骨膜包裹胭绳肌腱重建前交叉韧带促进腱骨愈合的临床观察

Anterior cruciate ligament reconstruction using periosteum wrapped autologous hamstring tendons： clinical research

目的观察采用自体骨膜包裹胭绳肌腱移植物重建前交叉韧带的临床疗效。方法110例（110膝）前交叉韧带损伤的患者分为2组：实验组采用自体骨膜包裹胭绳肌腱重建前叉韧带（52膝），对照组采用单纯胴绳肌腱重建前交叉韧带（58膝）。术后1年采用IKDC评分、Tegner评分和HSS评分评价临床效果；采用KT-1000，Lachman试验和轴移试验评估关节稳定性；采用膝关节MR测量骨隧道宽度。统计学处理采用t检验和χ^2检验。结果实验组HSS评分与对照组比较差异无统计学意义（t=0．714，P〉0．05）；KT-1000测量实验组胫骨前移值小于对照组（t=6．427，P〈0．05）；术后1年MR观察实验组股骨隧道扩大率小于对照组（χ^2=4．17，P〈0．05），实验组胫骨隧道扩大率小于对照组（χ^2=3．90，P〈0．05）。结论自体骨膜包裹胭绳肌腱移植物重建前交叉韧带的方法短期临床效果确定，并能够增强重建韧带的稳定性，降低骨隧道扩大的发生率。

Objective To develop a surgical technique using a periosteal flap wrapped autotogous hamstring tendons in ACL reconstruction and to examine its short-term outcome. Methods A total of 110 patients （110 knees） were included. The experimental group （n =52） received ACL reconstruction with hamstring tendons wrapped in periosteum. In the other 58 patients, ACL was reconstructed with autologous hamstring tendons. The mean post-operative follow-up was 19 （ 12-25 ） months. All patients were assessed at 12 months post-operation. The parameters of efficacy evaluation included IKDC score, Tegner score, modified HSS score, KT-1000 arthrometer reading and a radiographic assessment using anteroposterior and lateral radiographs. The incidence of femoral and tibial bone tunnel enlargement between two groups was compared with χ^2 test. Results Clinical outcomes in experimental group （periosteum-wrapped grafts） were dependent on the wrap-up of periosteum, bone tunnel, graft fixation and postoperative rehabilitation. The good or excellent outcomes were reported in approximately 90% of the experimental group. And 44 patients showed normal or nearly normal knee function according to IKDC criteria. KT-1000 tests showed an average maximal manual side-to-side difference of 1.7 ± 1.1 mm. Forty patients showed the outcomes of KT-1000, Lachman＇s knee ligament test and pivot-shift testing. The evaluation of the level of activity using the Tegner score revealed that 40 patients regained their pre-injury activity level And 44 patients showed full knee extension and 42 patients showed full knee flexion after surgery. The average HSS score showed no significant difference between experimental group （ 90. 6 ± 0. 57 points ） and control group （ 89. 9 ±0. 8 points） （t =0. 714, P 〉0.05）. The KT-1000 measurement （133N） was larger in control group （2. 3 ±1.0 mm） than in experimental group （1.7± 1.1 mm）. There was significant difference in laxity between two groups （t=6. 427, P 〈0. 05）. At 12 months post-operation, tunnel enlargement could be observed in both groups. The average enlargement of femoral tunnel was less in experimental group （ 17.3% ） than control group （34. 5% ） （χ^2 = 4. 17, P 〈 0. 05 ）. And the enlargement of tibial tunnel was less in experimental group （ 19.2% ） than control group （ 36.2% ） （ χ^2 = 3.90, P 〈 0. 05 ）. Conclusions The surgical technique using a periosteal flap wrapped with autologous hamstring tendons in ACL reconstruction has definite clinical efficacies. It can enhance the stability of knee and prevent the enlargement of bone tunnel.