关节镜下自体与同种异体骨-髌腱-骨重建膝前交叉韧带的临床探讨

Autogenic and allogenic bone-patella tendon-bone reconstruction of anterior cruciate ligament under arthroscopy

目的探讨关节镜下自体与同种异体骨-髌腱-骨(B-PT-B)移植重建膝前交叉韧带(ACL)的临床疗效。方法对术前MRI检查有前交叉韧带断裂且术中关节镜检证实为前交叉韧带断裂者25例,按病人要求,分别选择采用关节镜下自体(自体组)和同种异体(同种异体组)骨-髌腱-骨移植重建膝前交叉韧带进行治疗,观察并记录两组治疗前后的症状、体征变化及术后Lysholm膝关节功能评分。术后随访6～24个月,平均16.7个月。结果两组术后均未发生严重的并发症,关节失稳明显改善,客观指标正常。手术时间自体组为(80±10)min,同种异体组为(60±10)min。术后发热时间自体组为(2±1)d,同种异体组为(3±1)d。膝关节功能按Lysholm评分标准,自体组为(86.7±4.3)min,同种异体组为(85.8±4.4)min。按Lukiano评分标准,自体组优良率为92.5%,同种异体组为90.09%。两组病例膝关节活动范围均正常。结论采用关节镜下自体B-PT-B移植手术时间较同种异体B-PT-B移植时间长,而术后吸收热时间较短(P<0.01),但自体与异体B-PT-B移植住院时间、Lysholm评分和重建ACL临床疗效差异均无统计学意义(P>0.05)。同种异体移植重建无明显排斥反应,避免了自体B-PT-B重建时的自体组织损伤。同种异体B-PT-B是ACL重建的良好选择之一。

Objective To evaluate the clinical effects of autogenic and allogenic bone- patella tendon-bone （B-PT-B） reconstruction of anterior cruciate ligament （ACL） under arthroscopy. Methods According to requirements of patients, selected respectively the autogenic or allogenic B-PT-B reconstruction of ACL under arthroscopy. For the ACL injuried patients which were examined by MRI before operation and by arthroscopy on operation, chose the autogenic or allogenic B-PT-B reconstruction of ACL under arthroscopy, fixed the grafts by interference screws, observed and recorded the symptoms before and after the treatment respectively and postoperative Lysholm score. The follow-up time after operation were 6 to 24 months and the average were 16.7 months. Results The severe complications of the cases didn＇ t occur and the function of knee joint was ameliorated ; otherwise, the objective indicators were normal. The operation time of the autogenic group was [ average （ 80 ± 10） min] and the allogenic group was [ average （60 ± 10） mini. The postoperative fever time of the autogenic group was [ average （2 ± 1 ） d ] and the allogenic group was [ average （3 ±1 ） d]. According to Lysbolm score, the result of the autogenlc group was [ average （ 86. 7 ± 4. 3 ） mini and the allogenic group was [ average （85. 8 ±4.4）mini. According to Lukiano sore, the good-rate of the autogenic group was 92. 5% and the allogenic group was 90. 09%. The range of knee activity was equally normal of the two group. Conclusion Compared to allogenic B-PT-B reconstruction of ACL under arthroscopy, the autogenic time of operation is longer and absorption of heat after operation is shorter. The clinical effect has no significant differences between the two groups. Allogenic B-PT-B reconstruction has no obvious immune rejection, and avoids the autologous tissue injury by autogenic B-PT-B reconstruction. Therefore allogenic B-PT-B is one of the best choice of the reconstruction of ACL.