髌腱移植重建前交叉韧带后膝关节功能恢复1年随访

Functional recovery of knee joint after patellar tendon graft for anterior cruciate ligament reconstruction in one-year follow-up

目的:通过随访观察前交叉韧带断裂自体异体髌腱移植重建后患者膝关节功能的恢复。方法:选取2002-08/2004-08广州市第一人民医院关节外科24例成功随访的前交叉韧带重建患者为观察对象。采用髌腱重建前交叉韧带自体髌腱移植髌骨供区植骨9例,采用异体髌腱移植14例,绳肌移植1例,术后1年随访进行评估,以临床检查(前抽屉试验、Lachman试验、轴移试验),IKDC评分(采用4级评分法:即正常、接近正常、异常、严重异常,包括8个方面的21项内容,具体为:①按0～3级患者主观评估膝关节的功能及膝关节影响活动水平;②症状;③活动范围;④Lachman法;⑤关节间隙征;⑥受检部位病征压痛、敏感、麻木;⑦X射线退行性关节病改变;⑧功能方式检验),Lysholm评分评估患者膝关节功能,包括8个方面的34项内容①跛行;②支撑;③交锁;④不稳;⑤疼痛;⑥肿胀;⑦上下梯;⑧下蹲。总分100分,分数愈高,膝关节功能恢复愈好。结果:23例患者平均随访时间1年,随访率100%。①9例采用自体髌腱移植重建前交叉韧带,术中髌骨供区植骨的患者,前抽屉试验(+)1例;Lachman试验(+)1例;轴移试验(+)1例;IKDC评分正常8例(88.9%),接近正常1例(11.1%);患者主观感觉良好;Lysholm评分,患膝术前平均45.3分,术后89.8分,其中优6膝、良1膝、中1膝,优良率88.9%,患膝力量达对侧膝的75%以上,可免支具和拐杖行走。无伸膝受限,屈膝活动达130°以上。3例膝部皮肤麻木,1例跪地疼痛,2例膝行疼痛。②14例异体髌腱移植重建前交叉韧带、髌骨供区植骨患者:前抽屉试验I度1例,Lachman试验(+)1例,轴移试验(+)1例;IKDC评分正常11例(78.6%),接近正常2例(13.9%),异常1例(7.5%);Lysholm评分,患膝术前平均46.1分,术后88.7分,其中优11膝、良2膝、中1膝,优良率92.8%,患膝力量达对侧膝的75%以上,可免支具和拐杖行走。无伸膝受限,屈膝活动达130°以上。结论:植骨修补髌骨表面缺损,有助于供区的修复,特别是髌骨的修复,植骨可减少以往自体髌腱移植的不适症状,尤其是髌股关节疼痛。

AIM： To explore the recovery of function of knee joint after patellar tendon autograft in anterior cruciate ligament （ACL） reconstruction by follow-up.METHODS： Twenty-four patients after ACL reconstruction were selected from Department of Joint Surgery, Guangzhou Municipal First People＇s Hospital between August 2002 and August 2004 by follow-up. Nine ACL reconstructions were performed using allograft and autograft; Fourteen patients were allograft patellar tendon graft. One patient was treated with hamstring muscle graft. Evaluation was conducted after one-year follow-up, and function of knee joint was assess with clinical examination [anterior drawer test （ADT）, Lachman trial and pivot shift test], IKDC assessment [four rating： normal, close to normal, abnormality, severe abnormality, including 8 aspects （21 items）, ①function and activity level of knee joint was evaluated subjectively according to 0-3 rating, ②symptom,③range of activity, ④Lachman method, ⑤symptom of joint space, ⑥tenderness, sensitive and numbness of checked part, ⑦ alteration of regressive arthropathy of X-ray and ⑧function test] and Lysholm assessment, which composed of 8 aspects and 34 items ①clandieation, ② shoring, ③exchange-locking,④labiligy, ⑤ache, ⑥swelling, ⑦ up and down stairs and ⑧squat. Torally 100 points, the higher the score, the better the functional recovery of knee joint was. RESULTS： Average follow-up time was one year in 23 patients with the follow-up rate of 100%. ①Nine ACL reconstructions were performed autograft patellar tendon graft. One patient was treated with ADT （＋）; one patient was treated with Lachman （＋）; one patient was treated with pivot shift test （＋）; in the IKDC assessment, 8 patients were normal （88.9%）, 1 was close to normal （11.1% ）, the subjective sensation of the patients was good. In the Lysholm assessment, the average score of knee was 45.3 points before operation and 89.8 points after operation, in which 6 knees were excellent, 1 good and 1 was moderate with the excellent and good rate of 88.9%. The power of injured knees was above 75% of the opposite knees and the patients could walk without tool and crutch. Without extended limitation of knee and the activity of knee was over 130°. Skin was numb in knee of 3 patients; 1 patients pained when kneeled and 2 patients were pained when walking. ②Fourteen ACL reconstructions were performed at allograft patellar tendon： One patient was in the ADT I degree, 1 in the Lachman （＋）, 1 in the pivot shift test （＋）. In the IKDC assessment, there were 11 cases （78.6%） with normal score, 2 cases was close to normal （13.9%）, and 1 case was abnormal （7.5%）. In the Lysholm assessment, the average score of knee was 46.1 points before operation and 88.7 points after operation, in which 11 knees were excellent, 2 knees were good and 1 knee was moderate with the excellent and good rate of 92.8%. The power of injured knees was over 75% of the opposite knee, and the patients could walk without took and crutch. Without extended limitation of knee, the activity of knee was over 130°. CONCLUSION： Planting bone can repair the defect of the surface of patella, which is helpful for the plerosis of donor site, especially the plerosis of patella. The planting bone can decrease unsuitable symptom of autograft patellar tendon, especially the pain of joint of patella.