自体及同种异体肌腱重建前交叉韧带的前瞻性比较研究

Prospective comparative study of arthroscopic anterior cruciate ligament construction with autografl and allograft

目的前瞻性对比研究采用自体与同种异体肌腱进行关节镜下重建膝关节前交叉韧带（ACL）的临床疗效。方法2006年3月至2009年4月采用手术治疗86例ACL断裂患者，其中男性60例，女性26例，年龄22—56岁，平均（32±7）岁。其中根据采用移植物不同术前应用电脑随机抽样方法将患者随机分为自体肌腱组（44例，A体胭绳肌）和异体肌腱组（42例，深冻同种异体肌腱）。两组一般资料比较差异均无统计学意义（P〉0．05），两组患者均由同一组术者采用标准关节镜技术、同一术式完成ACL重建。通过术后随访测量关节活动度和胫骨前移距离，进行Lachman试验、轴移试验、Daniel单腿水平跳跃试验、IKDC综合功能评分、Lysholm、Tegner运动水平评分评估疗效。组间比较采用独立样本t检验，对计数资料采用非参数检验，其余采用x^2检验。结果79例患者获得随访，自体肌腱组41例，平均随访39．6个月；异体肌腱组38例，平均随访37．4个月。自体肌腱组术后出现深静脉血栓3例，异体肌腱组卅现伤口迟发感染1例。自体肌腱组手术时问平均为（87±11）min长于异体肌腱组的（55±10）min（t=15．732，P〈0．05）；自体肌腱组术后发热时间为（3．2±1．4）d短于异体肌腱组的（7．6±5．3）d（t=5．740，P〈0．05）。自体肌腱组术前及末次随访时Lysholm评分为（42±7）和（89±8）分，异体肌腱组分别为（44±6）和（87±9）分，差异均具有统计学意义（t=13．534和17．768，P〈0．05）；两组间术前及末次随访比较差异均无统计学意义（P〉0．05）。自体肌腱组术前及末次随访时Tegner评分为（2．9±2．1）和（7．7±1．2）分，异体肌腱组为（2．7±1.4）和（7．1±1．6）分，差异均具有统计学意义（t=16．004和12．338，P〈0．05）；两组间术前及末次随访比较差异均无统计学意义（P〉0．05）。KT2000测量术前及末次随访胫骨前移，自体肌腱组分别为（10．7±3．5）和（5．0±2．7）mm，异体肌腱组分别为（10．9±2．9）和（6．5±2．4）mm，差异均具有统计学意义（t：16．354和13．296，P〈0．05）；两组间术前及末次随访比较差异均无统计学意义（P〉0．05）。IKDC综合功能评分显示，两组末次随访均较术前明显改善。结论同种异体肌腱重建ACL术后患者膝关节功能、稳定性及运动水平与自体肌腱重建ACL相近，是重建ACL良好的移植物。

Objective To study the clinical effect of arthroscopic anterior cruciate ligament （ACL） construction with different transplants. Methods From March 2006 to April 2009, 86 patients including 60 male and 26 female undergoing arthroseopic ACL reconstruction were prospectively randomized consecutively into autograft group （44 patients, using autogeneic hamstring tendons ）and allograft group （42 patients, using allogenic lower extremity tendons）. The age of those patients were 22-56 years, averaging （32 ± 7） years. The operations were made by the same doctor with the standard technology. The postoperative effects were assessed by the range of motion and tibia forward distance, Lachman test, pivot shift test, Daniel test, IKDC scores systems, Lysholm-Tegner scores. Results Seventy-nine patients were followed up, 41 patients in autografl groups averaged 39. 6 months and 38 patients in allograft group averaged 37.4 months. The operation time of autograft group was （ 87 ± 11 ） minutes, that of allograft group was （55 ＋ 10） minutes （t = 15. 732, P 〈 0. 05 ）. The time of postoperative fever of autograft group was （ 3.2 ± 1.4） days, that of allograft groups was （7.6 ± 5.3） days（t = 5. 740,P 〈 0. 05）. The Lysholm scores of autograft group was 42 4. 7 before operation, and 89 ±8 at final follow-up. The Lysholm scores of allograft group was 44 ± 6 before operation, and 87 ± 9 at final follow-up. There was statistic difference in both groups between before operation and final follow-up （t = 13. 534 and 17. 768 ,P 〈0. 05）. But no statistic difference existed between the two groups （ P 〉 0. 05 ）. The Tegner scores of autograft group was 2. 9 ±2. 1 before operation ,and 7.7± 1.2 at final follow-up. The Tegner scores of allograft group was 2. 7 ± 1.4 before operation, and 7.1 ± 1.6 at final follow-up. There was statistic difference in both groups between before operation and final follow-up （t = 16. 004 and 12. 338, P 〈 0. 05 ）. No statistic difference existed between the two groups （ P 〉 0. 05 ）. The KT2000 results showed that the anterior displacement of autograft groups was （ 10. 7 ±3.5 ）mm before operation and （ 5.0 ± 2. 7 ） mm at final follow-up, the anterior displacement of allograft groups was （10. 9 ±2.9 ） mm before operation and （6. 5 ± 2. 4） mm at final follow-up, there was statistic difference between before and after operation in anterior displacement in two groups （t = 16. 354 and 13.296 P 〈 0. 05 ）. There was no difference between two groups before operation and at final follow-up. Compared to before operation, the IKDC scores were improved greatly after operation （ P 〈 0. 05 ）. Conclusion The clinical effect of arthroscopic ACL construction with allograft transplants is near to autograft.