关节镜下肌腱移植交叉韧带重建术后患肢肿胀情况分析

Comparison of pretibal oedema of tendon transplantation in cruciate ligament reconstruction with allografts and hamstring tendon autografts under arthroscope

目的探讨关节镜下同种异体肌腱和自体腘绳肌腱重建交叉韧带后患肢肿胀情况的异同及发生原因。方法观察37例交叉韧带损伤病例术后患肢胫前肿胀及消退情况。单纯前交叉韧带(ACL)损伤23例,单纯后交叉韧带(PCL)损伤9例,前后交叉韧带同时损伤5例。使用同种异体肌腱重建20例,其中ACL9例,PCL6例,双交叉韧带5例;使用自体腘绳肌腱重建17例,其中ACL14例,PCL3例。结果同种异体肌腱重建交叉韧带患者术后患肢胫前区肿胀出现率为35%,自体腘绳肌移植组患肢胫前区肿胀出现率为82.3%,差异有显著性(P<0.01)。同种异体肌腱组出现肿胀患者肿胀持续时间为(3.43±1.27)d,明显低于自体腘绳肌组([5.57±1.95)d](P<0.01)。结论相比同种异体肌腱,关节镜下自体腘肌腱重建交叉韧带早期胫前肿胀明显较重,淋巴回流受阻、创伤较大、操作时间相对较长是其主要原因。在患者经济情况允许的情况下宜选用同种异体肌腱或人工肌腱行交叉韧带重建。

[Objective] To discuss the pretibal oedema after tendon transplantation in cruciate ligament reconstruction with allografts（allografts group） and hamstring tendon autografts（autografts group） under arthroscope.[Methods] From Oct 2008 to Feb 2010,37 cases of cruciate ligament injury were reconstruction under arthroscope,whose pretibal oedema of postoperative was measured and compared.20 cruciate ligaments of 37 cases were reconstructed with allografts（9 ACLs,6 PCLs,5 ACLs and PCLs）,and the 17 others were reconstructed with hamstring tendon autografts（14 ACLs,3 PCLs）.[Results] The positive rate of the pretibal oedema was 35% in allografts group,and was 82.3% in autografts group.The duration of the pretibal oedema was（3.43±1.27） days in allografts group,and was（5.57±1.95） days in autografts.The statistics differences between them were significant（P〈0.01）.[Conclusions] The lymphostasis is the prime reason for the pretibal oedema after the cruciate ligament reconstruction.Compare with hamstring tendon autografts,it＇s more simple operation and less trauma to reconstructing cruciate ligament with allografts under arthroscope,and is recommended for clinical use.