摘要目的 探讨LARS人工韧带重建前交叉韧带(ACL)术后骨隧道的变化特点及可能的影响因素.方法 2004年8月至2007年4月应用LARS人工韧带重建43例单纯ACL损伤患者,男31例,女12例；左膝19例,右膝24例；年龄17～48岁,平均27.5岁.于术后l、3、6、12、24、36个月分别行膝关节X线片和CT检查,记录各个时间点胫骨和股骨骨隧道的宽度.骨隧道增宽采用Peyrache等提出的分级方法进行评定.末次随访时根据Lysholm评分标准评定膝关节功能,应用KT-1000TM测量膝关节的松弛度. 结果 43例患者术后获36 ～49个月(平均39.5个月)随访.末次随访时仅3例患者出现骨隧道l级增宽,均为术后6个月发生于股骨隧道近关节面水平,平均增宽(2.5 ±0.3) mm.无一例患者出现2级和3级骨隧道增宽.不同时间点股骨、胫骨骨隧道宽度比较差异均无统计学意义(P＞0.05).X线片与CT测量结果基本一致,二者比较差异均无统计学意义(P＞0.05).末次随访时3例骨隧道l级增宽患者Lysholm评分平均为(94.5±4.6)分,KT-1000TM前移差值平均为(1.5±1.1)mm；40例0级增宽患者Lysholm评分平均为(95.6±4.8)分,KT-1000TM前移差值平均为(1.4±1.5)mm.结论 LARS人工韧带重建ACL术后骨隧道增宽并不显著,这种变化特点可能与LARS人工韧带移植物的特性及固定方法不同有关.

abstractsObjective To observe changes of bone tunnel after anterior cruciate ligament (ACL)reconstruction using LARS artificial ligaments.Methods From August 2004 to April 2007,we treated 43 patients with ACL injury (in 19 left and 24 right knees) with ACL reconstruction using LARS artificial ligaments.They were 31 males and 12 females,17 to 48 years of age (average,27.5 years).X-ray and CT examinations were conducted respectively at 1,3,6,12,24 and 36 months postsurgery to measure enlargements of the tibia1 and femoral tunnels according to the grading system by Peyrache et al.At the last follow-up,Lysholm knee scoring was used to evaluate knee functional recovery and KT-1000TM test to evaluate the anterior and posterior stability of the knee.Results Follow-ups lasted 36 to 49 months for the 43 patients (average,39.5 months).Only 3 cases of bone tunnel enlargement of grade 1 occurred 6 months postsurgery,all in the femoral tunnel near the level of articular surface,with an average tunnel expansion of 2.5 ± 0.3 mm.No enlargements of grade 2 or 3 were observed.There were no statistically significant differences in bone tunnel width at any time point (P ＞ 0.05).The measurements by X-ray and CT examinations were quite the same.At the last follow-up,the Lysholm score and KT-1000TM anterior translation value for the 3 cases of grade 1 tunnel enlargement were respectively 94.5 ± 4.6 points and 1.5 ± 1.1 mm,and respectively 95.6 ± 4.8 points and 1.4 ± 1.5 mm for the 40 cases of grade 0 tunnel enlargement.Conclusions Bone tunnel enlargement may not occur commonly in ACL reconstruction using LARS artificialligaments.This may be associated with specific features and different graft fixation of LARS artificial ligament.