关节镜下自体、异体骨-髌腱-骨与半腱肌腱3种重建后交叉韧带方法的比较

A comparative study on arthroscopic posterior cruciate ligament reconstruction using bone-patellar tendon-bone allograft,bone-patellar tendon-bone autograft and semitendinosus tendon autograft

背景:目前重建后交叉韧带的方法很多,常涉及到不同的移植材料,但不同移植材料之间比较的研究较少见。目的:比较分析膝关节镜下自体、异体骨-髌腱-骨与半腱肌腱3种重建后交叉韧带的疗效。设计、时间及地点:回顾性病例分析,于2000-01/2005-09在解放军广州军区广州总医院骨科完成。对象:选择2000-01/2005-09收治的交叉韧带损伤患者76例,其中异体骨-髌腱-骨移植27例,自体骨-髌腱-骨移植21例,自体四股半腱肌28例。方法:回顾分析21例膝关节镜下自体骨-髌腱-骨移植、28例自体半腱肌腱移植和27例异体骨-髌腱-骨移植重建后交叉韧带的情况。采用Lysholm膝关节评分、国际膝关节文献编制委员会分级评估标准(IKDC)和KT-1000评价疗效。检测术后住院期间患者体温。主要观察指标:①关节活动范围。②后抽屉试验及KT-1000检查关节稳定性。③Lysholm和IKDC评分检测膝关节整体功能。④不良反应。结果:随访26～79个月。3组患者终末随访的IKDC分级、Lysholm评分、KT-1000结果和后抽屈试验阳性率之间的组间差异无显著性意义(P>0.05)。自体骨-髌腱-骨重建组3例膝关节10°屈曲受限;同种异体骨-髌腱-骨重建组1例5°屈曲受限;半腱肌腱重建组2例屈曲受限。3组间膝关节屈曲受限比率差异无显著性意义。3组患者均无关节粘连、伤口感染、植入物断裂、螺丝钉松脱、髌骨骨折、血管神经损伤等并发症;自体骨-髌腱-骨重建组12例有不同程度的膝前痛。半腱肌腱重建组5例有不同程度的膝后痛。3组膝周痛发生率的组间差异有显著性意义(P=0),自体骨-髌腱-骨组最高,半腱肌组次之,异体骨-髌腱-骨最低。3组术后发热时间组间比较发现,异体骨髌腱骨高于自体骨髌腱骨和自体半腱肌组(P=0)。自体骨髌腱骨与自体半腱组间的差异无显著性意义(P=0.844)。4例异体骨-髌腱-骨出现排斥反应,表现为胫骨隧道外口持续果酱样液体流出,经换药、激素或消炎痛治疗后痊愈。结论:关节镜下自体、异体骨-髌腱-骨与半腱肌腱移植重建后交叉韧带均取得满意的结果,并且疗效相似。

BACKGROUND： There are many methods for posterior cruciate ligament （PCL） reconstruction, which is involved in many graft materials, but few studies aim to compare the differences in outcomes of different grafts for PCL reconstruction. OBJECTIVE： To compare the clinical results of arthroscopic PLC reconstruction with bone-patellar tendon-bone （B-PT-B） autograft, B-TP-B allograft and semitendinosus tendon autograft. DESIGN, TIME AND SETTING： A retrospective case analysis was completed in the Department of Orthopedics, Guangzhou General Hospital of Guangzhou Area Military Command of Chinese PLA from January 2000 to September 2005. MATERIALS： Totally 75 patients underwent arthroscopic PLC reconstruction from January 2000 to September 2005, with the use of B-TP-B autograft in 21 patients, B-TP-B allograft in 27 patients, semitendinosus tendon autograft in 28 patients. METHODS： A retrospective analysis was performed in 76 patients underwent arthroscopic PCL reconstruction, with the use of B-TP-B autograft in 21 patients, B-TP-B allograft in 27 patients, semitendinosus tendon autograft in 28 patients. Postoperative body temperature was examined duration hospitalization. The follow-up parameters included International Knee Documentation Committee （IKDC） scores, Lysholm knee joint scores, and KT-1000 evaluation. MAIN OUTCOME MEASURES： （1）Range of motion. （2）joint stability： posterior draw test and KT-1000 test. （3）overall function of knee： IKDC scores and Lysholm scores; （4）complications and side effect. RESULTS： The time of follow-up visit was 26-79 months. Differences were no statistically significant among the IKDC scores, Lysholm scores, KT-1000 side-side difference, the positive rate of posterior draw test in three groups of patients with PCL reconstruction using B-TP-B autograft, B-TP-B allograft and semitendinosus tendon graft （P 〉 0.05）; 10° flexion limitation was found in 3 cases of B-TP-B autograft, 5° flexion limitation in 1 case of B-TP-B allograft and flexion limitation in 2 case of semitendinosus tendon graft. There was no significant difference in the ratio of knee joint flexion limitation among three groups. No synarthrophysis, wound infection, implant disrupture, screw loose, patellar fracture or vascular nerve injury was observed in three groups of patients; There were 12 cases presenting anterior knee pain in the B-TP-B autograft group and 5 cases presenting posterior knee pain in the semitendinosus tendon graft group. The difference of peri-knee pain incidence was statistically significant among three groups （P=O）, the highest in B-TP-B autograft group, then semitendinosus tendon graft group and the lowest in B-TP-B allograft group. The time of post-operative fever in B-TP-B autograft group was earlier than that in the B-TP-B allograft and semitendinosus tendon graft groups （P=0）. There was no significant difference between allograft group and semitendinosus tendon autograft group （P=0.844）. The rejections appeared in 4 cases of B-TP-B allograft with the manifestations of the sustained jam-like liquid outflow from tibial tunnel. After dressing, hormones or indomethacin, the rejection was healed. CONCLUSION： The arthroscopic B-TP-B autograft, B-TP-B autograft and semitendinosus tendon autograft have the same clinical curative effect in PCL reconstruction.