解剖学前交叉韧带重建术后股骨隧道扩大：骨-髌腱-骨/单矩形隧道与腘绳肌腱/双隧道对比
Femoral tunnel enlargement after anatomic anterior cruciate ligament reconstruction: Bone-patellar tendon-bone /single rectangular tunnel versus hamstring tendon / double tunnels.
作者信息
Tachibana Yuta, Mae Tatsuo, Shino Konsei, Ohori Tomoki, Amano Hiroshi, Yoshikawa Hideki, Nakata Ken
机构信息
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada, Suita, Osaka, 565-0871, Japan.
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada, Suita, Osaka, 565-0871, Japan.
出版信息
J Orthop Sci. 2018 Nov;23(6):1011-1018. doi: 10.1016/j.jos.2018.06.014. Epub 2018 Jul 25.
PURPOSE
This study aimed to prospectively compare the femoral tunnel enlargement at the aperture as well as inside the tunnel after anatomic anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BTB) graft to that with hamstring tendon (HST) graft.
METHODS
This study included 24 patients with unilateral ACL rupture. Twelve patients underwent anatomic rectangular tunnel (ART) ACL reconstruction with BTB graft and the remaining 12 underwent anatomic triple-bundle (ATB) ACL reconstruction with HST graft. Three-dimensional computer models of femur and bone tunnels were reconstructed from computed tomography images obtained at 3 weeks and 1 year postoperatively. The femoral tunnel enlargement from 3 weeks to 1 year was evaluated by comparing the cross-sectional area (CSA), and compared between the two groups.
RESULTS
The CSA in the ART group at 1 year decreased at the aperture as well as inside the tunnel comparing that at 3 weeks. The CSAs of both tunnels in the ATB group at 1 year significantly increased at the aperture in comparison to those at 3 weeks, and gradually decreased toward the inside of the tunnel. The enlargement rate at the aperture in the ART group was -12.9%, which was significantly smaller than that of anteromedial graft (27.9%; P = 0.006) and posterolateral graft (31.3%; P = 0.003) in the ATB group. The tunnel enlargement rate at 5 mm from the aperture in the ART group was also significantly smaller than that in the ATB group. At 10 mm from the aperture, there was no significant difference between the tunnel enlargement rate in the ART group and that of anteromedial tunnel.
CONCLUSIONS
The tunnel enlargement rate around the aperture was significantly smaller after the ART procedure than that after the ATB procedure. Thus, BTB graft might be preferable as a graft material to HST graft in the femoral tunnel enlargement.
目的
本研究旨在前瞻性比较采用骨-髌腱-骨（BTB）移植物和采用腘绳肌腱（HST）移植物进行解剖学前交叉韧带（ACL）重建术后，股骨隧道开口处及隧道内的扩大情况。
方法
本研究纳入24例单侧ACL断裂患者。12例患者采用BTB移植物进行解剖学矩形隧道（ART）ACL重建，其余12例采用HST移植物进行解剖学三束（ATB）ACL重建。根据术后3周和1年获得的计算机断层扫描图像重建股骨和骨隧道的三维计算机模型。通过比较横截面面积（CSA）评估3周龄至1岁时股骨隧道的扩大情况，并在两组之间进行比较。
结果
与3周龄时相比，ART组1岁时开口处及隧道内的CSA均减小。与3周龄时相比，ATB组1岁时两个隧道开口处的CSA均显著增加，并向隧道内侧逐渐减小。ART组开口处的扩大率为-12.9%，显著小于ATB组前内侧移植物（27.9%；P = 0.006）和后外侧移植物（31.3%；P = 0.003）。ART组距开口5mm处的隧道扩大率也显著小于ATB组。在距开口10mm处，ART组的隧道扩大率与前内侧隧道的扩大率之间无显著差异。
结论
ART手术后开口周围的隧道扩大率显著小于ATB手术后。因此，在股骨隧道扩大方面，BTB移植物可能比HST移植物更适合作为移植物材料。
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