| 李俊,刘俊才,李凌志,等.青少年前交叉韧带重建术后胫骨骨隧道变化与临床疗效的关系.骨科,2022,13(6): 492-497. |
| 青少年前交叉韧带重建术后胫骨骨隧道变化与临床疗效的关系 |
| Correlation Between Tibial Tunnel Changes and Clinical Outcomes after Anterior Cruciate Ligament Reconstruction in Adolescents |
| 投稿时间：2022-08-12 |
| DOI：10.3969/j.issn.1674-8573.2022.06.003 |
| 中文关键词: 前交叉韧带 青少年 骨隧道扩大 胫骨 经骺板重建术 |
| 英文关键词: Anterior cruciate ligament Adolescent Bone tunnel enlargement Tibial Transphyseal |
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| 中文摘要: |
| 目的 观察青少年前交叉韧带（anterior cruciate ligament，ACL）重建术后胫骨骨隧道的变化情况及其与临床疗效的关系。方法 回顾性分析2017年12月至2020年3月我院收治的16例取自体肌腱于关节镜下经骺板重建ACL的青少年病人的临床资料。其中男7例，女9例，年龄为（15.1±0.9）岁（14~17岁）。术后1、24、52、104周行MRI检查，测量胫骨隧道内口、中段、外口处宽度，计算绝对扩张量，对骨隧道扩大进行定义及分度。手术前后采用Lysholm评分、国际膝关节文献委员会（International Knee Documentation Committee，IKDC）评分及Tegner评分评价膝关节功能，对胫骨骨隧道扩大分度不同的病人的上述功能评分进行比较。末次随访时评估有无双下肢不等长、膝关节内外翻畸形等发生。结果 16例病人术后24、52周时胫骨骨隧道均发生扩大，胫骨隧道扩大程度不同病人术后同时间点的各项功能评分比较，差异均无统计学意义（P＞0.05）。术后24、52、104周Lysholm、IKDC及Tegner评分逐步提高，不同时间点之间的评分两两比较，差异均有统计学意义（P＜0.05）。术后104周时胫骨骨隧道直径与术后1周比较，差值均＜2 mm。末次随访时病人身高增长（8.0±3.1） cm（3.2~14.6 cm）。随访时辅助检查提示除1例病人骨骺未完全闭合外，余病人骨骺均闭合，所有病人无双下肢不等长、膝关节内外翻畸形等发生。结论 取自体肌腱经骺板重建青少年ACL术后胫骨骨隧道呈先扩大后变小的趋势，早期胫骨骨隧道扩大对病人膝关节功能恢复、下肢生长发育无明显影响。 |
| 英文摘要: |
| Objective To observe the changes in the tibial tunnel after anterior cruciate ligament (ACL) reconstruction in adolescents and their relationship with clinical outcomes. Methods The clinical data of 16 adolescent patients who underwent arthroscopic ACL reconstruction via epiphyseal plate from a body tendon in our hospital from December 2017 to March 2020 were retrospectively analyzed. There were 7 males and 9 females, aged (15.1±0.9) years (range, 14-17 years). MRI was performed at 1, 24, 52, and 104 weeks after the operation. The width of the inner, middle and outer openings of the tibial tunnel was measured, and the absolute dilatation was calculated. The enlargement of the bone tunnel was calculated and graded. Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner score were used to evaluate knee function before and after surgery. The above functional scores were compared between patients with different tibial tunnel enlargement grades. At the last follow-up, assess whether there is unequal length of lower limbs and varus deformity of the knee joint. Results The tibial tunnel was enlarged in all 16 patients at 24 and 52 weeks after surgery. There was no significant difference in the functional scores of patients with different degrees of tibial tunnel enlargement at the same time point after surgery (P＞0.05). The Lysholm, IKDC, and Tegner scores were gradually improved at 24, 52, and 104 weeks after the operation, and the differences were statistically significant between pairwise comparisons at different time points (P＜0.05). The difference between tibial tunnel diameter at 104 weeks postoperatively and 1 week postoperatively was less than 2 mm. At the last follow-up, the patient's height increased by (8.0±3.1) cm (range, 3.2-14.6 cm). Auxiliary examination during follow-up suggested that the epiphyseal was not completely closed in one patient. The epiphysis of the remaining patients was closed, and there was no unequal length of lower limbs or varus deformity of the knee joint in all patients. Conclusion The tibial tunnel after anterior cruciate ligament reconstruction with body tendon and epiphyseal plate showed a trend of first expanding and then decreasing. The early expansion of the tibial tunnel had no significant effect on the recovery of knee joint function and the growth and development of lower limbs. |
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