关节镜下重建前交叉韧带移植物的选择与疗效比较

A Comparison of Five Types of Grafts Used for Arthroscopic Anterior Cruciate Ligament Reconstruction

目的比较分析膝关节镜下自体和异体骨-髌腱-骨、自体半腱肌腱、异体胫前肌肌腱、LARS人工韧带五种重建前交叉韧带方法的疗效。方法回顾分析112例膝关节镜下自体骨-髌腱-骨移植、23例自体半腱肌肌腱移植、87例异体骨-髌腱-骨移植、126例异体胫前肌肌腱、28例LARS人工韧带重建前交叉韧带的情况。采用Lysholm评分、IKDC分级和KT-1000评价疗效。结果前四组中期关节稳定性及功能差异无统计学意义。LARS人工韧带近期效果与其他移植物相比有统计学意义。自体骨-髌腱-骨组膝前痛发生率高,异体骨-髌腱-骨排斥反应发生率高于异体胫前肌肌腱。结论关节镜下前四种前交叉韧带替代物重建前交叉韧带的疗效大致相同,但LARS人工韧带近期效果优于其他移植物。

Objective To comparatively analyze the results of arthroscopic anterior cruciate ligament （ACL） reconstruction with autologous and allogeneic bone - pateUar tendon - bone, semitendinosus tendon autograft, anterior tibialis aUograft and LARS artificial ligament. Methods the 112 cases of arthroscopic autologous bone - patellar tendon - bone, 23 cases of autologous semitendinosus tendon graft, 87 cases of bone - patellar tendon - bone allograft, 126 cases of anterior tibialis tendon allograft, and 28 cases of LAIRS artificial ligament were retrospectively analyzed with follow-up of 22 to 66 months, an average of 42.3 months. Lysholm knee score.and the international knee documentation committee scores （IKDC） and KT-1000 test were used for evaluation. Results There was no statistically significant difference in the results of the first four groups including stability and function. However, in LARS artificial ligament group, there was statistically significant difference in short-time results compared with the four other grafts groups. The incidence of anterior knee pain in autologous bone - patellar tendon - bone group was higher than other groups; the incidence of the rejection of bone - patellar tendon - bone allograft was much higher than anterior tibialis tendon allograft. Conclusion Arthroscopic ACL construction with the first four alternatives achieves the similar effect, but the short-term result of reconstructed ACL with LARS artificial ligament is much better than the other four kinds of graft.