关节镜下应用同种异体骨-腱-骨重建前交叉韧带21例疗效观察

Reconstruction of the anterior cruciate ligament with bone-patellar tendon-bone graft under arthroscope in 21 cases

目的:观察应用同种异体骨腱骨移植物在关节镜下重建膝关节前交叉韧带的临床疗效。方法:对21例膝关节前交叉韧带断裂的患者,在关节镜下应用由山西骨组织库提供的同种异体骨-腱骨移植物进行膝关节前交叉韧带重建,同时处理膝关节合并损伤。观察患者手术前、后生化、免疫指标的变化情况以及患者全身状况和膝关节局部的反应,定期检查康复锻炼、关节功能情况,并应用Lysholm评分进行关节功能评定。结果:术后所有患者均未见排异反应及感染发生,并都获得随访。所有患者膝关节屈伸活动正常,术后Lysholm评分1明显低于术前(t=24.211,P<0.01),差别有统计学意义。结论:应用同种异体骨腱-骨在关节镜下重建前交叉韧带有良好的临床疗效,同时也验证了股骨外髁中点是前交叉韧带等距重建的理想位置和手术疗效的重要保证。

Objective： To retrospectively study the effectiveness and experience of reconstruction of anterior cruciate ligament （ACL） with allogeneic bone-patellar tendon-bone （B-PT-B） graft under knee arthroscope in 21 cases. Methods： Twenty one cases with ruptured ACL were reconstructed under arthroscope with allogeneic B-PT-B graft, which was provided by Shanxi bone bank. As the same time, the associated injuries were managed. The preoperative and postoperative changes of biochemical and immunological indicators as well as systemic reaction and regional reaction of knee joint were observed. Periodical examination was done on rehabilitation exercise and knee joint function. Knee joint function was determined by Lysholm knee function scales. Results： In all of postoperative patients, infection or graft rejection were not found and all cases were followed up for 12-18 months, with normal function of knee joint after operation. The average preoperative and postoperative Lysholm knee functional scales were to compared each other, with statistically significant difference （t = 24. 211 ,P 〈0.01）. Conclusions： The allogeneic B-PT-B groft is an ideal alternative material for reconstruction of ACL, because it can bring about satisfactory clinical effectiveness in reconstruction of ACL. Meanwhile,the central position in the femoral insertion is the optimal location of ACL isometric reconstruction which was proved in this study.