Objective: To evaluate the effects of two different femoral cortical suspension devices (fixation loop and adjustable loop) on tunnel widening and knee function in patients following anterior cruciate ligament reconstruction for 12 months.
Methods: A total of 60 patients who had undergone anterior cruciate ligament reconstruction were included in this study. According to the length of the loop(n)[n= total length of loop-(total length of femoral tunnel-total length of coarse tunnel)] in the rough bone tunnel, the patients were divided into A (adjustable loop was 0 mm in the coarse bone tunnel), B (fixation loop was greater than 0 mm and less than or equal to 10 mm in the coarse bone tunnel) and C (fixation loop was greater than 10 mm in the coarse bone tunnel) groups, of which 11 cases were in group A, 27 cases in group B and 22 cases in group C. In the three-dimensional reconstruction of the knee joint with multi-slice spiral CT, the widening of the bone tunnel in the three groups was compared. At the same time, IKDC, Lysholm and Tegner scores of the patients in the three groups were compared.
Results: There were differences in the widening degree of the femoral canal among groups A, B and C, and the median difference of the widening degree of the femoral tunnel 12 months and immediately after the surgery was A < B < C. The difference of femoral canal widening in group A was significantly different from that in groups B and C (P < 0.05).According to the linear regression the relationship between the difference of the width of the femoral canal and the change of the length (n) of the loop in the coarse canal, it was found that there was a linear relationship between the value of n and the difference of the width of the bone canal. With the increase of the value of n, the difference of the width of the bone canal gradually became larger. The median difference of the width of the middle and superior tunnel was negative, while the median difference of the width of the middle and inferior tunnel was positive. During the follow-up, we found that there were no statistical differences in IKDC, Lysholm and Tegner scores among the three groups one year after surgery (P > 0.05).
Conclusion: Twelve months after surgery, compared with group B (fixed loop group) and group C (fixed loop group), group A (adjustable loop group) had less bone tunnel widening.In groups A, B and C, as the length of the loop in coarse bone tunnel gradually increased, the width of bone tunnel became more significant. At the end of 12 months follow-up after anterior cruciate ligament reconstruction, the medial and inferior femoral tunnel was significantly wider than immediately after surgery, and the medial and superior femoral tunnel had gradually begun to undergo tendon-bone healing. There was no significant difference in knee function scores among groups A, B, and C in the follow-up 12 months after surgery.
目的: 评估两种不同的股骨皮质悬吊装置(固定袢和可调节袢)重建前交叉韧带术后12个月患者的股骨骨道增宽情况及膝关节功能。
方法: 共纳入60例行前交叉韧带重建术的患者，根据袢在粗骨道中长度(n)[n=袢的总长度-(股骨骨道总长度-粗骨道的总长度)]将患者分为A(可调节袢在粗骨道中长度为0 mm)、B(固定袢在粗骨道中长度为＞0 mm、≤10 mm之间)、C(固定袢在粗骨道中长度＞10 mm)三组，其中A组病例数为11例，B组病例数为27例，C组病例数为22例，比较三组患者在膝CT关节三维重建术后12个月与术后即刻股骨骨道增宽情况，同时比较三组患者的国际膝关节委员会(International Knee Documentation Committee，IKDC)评分、Lysholm评分及Tegner评分。
结果: A、B、C三组的股骨骨道增宽程度存在差异，术后12个月和术后即刻股骨骨道增宽差值中位数：A＜B＜C。A组的股骨骨道增宽差值及差值占比与B、C两组相比，差异有统计学意义(P＜0.05)。根据线性回归关系发现n值与骨道增宽差值存在线性关系，随着n值的增大，骨道增宽的差值逐渐变大。股骨中上骨道的增宽差值中位数出现负数，中下骨道的增宽差值中位数均为正数。随访时发现三组术后12个月的IKDC、Lysholm、Tegner评分差异无统计学意义(P＞0.05)。
结论: A组与B组、C组相比，其术后12个月的骨道增宽程度较小；在A、B、C三组中随着袢在粗骨道中的长度逐渐增大，骨道增宽程度越显著；前交叉韧带重建术后12个月患者，其股骨中下骨道较术后即刻骨道增宽明显，股骨中上骨道已逐渐开始发生重建肌腱和股骨愈合；在术后12个月的随访患者中，A、B、C三组膝关节功能评分差异无统计学意义。
Keywords: Adjustable loops; Anterior cruciate ligament reconstruction; Bone tunnel widening; Fixation loops; Knee function.