioperative period, follow- up and imaging data were com- pared between the two groups. [Results] All the patients in both groups got operation performed successfully, without complications such as injuries to vascular vessel and nerve during operation. The subaxillary group proved significantly less intraoperative blood loss than that in the conventional group (P＜0.05) . All patients were followed up for more than 2 years, and there was no significant difference in the time to return to full weight-bearing activity between the two groups (P＞0.05) . The Lysholm score, IKDC score, and knee flexion-extension range of motion (ROM) increased significantly (P＜0.05) , while VAS pain score and extent of posterior drawer test were significantly reduced in both groups over time (P＜0.05) . The subaxillary group proved significantly superior to the conventional group in terms of VAS pain score, Lysholm score, IKDC score, and posterior drawer test at 6 months and last follow-up (P＜0.05) . In terms of imaging, the subaxillary group got significantly better coronal position ratio (a/b) of the tibial tunnel intraarticular aperture than the conventional group (P＜0.05) , despite the fact that there was no significant difference in sagittal position ratio (c/d) between the two groups (P＞0.05) . The posterior tibial displace- ment in stress X-ray at 90° of knee flexion significantly reduced postoperatively in both group compared with that preoperatively (P＜0.05) , which in the subaxillary group was significantly less than the conventional group at 6 months and latest follow-up (P＜0.05) . [Conclusion] This arthroscopic remnant preserved PCL reconstruction by ACL subaxillary positioning of tibial tunnel is more conducive to accurate posi- tioning of the internal aperture of tibial bone tunnel, and does more effectively preserve the PCL remnant, and achieve better clinical outcome.