关节镜下应用深低温冷冻异体骨-髌腱-骨复合体重建膝前交叉韧带

Arthroscopic reconstruction of ACL with a deep-frozen allogenic bone-patellar-bone tendon complex

目的探讨关节镜下应用深低温冷冻异体骨-髌腱-骨复合体重建损伤的前交叉韧带的方法及疗效。方法2006年～2007年间我科在关节镜下应用深低温冷冻异体骨-髌腱-骨复合体重建损伤的前交叉韧带的患者16例,其中单纯ACL损伤9例,合并半月板损伤7例,1例合并内侧副韧带(MCL)和后交叉韧带(PCL)损伤。对其术前和随访过程中的症状、体征及Lysholm膝关节评分和国际膝关节文献委员会(IKDC)的分级标准评定的情况进行分析。结果随访时间6～22个月。16例患者术前弹响、交锁和打软腿症状均消失,无关节不稳主诉。浮髌试验均为阴性,均无过伸、过屈痛,Lachman征、前抽屉试验、轴移试验均为阴性。残留关节轻度疼痛4例。Lysholm评分术前评分58.72分,术后6个月以上随访评分92.16分(P<0.01)。优秀率75%。IKDC评定结果明显优于术前。结论关节镜下应用深低温冷冻异体骨-髌腱-骨复合体重建损伤的前交叉韧带的方法可有效改善膝关节稳定性;减少自体肌腱移植的供区损伤;解决了多根韧带损伤带来的重建材料匮乏的问题。

Objective To evaluate the method and result of the arthroscopic reconstruction of ACL with a deep-frozen allogenic bone-patellar-bone tendon complex. Methods Sixteen patients underwent arthroscopic reconstruction of ACL with a deep-frozen bone-patellar-bone tendon complex allograft from 2006 to 2007. The follow-up time ranged from 6 to 22 months. Among them, 9 patients sustained single ACL injury, 7 ACL injury associated with meniscus injury, 1 ACL injury associated with medial collateral ligamente （MCL） and posterior cruciate ligamente （PCL） injury. The symptom, physical signs and Lysholm score and IKDC （International Knee Documentation Committee） score were recorded preoperatively and postoperatively. Results All patients had good clinical results with no symptoms of clicking, locking, ＂give way＂ and extra-extension and flexion pain. The postoperative examination revealed negative floating patella test, lachman test, ADT and PST. Only mild residual pain was found in 4 patients. The preoperative Lysholm score was 58.72 and 92,16 at follow-up （P 〈0.01） and excellent rate reached 75%. The postoperative IKDC score was significantly superior to the preoperative one. Conclusion Arthroscopic reconstruction of ACL with a deep-frozen allogenic bone-patellarbone tendon complex can effectively improve the stability of the knee joint without the donor sacrifice. The single tendon＇s strength is strong enough with abundant donor source and consequently a good solution of shortage of autograft in the case of multiple ligament injury. It can simplify the surgical procedure and reduce the time of operation. No immune reaction and infection were found.