膝关节镜下同种异体髌骨-髌腱-胫骨移植物重建交叉韧带41例

Reconstruction of the cruciate ligament with allogeneic bone-patellar tendon-bone under arthro- scope in 41 cases

目的探讨应用同种异体髌骨-髌腱-胫骨(B-PT-B)移植物在关节镜监视下重建膝关节前交叉韧带(ACL)、后交叉韧带(PCL)的体会及疗效观察。方法对32例ACL断裂、6例PCL断裂、3例ACL及PCL同时断裂共41例43个膝关节的患者,在关节镜下应用由山西骨组织库提供的同种异体B-PT-B移植物(包括新鲜及经辐射两种材料)进行膝关节交叉韧带重建,同时处理合并伤,观察手术前后生化、免疫学指标的变化及全身及膝关节局部反应,定期检查康复锻炼、关节功能等情况,应用Lysholm评分进行功能评定。结果除1例于术后10d因急性化脓性扁桃体炎致患膝感染(经关节腔冲洗、应用抗生素后治愈),其余患者均未见排异反应及感染发生。38例获得随访,时间4-40个月,所有患膝关节屈伸活动度正常,无膝前区疼痛;6例患者体检有弱阳性或阳性体征,其中2例ACL及PCL均重建者术后抽屉试验阳性需再次行紧缩及后外侧结构重建手术,1例ACL重建者于术后2个月爬山跌倒致重建ACL部分撕裂伤而行紧缩术。术后Lyaholm评分为(92.20±2.14)分,与术前(57.63±7.14)分比较,差异有统计学意义(P<0.01)。结论应用同种异体B-PT-B在关节镜下重建膝关节ACL、PCL有良好的手术疗效,可避免自体移植物取材后造成的并发症;同种异体B-PT-B移植物是重建ACL、PCL理想的替代材料。

Objective To retrospectively study the effectiveness and experience of reconstruction of anterior cruciate ligament (ACL) or posterior cruciate ligament ( PCL) with allogeneic bone-patellar tendon-bone (B-PT-B) under knee arthroscope in 41 cases. Methods Ruptured ACL in 32 cases, ruptured PCL six and both ruptured ACL and PCL in three were reconstructed under arthroscopy with allogeneic bone-patellar tendon-bone (including fresh and irradiated B-PT-B materials) , which was provided by Shanxi bone bank. At the same time, the associated injuries were managed. Preoperative and postoperative changes of biochemical and immunological indicators as well as systemic reaction and regional reaction of knee joint were observed. Periodical examination was done on rehabilitation exercise and knee joint function. Knee joint function was determined by Lysholm knee functional scales. Results No infection or immunological rejection were found except for one infected case suffered from acute suppurative tonsillitis 10 days after operation ( healed after articular cavity douche and antibiotics application). Of all cases, 38 cases were followed up for 4-40 months, with normal function of knee joint after operation. All patients' knee joint stability was recovered except that six cases had weakly positive or positive findings of drawer test. Of these six cases, two cases with positive findings of drawer test were treated with shrinkage and post-lateral structure reconstruction and one case falling from mountain treated with shrinkage. The average preoperative and postoperative Lysholm knee functional scales were 57. 63±7. 14 and 92. 20±2.14, respectively, with statistically significant difference (P<0. 01). Conclusions B-PT-B al-lograft is ideal alternative material for reconstruction of ACL or PCL, for it can not only bring about satisfactory results in reconstruction of ACL or PCL under arthroscope but also avoid donor site complications.