镜下后交叉韧带重建两种胫骨隧道建立技术比较

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

摘要:

[目的] 比较后三角定位技术与常规前后路技术镜下后交叉韧带 (posterior cruciate ligament, PCL) 重建术的临床效果。[方法]回顾性分析本院收治的 60 例 PCL 重建患者的临床资料，其中，32 例采用后三角定位技术(后侧组)，28 例采用常规前后技术(常规组)。比较两组围手术期情况、随访及影像资料。[结果]两组患者均顺利完成手术，术中未出现血管神经损伤等并发症。后侧组手术时间、术中失血量、术中透视次数均显著优于常规组 (P＜0.05)。所有患者平均随访 (20.4±4.7) 个月，后侧组恢复完全负重活动的时间显著早于常规组(P＜0.05)。与术前相比，末次随访时两组 VAS 评分、Lysholm 评分及 IK- DC 评分均显著改善 (P＜0.05)。末次随访时两组 VAS 评分差异无统计学意义 (P＞0.05)，但后侧组的 Lysholm 及 IKDC 评分显著高于常规组(P＜0.05)。影像方面，两组胫骨隧道位置的差异无统计学意义(P＞0.05)。与术前相比，末次随访时两组患者的屈膝 30°、90°后应力下胫骨后移显著减少 (P＜0.05)。相应时间点，两组间的屈膝 30°、90°时应力下胫骨后移差异均无统计学意义 (P＞0.05)。[结论] 采用后三角定位镜下后交叉韧带的重建，可以更好地暴露手术视野，减少操作损伤，节省手术时间， 而且保留了后交叉韧带残端及板股韧带，有利于膝关节的功能恢复。

Abstract:

[Objective] To compare the clinical results of posterior triangle location technique versus conventional anteroposterior loca- tion method in arthroscopic posterior cruciate ligament (PCL) reconstruction. [Methods] A retrospective study was conducted on 60 pa- tients who received arthroscopic PCL reconstruction in our hospital. Among them, 32 patients were treated with posterior triangulation tech- nique (the posterior group) , and 28 patients were treated with conventional anteroposterior technique (the conventional group). The periop- erative, follow-up and imaging data of the two groups were compared. [Results] All the patients had PCL reconstruction performed success- fully without complications such as vascular and nerve injury. The posterior group proved significantly superior to the conventional group in terms of operation time, intraoperative fluoroscopy times (P＜0.05) . All the patients were followed up for (20.4±4.7) months, and the posteri- or group resumed full weight- bearing activity significantly earlier than the conventional group (P＜0.05) . The VAS, Lysholm and IKDC scores significantly improved in both groups at the last follow-up compared with those before surgery (P＜0.05) . Although there was no sig- nificant difference in VAS scores between 2 groups (P＞0.05) , the posterior group proved significantly superior to the conventional group in terms of Lysholm and IKDC scores at the latest follow up (P＜0.05) . Radiographically, there was no significant difference in tibial tunnel lo- cation (P＞0.05) . The posterior translation at 30° and 90° of knee flexion under stress on imaging was significantly reduced at the latest fol- low-up in both groups compared with those before operation (P＜0.05) , which were not statistically significant between the two groups at any matching time points (P＞0.05) . [Conclusion] The posterior triangle technique for tibial tunnel location in arthroscopic PCL reconstruc- tion has advantages of improving exposure of the surgical field, reducing the iatrogenic injury, saving the operation time, and preserving the residual posterior cruciate ligament and the meniscofemoral ligament, which is conducive to the functional recovery of the knee joint.