关节镜下双束前交叉韧带重建中生物可吸收干扰螺钉与皮质纽扣-棒固定的隧道扩大和临床结果比较：一项前瞻性、随机研究，随访时间至少 2 年。
Comparison of Tunnel Enlargement and Clinical Outcome Between Bioabsorbable Interference Screws and Cortical Button-Post Fixation in Arthroscopic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Study With a Minimum Follow-Up of 2 Years.
机构信息
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Orthopedics, Songshan Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
出版信息
Arthroscopy. 2019 Feb;35(2):544-551. doi: 10.1016/j.arthro.2018.08.039.
PURPOSE
To investigate the tunnel enlargement rate and clinical function by comparing double-bundle anterior cruciate ligament reconstruction (ACLR) using different fixation devices.
METHODS
Patients receiving primary arthroscopic double-bundle ACLR were screened and divided into 2 groups on the basis of the method of graft fixation: bioabsorbable interference screw (BS) group and cortical button (CB) group. Bone tunnel size was assessed digitally using magnetic resonance imaging, which was performed a minimum of 2 years postoperatively. Clinical evaluations were performed using the Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee score, and KT-1000 arthrometer 2 years postoperatively.
RESULTS
Sixty patients receiving primary arthroscopic double-bundle ACLR were included. Overall, the BS group showed greater tunnel enlargement than the CB group, as well as a significantly increased rate of tunnel communication (P = .029). The average anteromedial tunnel enlargement rates for the BS and CB groups were 50% and 28%, respectively. The enlargement rate of the posterolateral (PL) femoral tunnel was similar in both groups. In the PL tibial tunnel, the CB group showed a significant increase in enlargement compared with the BS group (64% vs 45%, P = .0001). Both groups showed functional improvement in the Knee Injury and Osteoarthritis Outcome Score and International Knee Documentation Committee score. No significant difference in postoperative functional outcomes was found between the 2 groups.
CONCLUSIONS
The BS group showed significantly greater tunnel enlargement in anteromedial tunnels and an increased tunnel communication rate compared with the CB group. On the other hand, the CB group showed greater tunnel enlargement in tibial PL tunnels. Tunnel communication was observed mostly on the tibial side in the BS patients. Equivalent clinical function outcomes were noted at 2 years after surgery in both groups of patients.
LEVEL OF EVIDENCE
Level II, randomized controlled clinical trial.
目的
通过比较不同固定装置的双束前交叉韧带重建（ACLR），研究隧道扩大率和临床功能。
方法
筛选接受初次关节镜下双束 ACLR 的患者，并根据移植物固定方式将其分为两组：生物可吸收性干扰螺钉（BS）组和皮质纽扣（CB）组。术后至少 2 年，使用磁共振成像（MRI）对骨隧道大小进行数字评估。术后 2 年，使用膝关节损伤和骨关节炎结果评分（KOOS）、国际膝关节文献委员会评分（IKDC）和 KT-1000 关节测量仪进行临床评估。
结果
共纳入 60 例接受初次关节镜下双束 ACLR 的患者。总体而言，BS 组的隧道扩大程度大于 CB 组，且隧道连通率显著增加（P =.029）。BS 和 CB 组的前内侧隧道平均扩大率分别为 50%和 28%。两组的后外侧（PL）股骨隧道扩大率相似。在 PL 胫骨隧道中，CB 组的扩大率明显高于 BS 组（64%比 45%，P =.0001）。两组 KOOS 和 IKDC 评分均有功能改善。两组术后功能结果无显著差异。
结论
与 CB 组相比，BS 组前内侧隧道的隧道扩大程度明显更大，隧道连通率增加。另一方面，CB 组的胫骨 PL 隧道的隧道扩大程度更大。BS 患者的胫骨侧观察到大多数隧道连通。两组患者术后 2 年的临床功能结果相当。
证据水平
Ⅱ级，随机对照临床试验。
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