新一代人工韧带与自体骨-髌腱-骨前交叉韧带翻修的疗效比较

Efficacy comparison between a new generation of artificial ligaments and bone-patellar tendon-bone autograft for anterior cruciate ligament revision

目的 比较前交叉韧带(ACL)翻修手术中使用新一代人工韧带(LARS人工韧带)与自体骨-髌腱-骨(BTPB)作为移植物的临床疗效。 方法 回顾性队列研究。回顾性分析2018年1月至2020年6月在陆军军医大学第一附属医院接受ACL翻修手术的54例患者的临床资料,其中男44例,女10例;年龄(28.5±7.7)岁(15~45岁)。其中采用LARS人工韧带进行翻修24例(LARS组),采用自体BPTB进行翻修30例(BPTB组)。比较两组患者膝关节主观及客观评价指标以评估手术疗效。其中,主观评价指标包括Tegner评分、Lysholm评分以及国际膝关节文献委员会(IKDC)评分;客观评价指标包括Lachman试验、轴移试验、负重位胫骨前移距离(ATT)以及患者重返受伤前运动的比率。 结果 患者术后随访时间(32.8±5.3)个月(24~42个月)。末次随访时两组患者的IKDC评分、Tegner评分和Lysholm评分均较术前升高,差异均有统计学意义(均 P <0.05),而两组间比较差异均无统计学意义(均 P >0.05);负重位ATT测量LARS组为(3.1±0.7)mm、BPTB组为(4.1±0.9)mm,均较术前改善(均 P <0.05),而LARS组优于BPTB组,差异有统计学意义( P <0.05)。术后Lachman试验、轴移试验两组间比较LARS组优于BPTB组,差异均有统计学意义(均 P <0.05)。术后1年患者重返受伤前运动的比率,LARS组为79.2%(19/24)、BPTB组为50.0%(15/30),差异有统计学意义( P =0.029)。 结论 LARS人工韧带和BPTB自体移植物行ACL翻修手术均可取得良好的近期临床疗效,但LARS人工韧带较BPTB自体移植物在膝关节稳定性和早期重返运动方面更有优势。

Objective To compare the clinical efficacy of a new generation of ligaments(LARS artificial ligament)and bone-patellar tendon-bone(BPTB)autograft as grafts in anterior cruciate ligament(ACL)revision.Methods A retrospective cohort study.The clinical data of 54 patients who underwent ACL revision from January 2018 to June 2020 in the First Hospital Affiliated to Army Medical University were retrospectively analyzed.There were 44 males and 10 females with a mean age of(28.5±7.7)years(15-45 years).Among them,24 cases underwent ACL revision with LARS artificial ligament(LARS group),the other 30 cases underwent ACL revision with BPTB(BPTB group).The subjective and objective knee joint evaluation indexes were compared between the two groups to evaluate the clinical efficacy.The subjective evaluation indexes included Tegner score,Lysholm score and the International Knee Documentation Committee(IKDC)score.The objective evaluation indexes included the Lachman test,pivot-shift test,the anterior tibial translation(ATT)measurement at the weight-bearing position and the rate of patients returned to pre-injury sports.Results The follow-up period was(32.8±5.3)months(24-42 months).At the last follow-up,the IKDC score,Tegner score and Lysholm score in the two groups significantly increased when compared with those before surgery(all P<0.05),and there was no significant difference in those indexes between the two groups(all P>0.05).The ATT measurement in the weight-bearing position was(3.1±0.7)mm in the LARS group and it was(4.1±0.9)mm in the BPTB group,which were significantly improved when compared with those before surgery(both P<0.05),and it was better in the LARS group than in the BPTB group(P<0.05).Postoperative Lachman test and pivot-shift test results in the LARS group were better than those in the BPTB group with statistically significant difference(both P<0.05).The rate of patients returned to pre-injury sports one year after surgery was 79.2%(19/24)in the LARS group and it was 50.0%(15/30)in the BPTB group,and the difference was statistically significant(P=0.029).Conclusions Both LARS artificial ligament and BPTB autograft can achieve good short-term clinical efficacy in ACL revision,but LARS artificial ligament group has more advantages than BPTB autograft group in knee stability and early return to sports.