CAJ | 학술논문

目的比较跨后纵膈入路与前方入路单束解剖重建后交叉韧带(PCL)的疗效,探讨前者的优势.方法回顾性分析2008年1月至2012年1月期间行PCL单束解剖重建的60例PCL损伤患者,根据不同时期手术入路不同分为两组:常规组28例,男17例,女11例;平均年龄为(33.0±9.4)岁;早期采用前方入路重建PCL.跨后纵膈组32例,男22例,女10例;平均年龄为(32.2±8.0)岁;后期采用跨后纵膈入路重建PCL.比较两组患者的胫骨隧道位点距离、KT-2000值、后抽屉试验结果、神经血管损伤情况及末次随访时Lysholm膝关节功能评分和膝关节文献编制委员会(IKDC)评分等. 结果常规组和跨后纵膈组患者的随访时间平均分别为(15.9±2.2)、(15.6±2.0)个月,差异无统计学意义(P＞0.05).跨后纵膈组患者术后胫骨隧道位点距离[(2.9±1.2) mm]和KT-2000值[(2.1±1.2)mm]均小于常规组[(5.6±1.7)、(2.9±1.8) mm],术后后抽屉试验阴性率[90.6％ (29/32)]较常规组[75.0％ (21/28)]高,末次随访时Lysholm膝关节功能评分和IKDC评分[(90.9±3.0)、(88.3±3.5)分]均高于常规组[(87.8±2.9)、(85.4±3.7)分],以上项目两组间比较差异均有统计学意义(P＜0.05).常规组2例患者出现神经血管损伤的症状,经对症处理后症状消失.结论与前方入路比较,跨后纵膈入路单束解剖重建PCL的疗效更好,可以更好地恢复膝关节的稳定性.
목적 비교과후종격입로여전방입로단속해부중건후교차인대(PCL)적료효,탐토전자적우세.방법 회고성분석2008년1월지2012년1월기간행PCL단속해부중건적60례PCL손상환자,근거불동시기수술입로불동분위량조:상규조28례,남17례,녀11례;평균년령위(33.0±9.4)세;조기채용전방입로중건PCL.과후종격조32례,남22례,녀10례;평균년령위(32.2±8.0)세;후기채용과후종격입로중건PCL.비교량조환자적경골수도위점거리、KT-2000치、후추체시험결과、신경혈관손상정황급말차수방시Lysholm슬관절공능평분화슬관절문헌편제위원회(IKDC)평분등. 결과 상규조화과후종격조환자적수방시간평균분별위(15.9±2.2)、(15.6±2.0)개월,차이무통계학의의(P＞0.05).과후종격조환자술후경골수도위점거리[(2.9±1.2) mm]화KT-2000치[(2.1±1.2)mm]균소우상규조[(5.6±1.7)、(2.9±1.8) mm],술후후추체시험음성솔[90.6％ (29/32)]교상규조[75.0％ (21/28)]고,말차수방시Lysholm슬관절공능평분화IKDC평분[(90.9±3.0)、(88.3±3.5)분]균고우상규조[(87.8±2.9)、(85.4±3.7)분],이상항목량조간비교차이균유통계학의의(P＜0.05).상규조2례환자출현신경혈관손상적증상,경대증처리후증상소실.결론 여전방입로비교,과후종격입로단속해부중건PCL적료효경호,가이경호지회복슬관절적은정성.
Objective To compare the posterior trans-septum portal approach and the anterior approach for anatomic single-bundle reconstruction of the posterior cruciate ligament (PCL).Methods We reviewed 60 patients who had undergone anatomic single-bundle reconstruction of PCL from January 2008 to January 2012.They were divided into 2 groups according to surgical approaches used.In the conventional group,28 patients received early PCL reconstruction via the anterior approach.They were 17 males and 11 females,with a mean age of 33.0 ± 9.4 years.In the trans-septum group,32 patients received late PCL reconstruction via the posterior trans-septum portal approach.They were 22 males and 10 females,with a mean age of 32.2 ± 8.0 years.The 2 groups were compared in terms of tibial tunnel site distance,KT-2000 value,posterior drawer test result,neurovascular lesion,and Lysholm knee function and IKDC (International Knee Documentation Committee) scores at the last follow-up.Results The conventional and the trans-septum groups were followed up for 15.9 ± 2.2 and 15.6 ± 2.0 months respectively,with no significant difference (P ＞ 0.05).The conventional group yielded significantly better results than the trans-septum group regarding tibial tunnel site distance,KT-2000 value,negative rate of posterior drawer test [90.6％ (29/32) versus 75.0％ (21/28)],Lysholm knee function and IKDC scores (90.9 ± 3.0 and 88.3 ± 3.5 points versus 87.8 ± 2.9 and 85.4 ± 3.7 points) (P ＜ 0.05).Two patients in the conventional group had neurovascular symptoms which responded to the treatment.Conclusion In the anatomic single-bundle reconstruction of PCL,the posterior trans-septum portal approach may result in better outcomes than the conventional anterior approach in terms of facilitating recovery of knee joint stability.