使用导航系统测量前交叉韧带损伤膝关节轴移试验定量值的影响因素
简介
该研究纳入114例ACL重建患者，在麻醉下利用导航系统对轴移试验进行定量测量，并通过多元回归分析筛选影响旋转不稳程度的因素。结果显示，伤后至手术时间延长、膝过伸角度增大及外侧半月板损伤与更大的轴移定量值显著相关，其中伤后时间是最强预测因素。提示临床评估ACL损伤后旋转不稳时，应综合考量上述三方面因素。
英文摘要
This study aimed to identify factors associated with greater quantitative pivot shift in anterior cruciate ligament (ACL)-injured knees by quantitatively assessing the pivot shift under anaesthesia using a navigation system prior to ACL reconstruction. A total of 114 patients (66 males and 48 females) who underwent ACL reconstruction were included. Prior to reconstruction, the pivot shift test was performed under anaesthesia and measured using a navigation system. The maximum difference in the anterior-posterior position of the tibia during knee flexion-extension without stress and during the pivot shift test-termed peak coupled anterior tibial translation (peak c-ATT)-was recorded as the quantitative value. Multiple regression analysis was used to determine factors associated with the quantitative pivot shift value, with nine independent variables: sex, age, preoperative side-to-side difference in anterior knee laxity, time from injury to surgery, presence of medial and lateral meniscus injuries, knee extension angle, femorotibial angle, and pre-injury Tegner activity score. Among the 114 participants, 80 (70.2%) had normal lateral menisci and 34 (29.8%) had damaged lateral menisci. Multiple linear regression identified three variables significantly associated with greater quantitative pivot shift: time from injury to surgery (standardized partial regression coefficient (β) = 0.38, p = 0.000), knee extension angle (β = 0.29, p = 0.001), and presence of lateral meniscus injury (β = 0.29, p = 0.001). Other variables-including age, sex, anterior laxity, medial meniscus injury, femorotibial angle, and Tegner score-did not reach statistical significance. Three factors- prolonged time from injury to surgery, knee hyperextension, and lateral meniscus injury-were significantly associated with greater quantitative pivot shift in ACL-injured knees. The strongest predictor was the time elapsed between injury and surgery.