一端带骨块同种异体深冻下肢肌腱重建前交叉韧带的应用

Application of allogeneic deep-frozen tendon of lower limb with one-end bone block in reconstruction of anterior cruciate ligament

背景:关节镜辅助下重建前交叉韧带的移植物及固定方法的选择存在很多争论,各种固定方法均有其优缺点。目的:评估一端带骨块深冻同种异体肌腱股骨侧嵌入重建膝关节前交叉韧带的效果。方法:纳入2008-01/2009-09在承德医学院附属医院骨科就诊的15例关节损伤患者(15膝),经关节镜检查证实为前交叉韧带断裂,其中运动损伤7例,交通事故伤6例,摔伤2例。均于关节镜下行一端带骨块的同种异体腱前交叉韧带重建术,记录患者膝关节Lysholm功能评分、KT-1000测量值。结果与结论:对15例患者随访12～24个月,均未发生血管神经损伤、排异、感染等并发症。KT-1000测量值术前双侧膝关节前向松弛度差值为3～5mm4例(27%),6～10mm9例(60%),>10mm2例(13%);末次随访时0～2mm12例(80%),3～5mm3例(20%)。同时,Lysholm膝关节功能评分也由术前的(65.60±10.13)分提高到末次随访时的(90.93±4.06)分(P<0.05)。说明嵌入骨块在重建膝关节前交叉韧带中可增加股骨侧固定的可靠性,治疗效果满意。

BACKGROUND：There are a lot of debates on selections of grafts and ways of fixation methods about ansterior cruciate ligament（ACL） reconstruction.Each fixation has its advantages and disadvantages.OBJECTIVE：To evaluate the effectiveness of allogeneic deep froze tendon of lower limb with one-end bone block in ACL reconstruction.METHODS：Fifteen knees with ACL tear,of which,7 knees were caused by athletic injury,6 knees by traffic accident,and 2 knees by falling.ACL tear was verified by arthroscopy,and all the damaged ACL were reconstructed with allograft tendons by inserting technique under arthroscopy.The value of KT-1000 and the Lysholm scores were recorded before operations and at follow-up.RESULTS AND CONCLUSION：All cases were followed up for 12-24 months.No severe complication,such as vascular nerve injury,rejection or infection,occurred.The KT-1000 measurement showed that the preoperative difference of anterior laxity was 3-5 mm in 4 cases（27%）,6-9 mm in 9 cases（60%）,and greater than 10 mm in 2 cases（13%）;in the final followed up,difference of anterior laxity was 0-2 mm in 12 cases（80%）,and 3-5 mm in 3 cases（20%）.Lysholm score was remarkablely improved from（65.60±10.13） preoperatively to（90.93±4.06） at follow-up（P 0.05）.The reconstruction of ACL by inserting technique with allograft tendons can increase reliability of femoral side fixation,and the outcome is satisfactory.