摘要
目的:采用自体骨-髌韧带、自体双股半腱肌腱半膜肌及同种异体跟腱移植重建膝关节前交叉韧带,比较不同移植物的临床疗效。方法:选择1998-06/2003-02中山大学附属第三医院骨科单纯前交叉韧带损伤后行关节镜下重建手术病例96例,患者均签署知情同意书。根据不同移植物分为3组:①自体骨-髌韧带组38例,应用自体中1/3骨-髌韧带-骨移植物。②自体双股半腱肌腱股薄肌腱组22例,应用自体双股半腱肌腱股薄肌腱。③同种异体跟腱组36例,应用同种异体跟腱。术后定期随访,对膝关节活动度、肌力恢复程度、Werner髌股痛评分(最差为0分,最高为55分)、Lysholm评分(0～100分,分数越高膝关节功能恢复越好)、国际膝关节文献委员会评分(按病情严重程度分类分为正常、接近正常、异常、严重异常4个等级)等进行对比观察。结果:①96例患者随访2年,无脱落。②全部患者无感染,未发生髌骨骨折。也未发现关节内粘连、下肢深静脉血栓形成和血管神经损伤等并发症。③膝关节活动度、肌力恢复情况、髌股痛评分:随访结束时3组差异均无显著性意义(P>0.05)。④Lysholm膝关节评分:随访结束时自体骨-髌韧带组由术前(68.2±6.3)分提高至(88.6±6.8)分,自体双股半腱肌腱股薄肌腱组由术前(66.5±6.5)分提高至(86.4±6.6)分,同种异体跟腱组由术前(68.2±6.3)分提高至(86.3±6.2)分,随访结束时各组评分均显著高于术前(P<0.05),3组比较差异无显著性意义(P>0.05)。⑤国际膝关节文献委员会评分(术后活动水平正常或接近正常):随访结束时自体骨-髌韧带组为87%,自体双股半腱肌腱股薄肌腱组为86%,同种异体跟腱组为89%,各组移植术后膝关节功能均有所改善,3组间差异无显著性意义(P>0.05)。结论:关节镜下采用自体骨-髌韧带、自体双股半腱肌腱股薄肌腱和同种异体跟腱移植重建前交叉韧带,均能明显改善膝关节运动功能,3种移植方法的临床疗效无明显差异,提示重建前交叉韧带的术后疗效与移植物种类的相关性不明显。
AIM： To observe and compare clinical effects in arthroscopy assisted anterior cruciate ligament （ACL） reconstruction with bone-patellar tendon-bone （BTB） autograft, doubled hamstring tendon （HT） autogreft and achilles tendon bone （ATB） allogreft. METHODS： With the informed consents, 96 cases with ACL injury who underwent reconstruction in arthroscopy ware selected from Department of Orthopaedics on the Third Affiliated Hospital of Sun Yat-sen University from June 1998 to February 2003. ACL reconstruction with BTB autograft was performed in 38 cases, with semitendinosus and gracilis tendon autograft in 22 cases, and with ATB allogreft in 36 cases. All the patients ware followed up postoperetion to compare the range of motion （ROM）, myodynamic recovery, Wemer score for patellofemorel pain （0-55 points）, Lysholm score （0-100 points, higher scores indicated better functional recovery of knee joint）, and international knee documentation committee （IKDC） score （normal, nearly normal, abnormal, and severely abnormal） in the three groups, RESULTS：①All of 96 patients entered the follow-ups for 2 years.②No infection or patellar fracture appeared in the patients, additionally intra-articular adhesion, deep venous thrombosis of low extremity and vascular nerve injury ware not found.③There was insignificant difference in ROM, myodynamic recovery and Wemer score for patellofemoral pain after the follow-up was over （P 〉 0.05）.④Lysholm score was significantly increased in three groups postoperation [ BTB group： （68.2±6.3）, （88.6±6.8） points; HT group： （66.5±6.5）, （86.4±6.6） points; ATB group： （68.2±6.3）, （86.3±6.2） points, P 〈 0.05]. And no significant difference was found in three groups postoperation （P 〉 0.05）.⑤IKDC activity level which was normal or needy normal was 87% in the BTB group, 86% in the HT group and 89% in the ATB group. The function of knee joint was all improved postoperation, and no significant difference was found among the three groups （P 〉 0.05）. CONCLUSION：The motor of function of knee joint can be obviously improved in ACL reconstruction using BTB autograft, doubled semitendinosus and gracilis tendon autograft and ATB allograft. However the clinical effect is identical under arthroscopy, which indicates that the postoperative effect of ACL reconstruction is unrelated with the graft category.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第29期5676-5679,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
广东省科技计划项目(2003A302102
2006B60501020)~~
