Application of arthroscopic three-approach combined with elliptical tunnel technique in anterior cruciate ligament reconstruction

MA Yin-hua; CHEN Xiao-yan; TANG Hong-wei

doi:10.11659/jjssx.10E023083

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Application of arthroscopic three-approach combined with elliptical tunnel technique in anterior cruciate ligament reconstruction

Clinical Research | 更新时间：2024-11-18

- Application of arthroscopic three-approach combined with elliptical tunnel technique in anterior cruciate ligament reconstruction
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 33, Issue 11, Pages: 999-1003(2024)
- 作者机构：
  
  1.上海健康医学院附属嘉定区中心医院骨科，上海 201800
  2.上海健康医学院附属嘉定区中心医院日间病房，上海201800
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.10E023083
  CLC： R687.4
- Published：25 November 2024，
  
  Received：19 October 2023，
- 稿件说明：
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马寅华,陈肖燕,汤红伟.关节镜下三入路联合椭圆隧道技术在前交叉韧带重建术中的应用[J].局解手术学杂志,2024,33(11):999-1003.

MA Yin-hua,CHEN Xiao-yan,TANG Hong-wei.Application of arthroscopic three-approach combined with elliptical tunnel technique in anterior cruciate ligament reconstruction[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(11):999-1003.
马寅华,陈肖燕,汤红伟.关节镜下三入路联合椭圆隧道技术在前交叉韧带重建术中的应用[J].局解手术学杂志,2024,33(11):999-1003. DOI： 10.11659/jjssx.10E023083.

MA Yin-hua,CHEN Xiao-yan,TANG Hong-wei.Application of arthroscopic three-approach combined with elliptical tunnel technique in anterior cruciate ligament reconstruction[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(11):999-1003. DOI： 10.11659/jjssx.10E023083.

摘要

目的

探讨关节镜下三入路联合椭圆隧道技术在前交叉韧带（ACL）重建术中的应用价值。

方法

选取我院收治的ACL损伤患者104例开展前瞻性分析，按照随机数字表法分为观察组和对照组，每组52例。2组患者均行ACL重建术治疗，观察组患者采取关节镜下三入路联合椭圆隧道技术，对照组患者采取传统前内侧入路联合椭圆隧道技术。比较2组患者手术相关指标、术后骨隧道定位参数、术后移植物成熟情况、膝关节稳定性（Lachman试验）、膝关节功能Lysholm评分及并发症发生情况。

结果

观察组患者扶拐下床活动时间、弃拐行走时间、恢复运动时间短于对照组（

0.05）；观察组患者术后A/B大于对照组，a/c、α小于对照组（

0.05）；观察组患者术后6个月、12个月近端、中段、远端移植物信号/噪声比（SNQ）均低于对照组（

0.05）；术后6个月，观察组患者膝关节稳定性优于对照组，膝关节功能Lysholm评分高于对照组（

0.05）；2组患者术后并发症发生率比较，差异无统计学意义（

0.05）。

结论

关节镜下三入路联合椭圆隧道技术用于ACL重建术中能改善骨隧道形态，促进移植物成熟，缩短术后恢复进程，改善膝关节功能，具有较高的安全性。

Abstract

Objective

To investigate the application value of arthroscopic three-approach combined with elliptical tunnel technique in anterior cruciate ligament （ACL） reconstruction.

Methods

A prospective analysis was conducted on 104 patients with ACL injury admitted to our hospital. They were randomly divided into the observation group and the control group according to a random number table method， with 52 cases in each group.All patients in both groups underwent ACL reconstruction.The patients in the observation group were treated with the arthroscopic three-approach combined with elliptical tunnel technique，while the patients in the control group were treated with the traditional anteromedial approach and elliptical tunnel technique.The surgical related indicators，parameters of postoperative bone tunnel positioning，postoperative graft maturation， knee stability （Lachman test），Lysholm score of knee function，and complications of patients were compared between the two groups.

Results

The time of getting out of bed with crutches，time of walking without crutches and recovery time of patients in the observation group were shorter than those in the control group （

0.05）. The A/B value of patients in the observation group was greater than that in the control group，and the a/c and α were smaller than those in the control group （

0.05）.The signal/noise quotient （SNQ） of the proximal， middle， and distal grafts 6 and 12 months after surgery of patients in the observation group were lower than those in the control group （

0.05）. At 6 months postoperatively，the knee stability of patients in the observation group was better than that in the control group，and the Lysholm score of knee function was higher than that in the control group （

0.05）. There was no significant difference in the incidence of postoperative complications between the two groups （

0.05）.

Conclusion

Arthroscopic three-approach combined with elliptical tunnel technique can improve the morphology of bone tunnel，promote graft maturation，shorten postoperative recovery process，and improve knee function in ACL reconstruction，with high safety.

关键词

前交叉韧带重建术椭圆隧道技术关节镜三入路关节稳定性膝关节功能移植物

Keywords

anterior cruciate ligament reconstructionelliptical tunnel techniquearthroscopethree-approachjoint stabilityknee functiongraft

references

Beard DJ，Davies L，Cook JA，et al.Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury （ACL SNNAP）：a pragmatic randomised controlled trial［J］.Lancet，2022，400（10352）：605-615.doi：10.1016/S0140-6736（22）01424-6http://dx.doi.org/10.1016/S0140-6736（22）01424-6.

Ferri-Caruana A，Prades-Insa B，Serra-AÑÓ P.Effects of pelvic and core strength training on biomechanical risk factors for anterior cruciate ligament injuries［J］.J Sports Med Phys Fitness，2020，60（8）：1128-1136.doi：10.23736/S0022-4707.20.10552-8http://dx.doi.org/10.23736/S0022-4707.20.10552-8.

许继荣，李红，孙朝军，等.前交叉韧带损伤治疗的发展趋势［J］.临床医学进展，2023，13（2）：2450-2460.doi：10.12677/ACM. 2023.132345http://dx.doi.org/10.12677/ACM.2023.132345.

范冰洋，何海溶，袁凌伟，等.关节镜下前交叉韧带重建手术研究现状［J］.中国医药导报，2022，19（31）：65-68.doi：10.20047/j.issn1673-7210.2022.31.15http://dx.doi.org/10.20047/j.issn1673-7210.2022.31.15.

吴鹏，姬振伟，王志学，等.股骨椭圆隧道技术对膝关节前交叉韧带重建后膝关节功能、滑膜覆盖与张力程度的影响［J］.临床和实验医学杂志，2022，21（6）：625-628.doi：10.3969/j.issn.1671-4695.2022.06.019http://dx.doi.org/10.3969/j.issn.1671-4695.2022.06.019.

吕杰，杨自权，冯江峰，等.关节镜下三入路与传统前内侧入路重建前交叉韧带股骨骨道的比较及早期疗效分析［J］.中国骨伤，2021，34（7）：628-635.doi：10.12200/j.issn.1003-0034.2021.07.008http://dx.doi.org/10.12200/j.issn.1003-0034.2021.07.008.

Carey JL，Shea KG.AAOS clinical practice guideline：management of anterior cruciate ligament injuries：evidence-based guideline［J］.J Am Acad Orthop Surg，2015，23（5）：e6-e8.doi：10.5435/JAAOS-D-15-00095http://dx.doi.org/10.5435/JAAOS-D-15-00095.

高士基，刘宁.关节镜下“8”字缝线与网兜缝线固定治疗前十字韧带胫骨止点撕脱骨折［J］.中华骨科杂志，2020，40（3）：146-153.doi：10.3760/cma.j.issn.0253-2352.2020.03.003http://dx.doi.org/10.3760/cma.j.issn.0253-2352.2020.03.003.

Yoon KH，Park JY，Lee JY，et al.Costal chondrocyte-derived pellet-type autologous chondrocyte implantation for treatment of articular cartilage defect［J］.Am J Sports Med，2020，48（5）：1236-1245.doi：10.1177/0363546520905565http://dx.doi.org/10.1177/0363546520905565.

Jeong J，Choi DH，Shin CS.Core strength training can alter neuromuscular and biomechanical risk factors for anterior cruciate ligament injury［J］.Am J Sports Med，2021，49（1）：183-192.doi：10.1177/0363546520972990http://dx.doi.org/10.1177/0363546520972990.

Brophy RH，Lowry KJ.American academy of orthopaedic surgeons clinical practice guideline summary：management of anterior cruciate ligament injuries［J］.J Am Acad Orthop Surg，2023，31（11）：531-537.doi：10.5435/JAAOS-D-22-01020http://dx.doi.org/10.5435/JAAOS-D-22-01020.

华政哲，王宁，孙豪君，等.关节镜下前交叉韧带残端评估及保残重建的临床效果［J］.局解手术学杂志，2023，32（4）：318-322.doi：10.11659/jjssx.09E022102http://dx.doi.org/10.11659/jjssx.09E022102.

Chung K，Choi CH，Kim SH，et al.The relationship between lateral femoral anatomic structures and the femoral tunnel outlet in anterior cruciate ligament reconstruction using the transportal technique：a 3-dimensional simulation analysis［J］.Orthop J Sports Med，2020，8（9）：2325967120952783.doi：10.1177/2325967120952783http://dx.doi.org/10.1177/2325967120952783.

岳流伟，赵雨琛.改良三入路与标准入路关节镜下单束前交叉韧带重建的效果比较［J］.河南医学研究，2020，29（26）：4833-4836.doi：10.3969/j.issn.1004-437X.2020.26.010http://dx.doi.org/10.3969/j.issn.1004-437X.2020.26.010.

Porter M，Shadbolt B.Modified iliotibial band tenodesis is indicated to correct intraoperative residual pivot shift after anterior cruciate ligament reconstruction using an autologous hamstring tendon graft：a prospective randomized controlled trial［J］.Am J Sports Med，2020，48（5）：1069-1077.doi：10.1177/0363546520910148http://dx.doi.org/10.1177/0363546520910148.

Kosy JD，Walmsley K，Anaspure R，et al.Flexible reamers create comparable anterior cruciate ligament reconstruction femoral tunnels without the hyperflexion required with rigid reamers：3D-CT analysis of tunnel morphology in a randomised clinical trial［J］.Knee Surg Sports Traumatol Arthrosc，2020，28（6）：1971-1978.doi：10.1007/s00167-019-05709-7http://dx.doi.org/10.1007/s00167-019-05709-7.

Minguell J，Nuñez JH，Reverte-Vinaixa MM，et al.Femoral tunnel position in chronic anterior cruciate ligament rupture reconstruction：randomized controlled trial comparing anatomic，biomechanical and clinical outcomes［J］.Eur J Orthop Surg Traumatol，2019，29（7）：1501-1509.doi：10.1007/s00590-019-02455-xhttp://dx.doi.org/10.1007/s00590-019-02455-x.

徐忠建，蒋旭，张智鹏，等.透视辅助韧带重建术对前交叉韧带损伤患者膝关节功能及稳定性的影响［J］.实用临床医药杂志，2023，27（6）：24-28.doi：10.7619/jcmp.20223570http://dx.doi.org/10.7619/jcmp.20223570.

王新民，刘飞，赵海霞，等.关节镜下单隧道单束与三隧道双束不同植入物重建前交叉韧带：膝关节稳定性及活动功能［J］.中国组织工程研究，2018，22（27）：4387-4392.doi：10.3969/j.issn.2095-4344.0356http://dx.doi.org/10.3969/j.issn.2095-4344.0356.

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