镜下前交叉韧带重建两种股骨侧悬吊固定的比较

Comparison of two kinds of femoral side suspension fixation for anterior cruciate ligament reconstruction under arthroscope

摘要:

[目的] 比较关节镜前交叉韧带 （anterior cruciate ligament, ACL） 重建两种股骨侧悬吊固定的临床疗效。[方法] 回顾性分析 2021 年 6 月—2023 年 6 月镜下自体腘绳肌腱单束重建治疗单侧 ACL 断裂 106 例患者的临床资料。依据医患沟通结果，46 例采用 EndoButton 固定袢进行股骨侧固定（固定袢组），60 例采用 Rigidloop 可调节袢固定股骨侧（可调节袢组）。比较两组围手术期、随访指标与影像结果。[结果]两组手术时间、术中出血量、首次下地时间、住院时间、切口愈合质量、切口愈合时间、并发症发生率差异无统计学意义（P＞0.05）。随访 12 个月以上，两组恢复运动时间差异无统计学意义（P＞0.05）。随着时间的推移，两组的 IKDC 评分、Lysholm 评分和 KT-1000 侧侧差值均显著改善（P＜0.05），但是，相应时间点两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，随着时间的推移，两组前抽屉应力位胫骨前移距离显著减小（P＜0.05），相应时间点两组间前抽屉应力位胫骨前移距离的差异均无统计学意义（P＞0.05），但是，术后 12 个月固定袢组胫骨隧道内口直径显著大于可调节袢组 [(8.4±0.8) mm vs (7.9±0.6) mm, P＜0.05]。[结论]关节镜 ACL 重建术中，固定袢、可调节袢两种股骨侧固定材料均能获得较好且一致的近期疗效，但 EndoButton 术后骨隧道内口扩大更加明显。

Abstract:

[Objective] To compare the clinical outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with two kinds of femoral side suspension fixation. [Methods] A retrospective research was done on 106 patients who received unilateral arthroscopic single-bundle ACL reconstruction with hamstring tendon autograft from June 2021 to June 2023. According to doctor-patient communication preoperatively, 46 patients had ACL reconstructed by using EndoButton fixed loop for femur side fixation, while other 60 patients were by using Rigidloop adjustable loop for femoral side fixation. The perioperative period, follow-up and imaging documents were compared between the two groups. [Results] There were no statistically significant differences in operation time, intraoperative blood loss, first time to ambulation, hospital stay, incision healing quality, incision healing time, and incidence of complications between the two groups (P＞0.05). All patients in both groups were followed up for more than 12 months, and there was no a significant difference in the time for recovery exercise between the two groups (P＞0.05). The IKDC score, Lysholm score and KT-1000 side to side difference were significantly improved over time in both groups (P＜0.05), whereas which proved not statistically significant between the two groups at any corresponding time points (P＞0.05). In terms of image, the anterior tibial displacement under anterior drawer stress was significantly declined with time in both groups (P＜0.05), which was no statistical significance between the two groups at any time points accordingly (P＞0.05). However, the EndoButton group had significantly greater inner diameter of the tibial tunnel than the Rigidloop group at 12 months after operation [(8.4±0.8) mm vs (7.9±0.6) mm, P＜0.05]. [Conclusion] Both the fixed loop and the adjustable loop fixation of the tendon graft femoral side in arthroscopic ACL reconstruction do achieve good and consistent short-term consequence, but the EndoButtonthe fixed loop for femoral side fixation has more obvious tibial tunnel enlargement than the Rigidloop adjustable loop.