四股半腱肌腱和髌韧带修复陈旧性前十字韧带损伤的前瞻性研究

A prospective survey of a quadruple-strand semitendinosus tendon versus patellar tendon for anterior cruci-ate ligament reconstruction by arthroscopy

目的比较60例陈旧性前十字韧带(ACL)损伤患者关节镜下应用4股半腱肌腱或髌韧带重建ACL的疗效。方法对60例具有可比性的陈旧性ACL损伤患者行关节镜下重建术,重建材料选用自体4股半腱肌腱或髌韧带。所有手术均由同一名医生完成。术前和术中检查表明两组患者之间差异无显著性意义,具有可比性。术后随访时检查患者的膝关节活动度、膝关节稳定性、日常活动和运动恢复情况。结果两组患者术后的关节稳定性相同。半腱肌腱组恢复体育活动的百分比略大于髌韧带组,分别为80%和73%,两组间差异无显著性意义,但伸膝角度丧失(≤3°)的百分比小于髌韧带组,分别为6%和40%,差异有非常显著性意义。KT-2000关节动度仪检查,30磅(133.4N)拉力试验中,半腱肌腱组13%的患者双膝移位差值>3mm,髌韧带组中20%的患者>3mm。术后半腱肌腱组与髌韧带组中度髌股关节病变的发生率分别为6%和17%。结论关节镜下半腱肌腱或髌韧带移植重建ACL的疗效相当,差异无显著性意义。

Objective The attempts was made to compare the results of a quadruple-strand semi-tendinosus tendon versus patellar tendon reconstruction for anterior cruciate ligament by arthroscopy in chronic complete anterior cruciate ligament injury.Methods60patients were enrolled in a prospective,ran-domized,controlled study.30patients underwent reconstruction with a quadruple-strand semitendinosus tendon autograft,30patients were treated with a bone-patellar tendon-bone autograft.The surgery was car-ried out in an alternating sequence with two autograft constructed materials.At the time of arthoscopy,the knee was examined totally,associated joint pathology was documented,and irreparably torn meniscal frag-ments were removed.60patients were followed up14to30months after operation,and evaluated in terms of the clinical test findings,the activity level,the functional status in daily activities,the range of motion,the stability of the knee,the level of return to sports and the patellofemoral crepitus at final follow-up.Results The objective outcome of replacement with a bone-patellar tendon-bone graft was identical to that obtained with a quadruple-strand semitendinosus tendon graft.The stability of the knee in the quadrupled-strand semitendinosus reconstruction was equal with that in the bone-patellar tendon-bone autograft.The return to sport was more frequent in the quadrupled-strand semitendinosus group comparing with in the bone-patellar tendon-bone group,there was80%and73%in each group respectively with no significant difference.A mild loss(≤3°)of knee extension was more frequent in the patellar tendon group than that in the quadru-pled-strand semitendinosus group,there was40%and6%in each group respectively,the difference was sig-nificant statistically.KT-2000arthrometer side-to-side difference of anterior displancement was13%versus20%in the quadrupled-strand semitendinosus group and patellar tendon group at133.4N.Patellofemoral crepitus was6%and17%in the quadrupled-stranded semitendinosus group and patellar tendon group re-spectively.Conclusion In a chronic complete injury of anterior cruciate ligament,the clinical results of re-construction with a quadrupled-strand semitendinosus tendon or patellar tendon by arthroscopy were satis-factory without significant differences between the two operative procedures.