同种异体骨-髌腱-骨组织移植重建前交叉韧带36例临床分析

Clinical Result Analysis of 36 Cases of Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Allograft

目的：回顾性研究并评估采用同种异体骨-髌腱-骨组织移植重建前交叉韧带患者的临床疗效。方法：从2004年12月至2006年8月,对36例ACL损伤病例进行了同种异体骨-髌腱-骨组织移植重建。男性16例,女性20例;平均年龄28岁（15~56岁）;急性损伤11例,慢性损伤25例。对所有患者进行了主观评估（包括手术前后Lysholm评分、IKDC评分和症状改善情况）和客观评估（包括Lachman试验、轴移试验、KT-1000测量,以及关节活动范围）,并对比了患者术前以及术后的MR影像和关节镜手术探查影像,还对术后发热情况以及并发症进行了记录。结果：本组病例平均随访23.6个月（12~32个月）。主观评估：术前Lyshrolm评分为63.61±13.4分（46~90分）,术后最终评分为98.03±3.6分（85~100分）,与术前对比差异有统计学意义（P〈0.01）;术后IKDC评分总体优良率达到91.7%。客观评估：KT-1000测量结果：术前两侧胫骨前移的差别为7.05±2.15mm（2-11mm）,术后最终测量值为1.15±1.43mm（0-6mm）,与术前对比差异有统计学意义（P〈0.01）。所有患者均未出现明显的术后并发症以及病毒和细菌感染。1例患者移植物松弛度增加,给予固缩治疗后好转。另1例部分韧带磨损,但主观评估良好,给予清创和髁间窝成形术处理。结论：短期观察显示,采用同种异体骨-髌腱-骨组织移植重建ACL能够获得满意的临床疗效,具备有效性和安全性。

Objective The clinical results of 36 patients who underwent bone-patellar tendon-bone allograft for anterior cruciate ligament（ACL）reconstruction were reviewed and evaluated retrospectively. Methods From December 2004 to August 2006,36 patients with ACL laxity were treated with bone-patellar tendon-bone allograft reconstruction,including 16 males and 20 females with average age of 28 （15 - 56 years）. Among them, 11 were a- cute and 25 were chronic injury. Patients were evaluated preoperatively and postoperatively. Subjective measures included Lysholm questionnaire, IKDC questionnaire and symptom improvement. Objective measures included KT-1000 side-to-side difference（SSD）, Lachman test, Pivot shift test and range of motion. The images of MRI preand post-operation were compared and the second look surgery was performed one year post operation. The complication and the body temperatures of postoperative patients were also recorded. Results Average follow-up time was 23.6 months（12-32 months）. The mean Lysholm score post operation was 98.03±3.6 points（85-100 points）, significant higher than pre-operation, which was 63. 61±13. 4 points（46 - 90 points）（P〈0. 01）. The satisfactory rate of IKDC questionnaire was 91.7 %. KT-1000 measurement revealed significant difference in side- to-side difference（SSD） pre- and post-operation, which was 7.05 ± 2.15mm（2mm- 11mm） and 1.15 ±1.43mm （0-6mm）respectively（P〈0.01）. No significant complication and bacterial or virus infection were found for all patients. In second look surgery,one patient＇s ACL allograft was observed to be stretched and treated with electrothermal shrinkage. Another patient＇s allograft was partially frayed but the subiective evaluation result was good, was then treated with debridement and notch plasty. Conclusion For short-time follow up,ACL reconstruction with bone-patellar tendon-bone allograft achieved satisfactory clinical results, could be used as an effective and safe alternative.