自体及同种异体肌腱重建前交叉韧带术后本体感觉恢复的比较研究

COMPARISON STUDY ON RECOVERY OF PROPRIOCEPTION BETWEEN AUTOGRAFT AND ALLOGRAFT FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

目的比较自体及同种异体肌腱重建前交叉韧带(anterior cruciate ligament,ACL)术后本体感觉恢复情况,探讨两种移植物对本体感觉恢复的影响。方法分析2008年1月-2010年1月行ACL重建的40例患者临床资料,其中20例采用自体肌腱重建(自体组),20例采用同种异体肌腱重建(异体组)。两组患者性别、年龄、病程、膝关节活动度、国际膝关节文献委员会(IKDC)评分及Lysholm评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术中均采用单束重建方法,ACL止点残迹保留在胫骨或股骨髁间窝残端。术后随访测量膝关节活动度,行IKDC评分及Lysholm评分评定膝关节功能,采用双膝关节被动角度再生试验评定本体感觉恢复情况。结果两组患者术后切口均Ⅰ期愈合,无感染及关节腔内积血等并发症发生。患者均获随访,随访时间12～18个月,平均13.5个月。术后12个月膝关节活动度、IKDC评分及Lysholm评分均较术前显著改善,差异有统计学意义(P<0.05)。术后3个月,自体组患侧膝关节在30、60、90°位时与健侧比较,差异均无统计学意义(P>0.05);异体组患侧膝关节在30°位时与健侧比较,差异无统计学意义(P>0.05),在60、90°位时比较差异有统计学意义(P<0.05)。术后12个月,两组患侧膝关节在30、60、90°位时与健侧比较,差异均无统计学意义(P>0.05)。术后3个月,两组患侧膝关节在30°位时比较,差异无统计学意义(P>0.05);60、90°位时比较差异有统计学意义(P<0.05)。术后12个月,两组患侧膝关节在30、60、90°位时比较,差异均无统计学意义(P>0.05)。结论自体肌腱重建ACL术后膝关节的本体感觉恢复早于同种异体肌腱。

Objective To compare the recovery of proprioception between autograft and allograft for anterior cruciate ligament （ACL） reconstruction. Methods Between January 2008 and January 2010, 40 patients underwent ACL reconstruction with autologous tendon （autograft group, n=20） and allogeneic tendon （allograft group, n=20）. No significant difference was found in gender, age, disease duration, and function scores between 2 groups （P 〉 0.05）. All the patients underwent the ACL reconstruction with single-bundle technique. The knee range of motion （ROM）, International Knee Documentation Committee （IKDC） score, and Lysholm score were measured after operation. The proprioception was assessed by the joint position sense （JPS） at 3 and 12 months postoperatively. The normal knee was used as control. Results The patients of 2 groups achieved healing of incision by first intention without complication of infection or haemarthrosis. All patients were followed up 12-18 months （mean, 13.5 months）. There were significant differences in knee ROM, IKDC score, and Lysholm score between preoperation and 12 months postoperatively in 2 groups （P 〈 0.05）. There was no significant difference in JPS 30°, JPS 60°, and JPS 90° between affected knees and normal knees in autograft group at 3 months postoperatively （P 〉 0.05）. No significant difference was found in JPS 30° between affected knees and normal knees in allograft group at 3 months postoperatively （P 〉 0.05）; but significant differences were found in JPS 60° and JPS 90° between affected knees and normal knees in allograft group at 3 months postoperatively （P 〈 0.05）. There was no significant difference in JPS 30°, JPS 60°, and JPS 90° between affected knees and normal knees in 2 groups at 12 months postoperatively （P 〉 0.05）. Significant differences were also found in JPS 60° and JPS 90° between affected knees of 2 groups （P 〈 0.05） at 3 months postoperatively, whereas no significant difference was found in JPS 30° between affected knees of 2 groups （P 〉 0.05）. No significant difference was found in JPS 30°, JPS 60°, and JPS 90° between affected knees of 2 groups at 12 months postoperatively （P 〉 0.05）. Conclusion ACL reconstruction is better than allogeneic ACL reconstruction in the recovery of proprioception at early time Autologous and after surgery.