同种异体半腱肌腱双束重建前交叉韧带的近期临床疗效

PRIMARY CLINICAL RESULTS OF DOUBLE-BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH SEMITENDINOSUS ALLOGRAFTS

目的探讨采用同种异体半腱肌腱双束重建前交叉韧带的近期临床疗效。方法回顾分析2006年3月-10月应用同种异体半腱肌腱双束重建前交叉韧带33例中,获完整随访临床资料31例。男24例,女7例;年龄18～35岁,平均25岁。左膝18例,右膝13例。运动伤23例,车祸伤8例。所有患者均经MRI及关节镜检查证实为单纯前交叉韧带完全断裂,不伴侧副韧带及后交叉韧带损伤。受伤至手术时间为1～43个月,平均11个月。术后将膝关节固定于0°位2周,并逐步进行膝关节功能康复锻炼。结果2例分别于术后4d和7d出现切口渗液,对症处理后切口愈合;其余患者切口均Ⅰ期愈合。无膝关节僵硬、血管及神经损伤、膝关节感染等并发症发生。术后31例均获随访,随访时间为24～29个月,平均26个月。术后2年复查MRI示移植物连续性良好,信号接近正常前交叉韧带。术前及末次随访时双侧膝关节前向松弛度差异测量、Lachman试验及轴移试验结果比较,差异均有统计学意义(P<0.05)。术前及末次随访时双下肢周径差分别为(11.6±7.9)mm及(5.0±3.1)mm,差异有统计学意义(P<0.05)。术前Tegner评分、Lysholm评分及国际膝关节评分委员会评分分别为(3.83±1.15)、(64.38±6.81)、(41.42±6.30)分,末次随访时评分分别为(6.29±0.64)、(94.45±3.03)、(95.72±3.10)分,手术前后比较差异均有统计学意义(P<0.05)。结论同种异体半腱肌腱是一种良好移植物,双束重建前交叉韧带术后近期临床疗效满意。

Objective To evaluate the primary clinical results of double-bundle anterior cruciate ligament reconstruction （ACLR） with semitendinosus allografts. Methods From March 2006 to October 2006,33 patients underwent double-bundle ACLR with semitendinosus allografts. The complete followed-up data of 31 patients was analyzed retrospectively. There were 24 males and 7 females aged 18-35 years old （average 25 years old）. The injury was caused by sports accidents in 23 cases and traffic accidents in 8 cases,involving the left knee in 18 cases and the right knee in 13 cases. Anterior cruciate ligament rupture were confirmed by MRI and arthroscopy in all the patients,without lateral collateral ligaments injuries and posterior cruciate ligament injuries. The time from injury to operation was 1-43 months （average 11 months）. The knee was fixed at 0° position after operation for 2 weeks and got knee joint rehabilitation exercises gradually. Results The incision of 2 patients showed effusion 4 and 7 days after operation,respectively,and healed after symptomatic treatment. The incision of 29 patients healed by first intention. There were no complications such as stiffness of knee joint,neurovascular injuries and joint infections. All the patients were followed up for 24-29 months （average 26 months）. MRI displayed the anterior cruciate ligament grafts presented with good connection and signal similar to the normal 2 years after operation. There was significant difference between the preoperational value and the final follow-up value in terms of bilateral knee joint difference of prior laxity,Lachman test,and pivot shift test （P 〈 0.05 ）. The circumference difference between the injured and the normal was （11.6 ± 7.9） mm before operation and （5.0 ± 3.1） mm at the final follow-up （P 〈 0.05）. The Tegner score,Lysholm score,and International Knee Documentation Committee score was 3.83 ± 1.15,64.38 ± 6.81,and 41.42 ± 6.30,respectively,before operation,and 6.29 ± 0.64,94.45 ± 3.03,and 95.72 ± 3.10,respectively,at the final follow-up. There was a significant difference between before and after operation （P 〈 0.05）. Conclusion The primary clinical results of double-bundle ACLR with semitendinosus allografts are satisfactory and the allogeneic semitendinosus are good grafts for double-bundle ACLR.