关节镜下同种异体肌腱移植重建交叉韧带60例

Arthroscopic reconstruction of cruciate ligaments using homologous ligaments in 60 cases

背景:目前多采用关节镜下自体肌腱移植治疗膝关节韧带损伤,但取材处并发症严重影响了手术效果。目的:探讨关节镜下同种异体肌腱重建韧带的疗效和应用前景。方法:选择2006-12/2008-12安徽医科大学第一附属医院骨二科膝关节交叉韧带患者60例,男42例,女18例,年龄20～42岁,前交叉韧带损伤46例,后交叉韧带损伤14例,均于关节镜下行同种异体移植肌腱重建。术前进行临床体检及前/后抽屉试验、Lachman试验、膝关节应力X射线片、髌骨轴位片及MRI等相关检查,Lysholm评分。术后6～21个月随访进行评估,包括临床体检和Lysholm评分。结果与结论:60例患者中,57例获得随访,随访时间6～21个月。术后切口愈合良好,无明显免疫排斥反应发生,4例出现关节腔积血,术后1周行关节腔穿刺抽液、加压包扎,出院时关节腔肿胀基本消退。术前出现的不同程度关节疼痛、屈伸活动受限及关节肿胀、急停、急跑困难、打软腿等症状改善显著。术后Lysholm评分较术前明显提高(P<0.05)。提示关节镜下应用同种异体移植肌腱重建损伤交叉韧带可重建膝关节稳定性,有效恢复膝关节的功能,减少自体组织移植的供区损伤;同时具有手术损伤小、手术时间短、术后并发症少等优点。

BACKGROUND：Autoallergic ligments is used widely in arthroscopic cruciate ligaments reconstruction.However,the therapeutic effect of the surgery is affected severely by the complication at drawing place of the autoallergic ligaments.OBJECTIVE：To explore the application and therapeutic effect of homologous ligaments in arthroscopic reconstruction of cruciate ligments.METHODS：A total of 60 patients who received homologous ligaments at the Second Department of Orthopaedics,The First Affiliated Hospital of Anhui Medical University from December 2006 to December 2008 were selected,including 42 males and 18 females,aged 20-42 years.Totally 46 cases had anterior cruciate ligament injury,and 14 cases had posterior cruciate ligament injury.All patients received arthroscopic cruciate ligaments construction under arthroscopy.Physical and clinical examination and Lysholm score had been performed prior to and at 6-12 months after construction.RESULTS AND CONCLUSION：A total of 57 cases（60 cases） were followed up 6-21 months.The incision healed well,without serve immunological rejection.Four cases had hematocele of the articular cavity,which were regressed after puncturing of the articular cavity and packing with compression.All preoperative symptoms got better apparently.The Lysholm score was obvious elevated than that prior to operation（P0.05）.The results demonstrated that reconstruction of cruciate ligaments with homologous ligments can recovery the stability and knee function,avoid the complications of autografts.It also has advantages in terms of easy operation,small injury and less complication.