双束前交叉韧带重建术后隧道扩大：一项前瞻性随机研究。
Tunnel enlargement after double-bundle anterior cruciate ligament reconstruction: a prospective, randomized study.
作者信息
Järvelä Timo, Moisala Anna-Stina, Paakkala Timo, Paakkala Antti
机构信息
Orthopaedic Department, Hatanpää Hospital, Tampere, Finland.
出版信息
Arthroscopy. 2008 Dec;24(12):1349-57. doi: 10.1016/j.arthro.2008.07.018. Epub 2008 Oct 1.
PURPOSE
The aim of this study was to compare tunnel enlargement in patients with double-bundle and single-bundle anterior cruciate ligament (ACL) reconstruction.
METHODS
Sixty patients were randomized by closed envelopes into 2 different groups of ACL reconstruction with hamstring tendons: double-bundle technique with bioabsorbable screw fixation (n = 35) and single-bundle technique with bioabsorbable screw fixation (n = 25). Magnetic resonance imaging evaluation was performed in 53 patients (88%) (32 in double-bundle group and 21 in single-bundle group) for a mean of 27 months' follow-up (range, 24 to 36 months). Tunnel enlargement was determined by digital measurement of the widths perpendicular to the long axis of the tunnels on an oblique coronal and sagittal plane. The magnetic resonance imaging measurements were compared with the intraoperative drill diameter.
RESULTS
No significant differences were found between the double-bundle group and the single-bundle group in tunnel enlargement on the femoral side. However, on the tibial side, tunnel enlargement was greater in the single-bundle group than in the double-bundle group in each tunnel (P = .051). In all knees, tunnel enlargement both on the tibial side and on the femoral side correlated significantly with the anterior and rotational laxity of the operated knee. In the double-bundle group, no tunnel communication between the anteromedial and posterolateral tunnels was seen in any of the patients on either the tibial side or femoral side.
CONCLUSIONS
This prospective, randomized study showed that our double-bundle ACL reconstruction technique results in less tunnel enlargement in each tunnel on the tibial side than the single-bundle technique with similar fixation methods, graft material, and rehabilitation. In addition, no tunnel communication was observed in the patients undergoing double-bundle ACL reconstruction. The clinical results were good in both groups. However, the patients who had more tunnel enlargement had significantly more anterior and rotational laxity of the operated knee as well.
LEVEL OF EVIDENCE
Level I, therapeutic randomized controlled trial.
目的
本研究旨在比较双束和单束前交叉韧带（ACL）重建患者的隧道扩大情况。
方法
60例患者通过封闭信封随机分为2组，采用腘绳肌腱进行ACL重建：生物可吸收螺钉固定的双束技术（n = 35）和生物可吸收螺钉固定的单束技术（n = 25）。对53例患者（88%）（双束组32例，单束组21例）进行磁共振成像评估，平均随访27个月（范围24至36个月）。通过在斜冠状面和矢状面上数字测量垂直于隧道长轴的宽度来确定隧道扩大情况。将磁共振成像测量结果与术中钻孔直径进行比较。
结果
双束组和单束组在股骨侧的隧道扩大方面未发现显著差异。然而，在胫骨侧，单束组每个隧道的隧道扩大均大于双束组（P = 0.051）。在所有膝关节中，胫骨侧和股骨侧的隧道扩大均与手术膝关节的前向和旋转松弛度显著相关。在双束组中，无论是胫骨侧还是股骨侧，所有患者的前内侧和后外侧隧道之间均未观察到隧道连通。
结论
这项前瞻性随机研究表明，在固定方法、移植物材料和康复情况相似的情况下，我们的双束ACL重建技术导致胫骨侧每个隧道的隧道扩大少于单束技术。此外，在接受双束ACL重建的患者中未观察到隧道连通。两组的临床结果均良好。然而，隧道扩大较多的患者手术膝关节的前向和旋转松弛度也明显更大。
证据水平
I级，治疗性随机对照试验。
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