关节镜下同种异体肌腱重建前交叉韧带早期排斥反应初步观察

Primary observation on early immune rejection of arthroscopic anterior cruciate ligament reconstruction with allogenic tendon

目的：观察关节镜下同种异体肌腱重建前交叉韧带（ACL）术后早期排斥反应的临床特征。方法：对2000年3月至2005年8月期间收治的2l例ACL关节镜下同种异体肌腱重建病例进行回顾分析，同期23例自体肌腱重建病例作为对照，比较二者术后在体温、关节肿痛积液及白细胞计数方面各临床特征的差异。结果：异体肌腱重建组手术当天至术后14d的平均体温以及每日体温最高值均比自体肌腱重建组的患者高，主要热型为高热，且术后发热持续时间较长，平均长达10d。异体肌腱重建组发热高峰在术后1d下降后，第3天又迅速回升，呈“双峰”现象。同自体肌腱移植比较，异体肌腱移植术后出现关节疼痛、肿胀积液和白细胞升高的比率并无统计学上的显著差异，但整体上呈现高于自体肌腱重建组的趋势。结论：关节镜下同种异体肌腱重建前交叉韧带（ACL）术后早期存在排斥反应，主要表现为亚急性发热、持续关节肿胀积液和白细胞计数显著升高，个体表现明显的病例要警惕移植物的失败。

Objective：To observe the clinical character of the early immune rejection of arthroscopic anterior cruciate ligament （ACL）reconstruction With allogenic tendon. Methods： A retrospect study was done,on 21 cases undergoing reconstruction with allogenic tendon and 23 treated with an autograft tendon from. 2000 march to 2005 august. The temperature, juice in arthrosis and the white cell counter were compared. Results： The average temperature and the highest temperature of everyday in the group reconstruced with allogenic tendon were higher than that in the group reconstructed with autograft tendon. The fever type was high fever and the duration was long （average 10 days）.The peak of the group reconstructed with allogenic tendon failed 1 day after operation day and bound back in the 3rd day. It present as ＇double peak＇. The rate of arthralgia, swell and fluidify, white cells counter has no different between the two groups. But totally the rate in the group reconstructed with allogenic tendon tend to be higher than that in autograft tendon group. Conclusion： The immune rejection occurred early after arthroscopic anterior cruciate ligament （ACL）reconstruction with allogenic tendon. It present as subacute fever, durative arthrosis swell and fluidify, leukocytosis. The one which behave obviously hint the failure of the transplantion.