同种异体组织重建关节韧带临床疗效的初步观察

Clinical effect of allografts in ligament reconstruction:a preliminary and retrospective study

目的 评价同种异体组织重建膝关节前交叉韧带 (ACL)、后交叉韧带 (PCL)、内侧副韧带 (MCL)、外侧副韧带 (LCL)和肩关节喙锁韧带 (CCL)的疗效。 方法 回顾调查 4 3例患者 ,将其分为 3组 ,A组 :ACL或ACL/MCL损伤 34例 ;B组 :PCL或PCL/LCL损伤 6例 ;C组 :完全肩锁关节损伤 3例。分别应用同种异体骨 -髌腱 -骨 (B -PT -B)、半腱肌腱与股薄肌腱、胫后肌腱、跟腱 -骨重建。 结果 平均随访 19个月 ,A、B两组术前Lysholm评分 6 3.0± 5 .6 ,术后89 .0± 5 .9,手术前后差异有非常显著性意义 (P <0 .0 1) ;术后国际膝关节文献委员会 (IKDC)评分A级 3例 ( 8% ) ,B级 2 3例 ( 5 8% ) ,C级 12例 ( 30 % ) ,D级 2例 ( 5 % )。KT2 0 0 0测定 :A组手术前后胫骨前移分别为 ( 13.10± 0 .2 9)mm和 ( 4 .70± 1.37)mm ;B组胫骨后移则分别为 ( 10 .5 3±2 .5 0 )mm和 ( 5 .74± 1.33)mm ,手术前后差异有非常显著性意义 (P <0 .0 1)。术后健患侧比较 :A、B两组健患差异 <3mm 33例 ( 83% ) ;>5mm 4例 ( 10 % ) ;前后抽屉试验 36例 ( 90 % )由术前 3度恢复至术后平均 1.3度。合并MCL/LCL损伤患者的侧方应力试验由术前 3度恢复至术后平均1.2度 ,并呈现明显的硬终点 ;单纯与复合性ACL或PCL损伤 ,伸屈正常分别占 91%和 88%。?

Objective To evaluate the clinical effects of allografts in reconstruction of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL) and coracoclavicular ligament (CCL). Methods A retrospective study was done on 43 cases with ligament injuries, which were randomly divided into three groups, ie, Group A with injuries of ACL or ACL/MCL (34 cases), Group B with injuries of PCL or PCL/LCL (six cases) and Group C with complete injuries of acromioclavicular joint (AC) (three cases). Allografts of bone patellar tendon bone (B PT B), semitendinosus/gracilis, double tibialis posterior tendon as well as Achilles tendon bone were used in Group A, Group B and Group C, respectively. Results The mean follow up was 19 months. The Lysholm Score of Groups A and B changed from pre operation score for 63.0±5.6 to post operation score for 89.0±5.9, with very significant difference between groups ( P < 0.01) . According to international knee document committee (IKDC) score post operation, three cases (8%) were at grade A, 23 (58%) at grade B, 12 (30%) at grade C and two (5%) at grade D. KT 2000 testing showed that pre operative and post operative antedisplacements of the tibia were (13.10± 0.29 ) mm and (4.70±1.37) mm, respectively in Group A and the pre operative and post operative retroposition (10.53±2.50) mm and (5.74±1.33) mm, respectively in Group B, with very significant differences in both groups ( P <0.01). The difference of the involved side to the healthy side was less than 3 mm in 33 cases (83%) and more than 5 mm in four (10%) postoperatively. The drawer test was performed in 36 cases (36/40, 90%), in which the degree increased from pre operative 3 to post operative 1.3. The lateral stress experiment showed that the degree increased from preoperative 3 to postoperative 1.2 in average in the cases complicated by MCL/LCL and that significant callous end point emerged. In cases with single injuries and those with ACL or PCL injuries with normal range of motion (ROM) accounted for 91% and 88%, respectively. Radiography showed basically normal AC joint with sound ROM of acromioclavicular joint and humerus joint following reconstruction of CCL. Conclusion Allografts can obtain satisfactory curative effect in reconstruction of ACL, PCL, MCL, LCL and CCL and is a good alternative for autografts.