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Tibial tunnel enlargement after anatomic anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft. Part 2: Factors related to the tibial tunnel enlargement.

骨-髌腱-骨移植重建前交叉韧带后胫骨隧道扩大。第2部分: 胫骨隧道扩大的相关因素.

  • 影响因子:1.36
  • DOI:10.1016/j.jos.2019.03.016
  • 作者列表:"Ohori T","Mae T","Shino K","Tachibana Y","Yoshikawa H","Nakata K
  • 发表时间:2020-03-01
Abstract

BACKGROUND:Factors related to tunnel enlargement after anterior cruciate ligament (ACL) reconstruction should be evaluated by multivariate analysis, because the phenomenon has multifactorial characteristics. The purpose of this study was to elucidate the factors related to the tibial tunnel enlargement rate after anatomic ACL reconstruction with a bone-patellar tendon-bone (BTB) graft using multivariate analysis. METHODS:Eighteen patients with unilateral ACL rupture were included. The anatomic rectangular-tunnel (ART) ACL reconstruction with a BTB autograft was performed. 3D CT models of the tibia, the tibial tunnel, and the bone plug at 3 weeks and 1 year after surgery were reconstructed and superimposed using a surface registration technique. The cross-sectional area (CSA) of the tibial tunnel perpendicular to the tunnel axis was evaluated at the aperture. The CSA was measured at 3 weeks and 1 year after surgery, and the tunnel enlargement rate at the aperture was calculated. Multiple linear regression analysis was performed to detect the significantly related factors to the tibial tunnel enlargement rate at the aperture among potential factors consisting of preoperative demographic factors and predisposing factors with the tibial tunnel. RESULTS:The tibial tunnel enlargement rate at the aperture was 21.9 ± 14.1% (mean ± standard deviation). Multiple linear regression analysis detected the tendon length inside the tunnel as a significantly independent factor related to the tibial tunnel enlargement rate at the aperture (standardized β = 0.726, P = 0.008). There was no significant relationship between the tibial tunnel enlargement rate at the aperture and postoperative side-to-side difference (SSD) of the anterior knee laxity or Tegner activity level scale under single linear regression analysis. CONCLUSION:The greater tendon length inside the tunnel was independently related to the higher tibial tunnel enlargement rate at the aperture 1-year after anatomic ACL reconstruction with a BTB graft under multiple linear regression analysis.

摘要

背景: 前交叉韧带 (ACL) 重建术后隧道扩大的相关因素应通过多因素分析进行评估,因为该现象具有多因素的特点。本研究的目的是使用多变量分析阐明与骨-髌腱-骨 (BTB) 移植物解剖ACL重建后胫骨隧道扩大率相关的因素。 方法: 18例单侧ACL断裂患者。用BTB自体移植物进行解剖矩形隧道 (ART) ACL重建。使用表面配准技术重建并叠加术后3周和1年的胫骨、胫骨隧道和骨塞的3D CT模型。在孔处评价垂直于隧道轴线的胫骨隧道的横截面积 (CSA)。分别于术后3周和1年测量CSA,计算孔径处隧道扩大率。采用多元线性回归分析,从术前人口学因素和胫骨隧道的诱发因素中寻找与胫骨隧道扩大率显著相关的因素。 结果: 开口处胫骨隧道扩大率为21.9 ± 14.1% (平均值 ± 标准差)。多元线性回归分析检测到隧道内肌腱长度是与开口处胫骨隧道扩大率显著相关的独立因素 (标准化 β = 0.726,P = 0.008)。单线性回归分析下,膝关节前松弛度或Tegner活动水平量表孔径处胫骨隧道扩大率与术后侧偏差 (SSD) 无明显关系。 结论: 在多元线性回归分析下,隧道内较大的肌腱长度与解剖ACL重建后1年开口处较高的胫骨隧道扩大率独立相关。

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影响因子:2.98
发表时间:2020-01-01
DOI:10.1136/neurintsurg-2019-014962
作者列表:["Guo W","Liu H","Tan Z","Zhang X","Gao J","Zhang L","Guo H","Bai H","Cui W","Liu X","Wu X","Luo J","Qu Y"]

METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

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