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  • 张程远,蒋仕林,陆叶,等.髁间凹成形术对髁间凹容积影响的临床研究[J].同济大学学报(医学版),2023,44(2):180-187.    [点击复制]
  • ZHANG Chengyuan,JIANG Shilin,LU Ye,et al.Effect of intercondylar notchplasty on the change of intercondylar notch volume[J].同济大学学报(医学版),2023,44(2):180-187.   [点击复制]
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髁间凹成形术对髁间凹容积影响的临床研究
张程远,蒋仕林,陆叶,邱勇嘉,袁锋
0
(上海交通大学医学院附属第六人民医院骨科,上海200233)
摘要:
目的观察髁间凹成形术对于股骨髁间凹容积改变的影响情况,明确髁间凹成形术的效果。方法随访上海交通大学医学院附属第六人民医院2018年12月—2021年4月的前交叉韧带(anterior cruciate ligament, ACL)损伤患者,随机纳入200名符合入组标准患者(男性100名,女性100名)为ACL损伤组,其中根据是否进行髁间凹成形术分为成形组和非成形组,200名非膝关节韧带损伤患者为对照组。测量术前、术后(成形组)的髁间凹容积(notch volume, NV)以及随访术前术后1年的Lysholm评分、国际膝关节评分委员会(International Knee Documentation Committee, IKDC)膝关节评分,进行分组比较分析。结果ACL损伤组的NV为(6.25±1.40) cm3,而对照组为(7.13±1.65) cm3,差异具有统计学意义(P<0.001);成形组NV为(5.97±1.28) cm3,未成形组为(7.06±1.43) cm3,差异具有统计学意义(P<0.001),NV=6.36 cm3为最佳截断值,灵敏度为0.725,特异度为0.635;成形组成形术后NV为(6.75±1.34) cm3,较术前明显增大(P<0.001),与未成形组差异无统计学意义(P=0.160),与对照组差异存在统计学意义(P=0.006);成形组术后Lysholm评分与IKDC评分分别为92.34±2.92、93.56±3.08,未成形组为92.88±2.86、94.32±3.12,二者差异均无统计学意义(P=0.873,P=0.754)。结论髁间凹成形可以明确增大髁间凹容积,减小因髁间凹狭小或髁间凹/移植物不匹配造成的ACL移植物再次损伤或断裂的风险,具有明确的效果,无明显副作用,当NV<6.36 cm3时,有指征行髁间凹成形。
关键词:  前交叉韧带  髁间凹成形  髁间凹容积
DOI:10.12289/j.issn.1008-0392.22263
投稿时间:2022-06-21
基金项目:上海市卫生健康委员会项目(201940427);上海市科学技术委员会项目(20Y11913300);上海市申康医院发展中心项目(SHDC12020118);上海市卫生健康委员会青年项目(20194Y0279);上海市浦东新区卫生健康委员会项目(PW2022D-11);上海市第六人民医院医疗集团项目
Effect of intercondylar notchplasty on the change of intercondylar notch volume
ZHANG Chengyuan,JIANG Shilin,LU Ye,QIU Yongjia,YUAN Feng
(Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China)
Abstract:
ObjectiveTo investigate the effect of intercondylar notchplasty on the change of intercondylar notch volume. MethodsTwo hundred patients with ACL injury, 100 males and 100 females, admitted in our hospital from December 2018 to April 2021 were enrolled(ACL injury group), including 148 cases who underwent intercondylar notchplasty and 52 cases who did not receive notchplasty; and 200 patients with non-knee ligament injuries were assigned as the control group. The intercondylar notch volume(NV) before and after surgery(in notchplasty group), and the Lysholm score and the International Knee Scoring Committee(IKDC) knee score were measured before surgery and after 1 year of follow-up, and compared among groups. ResultsThe NV of the ACL injury group was (6.25±1.40) cm3, while that of the control group was (7.13±1.65) cm3(P<0.001). The NV of the notchplasty group was (5.97±1.28) cm3, and that of the non-notchplasty group was (7.06±1.43) cm3 (P<0.001). Taking NV=6.36 cm3 as the best cut-off value, the sensitivity was 0.725, and the specificity was 0.635. The NV was (6.75±1.34) cm3 after notchplasty surgery, which was significantly larger than that before surgery(P<0.001), and there was no statistical difference with the non-plasty group(P=0.160), but there was a significant difference with the control group(P=0.006). After the surgery,in the notchplasty group, the Lysholm scores and the IKDC scores were 92.34±2.92 and 93.56±3.08, in the non-notchplasty group, those were 92.88±2.86 and 94.32±3.12(P=0.873, 0.754). ConclusionIntercondylar notchplasty can clearly increase the intercondylar notch volume and reduce the risk of re-injury of the ACL graft caused by the narrow intercondylar concavity or the mismatch between the intercondylar notch and the ACL graft. It has a definite efficacy and has no obvious side effects. NV<6.36 cm3 may be used as an indication for intercondylar notchplasty.
Key words:  anterior cruciate ligament  intercondylar notchplasty  intercondylar notch volume

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