关节镜下LARS人工韧带与γ射线照射的同种异体肌腱重建前交叉韧带早期临床疗效比较

Comparison of early clinical outcome between the ligament advanced reinforcement system and the γ-ray irradiation allograft for anterior cruciate ligament reconstruction under arthroscopy

[目的]比较研究LARS人工韧带和γ射线照射的同种异体肌腱重建前交叉韧带的早期临床疗效。[方法]自2006年1月～2008年1月,前瞻性选择了55例前交叉韧带损伤病例,经医生介绍LARS(ligament advanced reinforcement system,LARS)人工韧带和γ射线照射的同种异体肌腱的使用指征,患者自主选择其中一种韧带作为移植物。其中LARS组25例,保留自身韧带残端不予清创,韧带两端以钛挤压螺钉固定;异体腱组30例,股骨端En-dobutton悬吊固定,胫骨端可吸收挤压螺钉固定。术后均行积极的功能康复训练。两组均于术前及术后3、6、9、12、15、18个月进行Lysholm-Tegner膝关节功能评分及KT-2000测定。[结果]术后52例病人得到完整随访,3例失访(LARS组1例,异体腱组2例)。在术后第3、6、9个月Lysholm-Tegner膝关节功能评分LARS组显著高于异体腱组(P<0.01),同期比较两组间差异有逐渐减小的趋势,自术后第12个月起两组比较差异无统计学意义;在术后18个月的随访期内LRAS组KT-2000检测结果优于异体腱组(P<0.05),随着时间的延长两组同期KT-2000检测结果差异有增大的趋势。[结论]应用LARS人工韧带重建前交叉韧带的患者较使用γ射线照射的同种异体肌腱重建前交叉韧带的患者术后膝关节前后稳定性好,早期膝关节功能恢复快,但远期效果两者相差不大,还需进一步观察。

[Objective]To compare the early clinical outcome of ACL reconstruction using the ligament advanced reinforcement system and the γ-ray irradiation allograft.[Method]From January 2006 to January 2008,55 cases of ACL reconstruction were studied.According to the indication of LARS ligament and allograft,suggestion from surgeon and patient＇s aspiration,one of them were chosen as grafts for ACL reconstruction,including 25 LARS ligaments with titanium screw fixation and 19 allografts with absorptive screw fixation.After reconstruction,both groups of patients carried on functional exercise.Each patient was evaluated with Lysholm-Tegner score and KT-2000 measurements preoperatively and postoperatively at 3 months,6 months,9 months,12 months,15 months and 18 months.[Result]Fifty-two cases were followed up,3 cases were dismissed.The Lysholm -Tegner score in cases using the LARS ligament were higher than that in cases using the allograft 3 months post-operation,6 months post-operation,9 months post-operation.Contemporary comparison of the score gap between the LARS ligament group and the allograft group showed a trend of decrease.During the follow up,the allograft group displayed significantly more laxity in KT-1000 measurements at all time points than the LARS ligament group.And the measurements gap between the two groups showed a trend of increase.[Conclusion]The knee anterior-posterior stability of the patients using the LARS ligament were better than that of patients using the allograft.The knee function of the patients using the LARS ligament recovered earlier than that of patients using allograft at nonage,but long-term effect is almost the same.