关节镜下自体与异体骨-髌腱-骨重建后交叉韧带的临床对比研究

Arthruscopic reconstruction of posterior cruciate ligament using autologous and allogeneic patellar tendons

目的 比较自体与异体骨-髌腱-骨（B-PT-B）移植苇建后交叉韧带（PCL）的临床疗效.方法 1999年5月至2008年9月,50例PCL完全断裂患者接受关节镜下自体B-PT-B重建PCL手术（自体组）,男42例,女8例 平均年龄（22.5±5.7）岁 受伤至手术时间平均为6.7个月.同期56例PCL完全断裂患者接受关节镜下异体B-PT-B重建PCL手术（异体组）,男44例,女12例 平均年龄（23.2±6.2）岁 受伤至手术时间平均为6.2个月.两组患者均采用相同的手术方法.记录两组患者的手术时间、发热天数、伤口愈合时间,采用国际膝关节文献委员会（IKDC）分级、Lysholm评分及KT-2000膝关节测量仪测量胫骨后移距离健患侧之间差值等评估两组患者手术疗效.结果 手术时间自体组[（85.5±11.5）min]长于异体组[（65.1±10.1）min],发热天数异体组[（7.1±1.5）d]长于自体组[（2.5±2.5）d],差异均有统计学意义（P〈0.05）.自体组随访时间19～43个月,平均（31.9±6.7）个月 异体组随访时间18～48个月,平均（33.4±8.2）个月.末次随访时自体组与异体组Lysholm评分平均分别为（85.5±4.1）、（86.7±4.8）分,胫骨后移距离健患侧差值平均分别为（2.1±0.9）、（2.4±1.1）mm,两组之间比较差异均无统计学意义（P〉0.05）,同-组内末次随访时与术前比较差异均有统计学意义（P〈0.05）.末次随访时自体组IKDC分级：A级30例,B级13例,C级7例 异体组：A级32例,B级17例,C级6例,D级1例,差异无统计学意义（P〉0.05）.结论 采用自体韧带移植手术时间较采用同种异体韧带长,而术后发热时间较短.自体与同种异体B-PT-B移植重建PCL的临床效果无明显差异.对自体韧带不足者,如多发伤、老年人、韧带翻修等,异体B-PT-B是一种良好的替代物.

Objective To compare the clinical results of autologous and allogeneie patellar tendons used in the arthroscopic bone-patellar ligament-bone reconstruction of posterior cruciate ligament（PCL）.Methods From May 1999 to Semptember 2008,106 patients with PCL rupture underwent arthroscopic bone-patellar ligament-bone reconstruction with autologous（50 cases）or allogeneic（56 cases）patellar tendon.In the autologous group,there were 42 men and 8 women,with an average age of 22.5 ± 5.7 years and an average time of 6.7 months between injury to operation.In the allogeneic group,there were 44 men and 12women,with an average age of 23.2 ± 6.2 years and an average time of 6.2 months between injury to operation.The same skills were used in both of the groups.Their clinical results were compared in terms of operation time,clinical complications and scores of KT-2000,Lysholm and International Knee Documentation Committee（IKDC）.Results The operation time in the autologous group[（85.5± 11.5）min]was significantly longer than in the allogeneic group[（65.1 ± 10.1）min],but the fever days in the latter[（7.1 ± 1.5）d]was significantly longer than in the former[（2.5 ± 2.5）d],The follow-up periods ranged from 19to 43 months（mean,31.9 ± 6.7 months）for the autologous group,and from 18 to 48 months（mean,33.4 ± 8.2months）for the allogeneic group.The scores of KT-2000,Lysholm and IKDC were significantly different between pre-operation and post-operation（P 〈 0.05）,but not significantly different between the autogaft and allograft groups（P 〉 0.05）.Conclusion Since using autologous or allogeneic patellar tendons will make no significant difference in clinical outcome,allogeneic patellar tendons can be a good substitute for patients whose autolognus patellar tendons are not sufficient for the arthroscopic bone-patellar ligament-bone reconstruction of PCL.