三种不同移植物重建前交叉韧带的疗效分析

Analysis of Effect of Three Graft Materials by Arthroscopy for ACL Reconstruction

目的观察及比较关节镜下自体四股半腱肌肌腱、深低温同种异体骨-腱-骨(B-PT-B)复合体、LARS人工韧带重建膝前交叉韧带(ACL)的临床疗效。方法对55例膝ACL断裂患者行关节镜下ACL重建术,根据重建ACL的材料来源分为自体四股半腱肌肌腱组(20例)、深低温同种异体B-PT-B复合体组(20例)、LARS人工韧带组(15例),并对3组在股四头肌肌力、关节稳定性、Lysholm膝关节功能评分等方面进行对比研究。结果术后3个月股四头肌肌力恢复情况:LARS人工韧带组较自体组、异体组恢复快,而自体组与异体组无明显差异;术后3个月膝关节稳定性:LARS人工韧带组较自体组、异体组好,自体组与异体组无明显差异,Lysholm评分:自体组(86.3±4.1)分与异体组(88.6±3.8)分无明显差异,但LARS人工韧带组(95.4±4.2)分明显高于前2组(P<0.05)。术后12个月,3组股四头肌肌力恢复情况、膝关节稳定性、功能评分差异无统计学意义(P>0.05)。结论关节镜下同种异体韧带、LARS人工韧带重建膝ACL疗效满意,可作为自体材料的良好替代物,但患者所承担费用较高;LARS人工韧带可在术后早期进行膝关节功能活动。

Objective To observe and compare the clinical effects of anterior cruciate ligament （ACL） reconstruction using the four--strand autogenous semitendinosus tendons, fresh-frozen bone-patellar tendon-bone allograft and the LARS artificial ligaments. Methods Fiftyfive cases of ACL reconstruction were operated by arthroscopy. According to the graft material of reconstruction ACL, they were divided into 3 groups. The first group was four-strand autogenous semitendinosus tendons（20 cases）, the second was fresh-frozen bone-pateUar tendon- bone allograft （20 eases ）, and the last was LARS artificial ligament （15 cases）. Three groups cases were evaluated and compared in power of quadriceps, knee stability and Lysholm score. Results The power of quadriceps restored in LARS was better than autograft group and allo- graft group 3 months after operation and there was not significant difference between autograft group and allograft group. The knee stability 3 months after operation： the LARS group was better than autograft group and allograft group, and the autograft group as same as alIograft group. Lysholm score： there was no significant difference between autograft group （86.3±4.1） and allograft group （88.6±3.8）, but the LARS group score （95.4±4.2） was higher than the others significantly（P〈0.05）. Twelve months after operation, 3 groups had no statistics difference in power of quadriceps restored, knee stability and Lysholm score （P〉0.05） .Conclusion The results of reconstruction ACL using freshfrozen bone-patellar tendon-bone allograft and LARS artificial ligament are satisfactory. These graft materials could be good substitute of A- CL, but expensive. The LARS artificial ligament allows knee early postoperative functional movement.