| 影响前交叉韧带自体肌腱过顶重建术后1年核磁共振愈合程度的风险因素分析 |
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投稿时间：2024-12-07
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| 作者 | Author | 单位 | Address | E-Mail |
| 林瓒 |
LIN Zan |
四川省骨科医院膝关节运动损伤科, 四川 成都 610041 |
Department of Knee Sports Injury, the Sichuan Provincal Orthopedics Hospital, Chengdu 610041, Sichuan, China |
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| 胡勇 |
HU Yong |
四川省骨科医院膝关节运动损伤科, 四川 成都 610041 |
Department of Knee Sports Injury, the Sichuan Provincal Orthopedics Hospital, Chengdu 610041, Sichuan, China |
yhoo425@vip.sina.com |
| 孙敏 |
SUN Min |
四川省骨科医院膝关节运动损伤科, 四川 成都 610041 |
Department of Knee Sports Injury, the Sichuan Provincal Orthopedics Hospital, Chengdu 610041, Sichuan, China |
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| 蒋旭 |
JIANG Xu |
四川省骨科医院膝关节运动损伤科, 四川 成都 610041 |
Department of Knee Sports Injury, the Sichuan Provincal Orthopedics Hospital, Chengdu 610041, Sichuan, China |
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| 期刊信息：《中国骨伤》2025年，第25卷，第5期，第500-507页 |
| DOI：10.12200/j.issn.1003-0034.20240613 |
| 基金项目:自贡市哲学社会科学重点研究基地"运动与健康创新研究中心"重点项目(编号:YDJKZ23-05) |
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中文摘要:
目的:探讨采用自体肌腱行前交叉韧带过顶重建患者术后1年韧带愈合情况可能的风险因素。
方法:回顾性分析2017年1月至2023年3月采用自体肌腱股骨端过顶重建前交叉韧带断裂的患者,筛选出其中随访时间超过1年且有术后1年膝关节核磁共振影像资料的患者207例,其中男137例,女70例;年龄12~56(28.01±9.71)岁;外伤至手术时间为(5.80±3.78)个月;所有患者术中轴移为Ⅰ-Ⅱ度。使用Howell法对术后1年膝关节核磁共振影像进行分类,Ⅰ度、Ⅱ度为愈合较好组(better healing degree,BHD),Ⅲ度、Ⅳ度为愈合较差组(poorer healing degree,PHD)。对两组患者年龄、性别、是否为运动伤、受伤至手术时间、术后重返运动的时间、身体质量指数(body mass index,BMI)、Beighton评分、膝过伸,移植物直径、是否保残、内外侧半月板是否切除以及缝合、外侧胫骨平台后倾角、髁间窝宽度比(intercondylar notch width ratio,ICNWR),股骨外髁深度(lateral femoral condyle depth ratio,LFCDR)进行单因素分析,再通过多因素Logistic回归分析来确定影响患者韧带愈合情况的高危因素。
结果:207例患者随访时间(18.59±4.63)个月,术后患者伤口愈合良好,无感染发生。3例术后1年发生重建前交叉韧带再断裂,2例因内侧半月板桶柄样撕裂再次行关节镜手术治疗。单因素分析结果显示,两组受伤至手术时间、手术至重返运动时间、ICNWR、外侧胫骨平台后倾角度、BMI比较,差异有统计学意义(P<0.05)。多因素回归分析显示,ICNWR过小[OR=0.684,95%CI(0.528,0.886),P=0.004],外侧胫骨平台后倾角度过大[OR=1.557,95%CI(1.222,1.984),P<0.001],BMI指数过大[OR=1.724,95%CI(1.369,2.172),P<0.001],重返运动时间过短,相对于<6个月的群体,6~12个月重返运动的患者[OR=0.167,95%CI(0.041,0.672),P=0.012]、>12个月的患者[OR=0.022,95%CI(0.004,0.108),P<0.001]均可能是导致术后1年MRI愈合程度较差的高危因素。
结论:采用自体肌腱行前交叉韧带股骨端过顶重建患者,ICNWR过小,外侧胫骨平台后倾角过大,BMI指数过大,重返运动时间过短均可能是导致术后1年核磁共振愈合程度较差的高危因素,对于此类患者,手术技术与术后康复的进程需个性化制定。 |
| 【关键词】磁共振成像 前交叉韧带 自体肌腱重建 过顶技术 Howell法 |
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| Analysis of risking factors affecting the graft healing degree on MRI by 1 year after anterior cruciate ligament autograft tendon over-the-top reconstruction |
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ABSTRACT
Objective To retrospectively analyze the healing degree of graft in patients who underwent over-the-top reconstruction of the anterior cruciate ligament(ACL) using autologous tendon 1 year postoperatively to find out possible risk factors.
Methods From January 2017 to March 2023,207 patients with more than 1 year of follow-up and 1-year postoperative MRI were selected from that receiving ACL autograft tendon over-the-top reconstruction surgery including 137 males and 70 females,with a mean age of (28.01±9.71) years rangeding 12 to 56 years old;time from trauma to surgery was (5.80±3.78) months. All patients had intra-operative pivoshift tested asⅠtoⅡdegree. The 1-year postoperative magnetic resonance imaging (MRI) Results were categorized by Howell's method,classifying degreesⅠandⅡas group BHD (better healing degree),while degrees Ⅲ and Ⅳ as group PHD (poorer healing degree). Potential influencing factors such as age,gender,whether it was a sports injury,time from injury to surgery,time to return to sports after surgery,body mass index (BMI),Beighton score,knee hyper-extension,diameter of the graft,whether it was remnant-preserving or not,whether the medial and lateral meniscus were resected,sutured or not,posterior lateral tibial slope,intercondylar notch width ratio (ICNWR),and lateral femoral condyle depth ratio (LFCDR) were analyzed by univariate analysis and Logistic regression to find the influencing factors.
Results All patients were follow-up time for (18.59±4.63) months,and all the patients had good wound healing without any infection after surgery. There were 3 cases of re-ruptrure and 2 cases with secondary medial meniscus barrel handle-like tear 1 year after surgery,which received arthroscopic surgical treatment. Univariate analysis showed statistically significant difference in time from injury to surgery,time from surgery to return to sports,ICNWR,posterior lateral tibial slope,and BMI between the two groups(P<0.05). Multi-factorial regression analysis showed that smaller ICNWR,OR=0.684,95%CI(0.528,0.886),P=0.004; larger posterior lateral tibial slope,OR=1.557,95%CI(1.222,1.984),P<0.001;larger BMI,OR=1.724,95%CI(1.369,2.172),P<0.001;and shorter return-to-sport time<6 months vs. 6 to 12 months,OR=0.167,95%CI(0.041,0.672),P=0.012;<6 months vs.>12 months,OR=0.022,95%CI(0.004,0.108),P<0.001 might be risk factors for poor MRI healing degree 1 year postoperatively.
Conclusion In patients received ACL autograft tendon over-the-top reconstruction,smaller ICNWR,larger posterior lateral tibial slope,larger BMI,and shorter time to return to sports may all be high-risk factors for poor graft healing degree on MRI 1 year postoperatively,and the surgical technique and the postoperative rehabilitation are supposed to be individualized for such patients. |
| KEY WORDS Magnetic resonance imaging Anterior cruciate ligament Autologous tendon reconstruction Over-the-top Howell method |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 林瓒,胡勇,孙敏,蒋旭.影响前交叉韧带自体肌腱过顶重建术后1年核磁共振愈合程度的风险因素分析[J].中国骨伤,2025,25(5):500~507 |
| 英文格式: | LIN Zan,HU Yong,SUN Min,JIANG Xu.Analysis of risking factors affecting the graft healing degree on MRI by 1 year after anterior cruciate ligament autograft tendon over-the-top reconstruction[J].zhongguo gu shang / China J Orthop Trauma ,2025,25(5):500~507 |
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