[初次前交叉韧带重建术后对侧前交叉韧带损伤的危险因素]
[Risk factors for contralateral anterior cruciate ligament injury after primary anterior cruciate ligament reconstruction].
作者信息
Wang Yong, Yu Zeping, Li Jian, Li Qi
机构信息
Department of Orthopedics, Institute of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China.
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 May 15;37(5):578-583. doi: 10.7507/1002-1892.202301045.
OBJECTIVE
To investigate the risk factors of contralateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction.
METHODS
A retrospective review was conducted on the 716 patients with ACL injury who received primary ACL reconstruction surgery and met the selection criteria between January 2012 and September 2018. After a mean follow-up period of 7.6 years (range, 4-10 years), 65 patients (9.1%) experienced contralateral ACL injury (injured group) and 651 patients (90.9%) did not (uninjured group). There was no significant difference in age, body mass index, and preoperative Lachman test degree between groups ( >0.05). However, the proportion of female in the injured group was significantly higher than that of male ( <0.05), and the preoperative posterior tibial slope (PTS) was significantly higher than that of the uninjured group ( <0.05). Using the outcome of contralateral ACL injury as the dependent variable, the clinical data of the patient was first used as the independent variable, and univariate COX regression was used to analyze the prognostic influencing factors. Then, the indicators with differences in univariate COX regression were used as the independent variable, and multivariate COX regression was used to analyze the independent risk factors affecting prognosis. Log-Rank (Mantel-Cox) test was used to test and analyze the occurrence time of contralateral ACL injury in patients of different genders; X-tile software was used to analyze the occurrence time of contralateral ACL injury in patients with different PTS using Log-Rank (Mantel-Cox) test and PTS cut-off values.
RESULTS
Univariate COX regression analysis showed that gender and PTS were influence factors for contralateral ACL injury ( <0.05); further multivariate COX regression analysis showed that female and increased PTS were independent risk factors for contralateral ACL injury ( <0.05). The Log-Rank (Mantel-Cox) test results showed that the contralateral ACL injury occurred in female at 8.853 (8.600, 9.106) years, which was significantly shorter than that in male [9.661 (9.503, 9.819) years] ( =20.323, <0.001). Using X-tile software to analyze the cut-off value of PTS, it was found that the cut-off value of PTS for contralateral ACL injury was 10.92°. According to the Log-Rank (Mantel-Cox) test, it was found that the contralateral ACL injury occurred in 5.762 (4.981, 6.543) years in patients with PTS≥10.92°, which was significantly shorter than patients with PTS<10.92° [9.751 (9.650, 9.853) years]( =302.479, <0.001).
CONCLUSION
Female and PTS≥10.92° after primary ACL reconstruction are independent risk factors for contralateral ACL injury.
目的
探讨初次前交叉韧带（ACL）重建术后对侧ACL损伤的危险因素。
方法
对2012年1月至2018年9月期间接受初次ACL重建手术且符合入选标准的716例ACL损伤患者进行回顾性研究。平均随访7.6年（范围4 - 10年）后，65例患者（9.1%）发生对侧ACL损伤（损伤组），651例患者（90.9%）未发生（未损伤组）。两组患者在年龄、体重指数和术前Lachman试验度数方面无显著差异（>0.05）。然而，损伤组女性比例显著高于男性（<0.05），且术前胫骨后倾角度（PTS）显著高于未损伤组（<0.05）。以对侧ACL损伤结果作为因变量，首先将患者的临床资料作为自变量，采用单因素COX回归分析预后影响因素。然后，将单因素COX回归中有差异的指标作为自变量，采用多因素COX回归分析影响预后的独立危险因素。采用Log-Rank（Mantel-Cox）检验对不同性别患者对侧ACL损伤的发生时间进行检验和分析；使用X-tile软件，采用Log-Rank（Mantel-Cox）检验和PTS截断值分析不同PTS患者对侧ACL损伤的发生时间。
结果
单因素COX回归分析显示，性别和PTS是对侧ACL损伤的影响因素（<0.05）；进一步多因素COX回归分析显示，女性和PTS增加是对侧ACL损伤的独立危险因素（<0.05）。Log-Rank（Mantel-Cox）检验结果显示，女性对侧ACL损伤发生时间为8.853（8.600，9.106）年，显著短于男性[9.661（9.503，9.819）年]（=20.323，<0.001）。使用X-tile软件分析PTS的截断值，发现对侧ACL损伤的PTS截断值为10.92°。根据Log-Rank（Mantel-Cox）检验，发现PTS≥10.92°的患者对侧ACL损伤发生时间为5.762（4.981，6.543）年，显著短于PTS<10.92°的患者[9.751（9.650，9.853）年]（=302.479，<0.001）。
结论
初次ACL重建术后女性及PTS≥10.92°是对侧ACL损伤的独立危险因素。
Zotero 插件