【作者】 李明； 刘宁；

【Author】 Li Ming;Liu Ning;Department of Sports Medicine, Zhengzhou Orthopaedics Hospital;

【机构】 郑州市骨科医院运动医学科；

【摘要】 目的对膝关节前交叉韧带重建术后再断裂患者的骨性结构、股骨和胫骨骨道口位置等相关因素进行分析,探究前交叉韧带重建术后再断裂的骨性结构原因及手术原因以指导临床。方法对2014年1月至2018年11月在郑州市骨科医院运动医学科就诊的膝关节前交叉韧带重建术后再断裂的患者进行随访,对其胫骨、股骨定位点,胫骨平台后倾角,内侧胫骨平台深度、髁间窝形态及股骨内侧髁形态等数据进行分析。结果共随访到前交叉韧带重建术后再断裂患者14例,其中有完整影像学资料的患者10例(男7女3),平均年龄29.2岁(20～44岁),左膝5例,右膝5例,前交叉韧带重建术后再断裂平均发生时间为54.1月(9～192月)。其中股骨定位点异常3例,胫骨定位点异常7例,胫骨后倾角13.083±2.648°,胫骨内侧平台深度1.446±0.902mm,膝关节屈曲45°时髁间窝形态5例为穹窿形,3例为锥形,2例因未做相关检查髁间窝形态不详。股骨内侧髁形态4例为近球形,6例为椭圆形,长短径比值为0.771±0.071(更接近近球形)。结论膝关节前交叉韧带重建后再断裂的原因很多,骨性结构的异常和定位点的差异占很大原因,因此在术前应注意患者骨性结构是否存在异常,尤其是胫骨平台后倾角和髁间窝形态等因素。术中精确定位韧带止点位置,保残重建,降低前交叉韧带重建术后再断裂发生率。更多还原

【Abstract】 Objective To explore the causes of the second Anterior Cruciate Ligament Tears by analyzing the bone structure and the footprint of ACLR. Methods From January 2014 to November 2018, the patients with the second anterior cruciate ligament tears were reviewed. The tibial and femoral fixation points, tibial plateau reclining Angle, medial tibial plateau depth, condylar fossa morphology and femoral medial condyle morphology were analyzed. Results A total of 14 patients were followed up, including 10 patients with complete imaging data(7 males and 3 females). The average age was 29.2 years old(20-44 years old), with 5 cases of left knee and 5 cases of right knee. The average occurrence time of the second ACL injury was 54.1 months(9-192 months). Among them, 3 cases had abnormal femoral footprint and 7 cases had abnormal tibial footprint. The posterior tibial slope was13.083±2.648°. The depth of the medial plateau was 1.446±0.902 mm. When knee flexion 45 °, 5 cases were dome shape, 2 cases pyramidal notch shape. The shape of the medial femoral condyle was nearly spherical in 4 cases and oval in 6 cases, and the ratio of length to diameter was 0.771±0.071(more nearly spherical). ConclusionThere are many reasons for the second anterior cruciate ligament tears after reconstruction. The abnormality of the bony structure and the difference of the positioning points account for a large proportion. Therefore, preoperative attention should be paid to the abnormality of the patient’s bony structure, especially the posterior tilt angle of the tibial plateau and the shape of the intercondylar notch.During the operation, the position of the ligament was accurately positioned and the residual ligament was preserved to reduce the incidence rate of the second ACL injury after ACLR.更多还原