关节镜下腘绳肌腱部分重建、单束重建和双束重建前交叉韧带的疗效比较

A comparative study on the clinic effects of arthroscopic reconstructions of partial, single-bundle and double-bundle ACLs

目的 研究使用腘绳肌腱进行关节镜下前交叉韧带（ACL）损伤后部分重建、单束重建和双束重建的疗效差异。方法 本研究共包括56例ACL重建病例，其中部分重建11例，单束重建25例，双束重建20例。所有患者术前及随访时均进行IKDC2000、Tegner和Lysholm评分以及常规KT-2000和后推KT-2000测量，并对结果进行统计学分析。结果 平均随访19．84±5．03个月（13～22个月）。对三组的IKDC、Lysholm和Tegner评分的配对t检验显示，术后的IKDC、Lysholm和Tegner评分比术前均有显著改善。后推法KT-2000测量显示，ACL双束重建可以比单束重建获得更好的膝关节稳定性，ACL部分重建组膝关节的稳定性优于单束重建和双束重建组。但常规KT-2000测量无法辨别三种术式之间膝关节稳定性的差异。结论 ACL双束重建可以比单束重建更好地重建膝关节的稳定性，ACL部分重建的临床效果优于单束重建和双束重建；后推KT-2000测量在ACL双束重建和部分重建的术后稳定性评估上可能具有重要的应用价值。

Objective To discuss the clinic differences among arthroscopic reconstructions of partial, single-bundle and double-bundle ACLs after ACL injury of the knee. Methods A total of 56 cases of ACL arthroscopic reconstruction were involved in this study, including 11 partial reconstructions, 25 single-bundle ones and 20 double-bundle ones. The IKDC2000, Tegner and Lysholm evaluations were performed for every patient pre- and postoperatively. KT-2000 and Back Pushing KT-2000 measurements were also done. Paired t-test was used to analyze the IKDC, Tegner and Lysholm scores before operation and at follow-up time. Mann-Whitney was used to analyze KT-2000 results. Results Follow-up time averaged 19.84± 5.03 months （13 to 22 months） . Paired t-test showed the IKDC, Lysholm and Tegner scores were significantly improved after operation. Back Pushing KT-2000 Measurement showed double-bundle ACL reconstruction restored the knee stability better than single-bundle technique, and partial ACL reconstruction resulted in the best outcome among the 3 groups. Normal KT-2000 measurement failed to detect any significant difference among them. Conclusion Partial ACL reconstruction can restore the knee stability better than the double-bundle reconstruction, and the double-bundle ACL reconstruction better than the single-bundle one. Back Pushing KT-2000 Measurement may have important value in knee stability analysis for partial and double-bundle ACL reconstructions.