两种不同移植物重建膝前交叉韧带的临床疗效比较

Differences of clinical results of anterior cruciate ligament reconstruction between two different transplants

[目的]探讨自体髌腱与深低温冷冻同种异体髌腱重建膝关节前交叉韧带的临床疗效差异。[方法]72例ACL断裂患者于术前应用电脑随机抽样方法分为两组:A组36例为自体髌腱组,B组36例为单纯深低温冷冻保存同种异体髌腱组。两组病例均由同一术者采用标准关节镜技术完成前交叉韧带重建。通过一般情况比较、轴移试验、Lachman试验、Daniel单腿水平跳跃试验、IKDC评分、Lysholm-Tegner运动水平评分及KT-2000检测评价临床疗效。[结果]70例患者获得随访,平均随访时间A组(36例)39.5个月、B组(34例)36.3个月,2例失访。A组发生术中髌骨骨折1例、术后髌前痛2例,B组出现迟发感染1例。A组平均手术时间较B组长,术后发热天数较B组短。两组住院时间无差异。A、B两组轴移试验、Lachman试验及KT-2000检测的差异无统计学意义。A、B两组ACL重建失败率分别为8%、9%,差异无统计学意义。两组间Daniel单腿水平跳跃试验、IKDC评分及Lysholm-Tegner运动水平评分的差异无统计学差异。[结论]单纯深低温冷冻同种异体髌腱与自体髌腱相比较,重建前交叉韧带的术后短期疗效接近,可作为自体移植物重建前交叉韧带的一个良好的移植替代物。

[ Objective] To analyze and compare the clinical outcomes of arthroscopic anterior eruciate ligament （ACL） reconstruction with patellar tendon （PT） autograft and compared with non-irradiated deep-frozen allograft. [Method]A total of 72 patients undergoing arthroseopie ACL reconstruction were prospectively divided into 2 groups （ A ： autograft, n = 36, B ： non-irradiated deep-frozen allograft,n = 36）. The same arthroseopie technique was used in all ACL reconstructions done by the same senior surgeon. Beforesurgery and at follow-up, patients were evaluated to compare the clinical outcomes by general conditions, pivot shift test,Lachman test,KT-2000 arthrometer testing, Daniel＇s one-leg hop test, overall IKDC rating, Lysholm knee scoring scale and Tegner activity score. [ Result ] Seventy patients （A 36, B 34） were available for full evaluation ,2 were lost. The mean follow-up time groups A and B were 39.5 and 36.3 months respectively. There were three patients in group A with complications, one had patellar fracture and two patients had anterior knee pain postoperatively. One patient in group B had late septic infection. According to the general conditions in the two groups, patients in the allograft groups （ B ） had shorter operation time and longer fever time postoperatively （ P 〈 0.05 ）. There was no statistical significance between the two groups in hospital stay time （ P 〉 0.05 ）. In the pivot shift test, Laehman test, ADT, and KT-2000 arthrometer testing, no statistically significant differences were found （ P 〉 0.05 ）. The failure rates of the ACL reconstruction with autograft and non-irradiated allograft were 8% and 9% respectively. According to Daniel＇s one-leg hop test,the overall IKDC,Lysholm and Tegner activity score,there were also no statistically significant differences between the two groups （ P 〉 0. 05 ）. [ Conclusion ] Patients undergoing ACL reconstruction with non-irradiated deepfrozen allograft or autograft had similar clinical outcomes. Non-irradiated allograft is a reasonable alternative choice to autograft for ACL reconstruction.