自体与同种异体肌腱重建膝关节前交叉韧带的比较

Hamstring tendon autograft versus tendon allograft for reconstruction of anterior cruciate ligament

背景：关节镜辅助下重建前交叉韧带的移植物主要有自体移植物、同种异体移植物和人工韧带3种,关于移植物的选择,存在较多争议。目的：评估自体健侧腘绳肌腱和同种异体肌腱两种移植物在膝关节前交叉韧带重建中的效果。方法：纳入2007-01/2009-01在承德医学院附属医院骨科就诊的经关节镜检查证实为前交叉韧带损伤的患者70例（70膝）,分别采用自体健侧腘绳肌腱和同种异体肌腱重建前交叉韧带,记录膝关节Lysholm功能评分、KT-1000测量值及不良反应。结果与结论：患者随访18~24个月,均未发生血管神经损伤,无感染、植入物断裂等并发症;同种异体肌腱移植患者有2例膝关节引流管口持续渗出,经换药半月后愈合,其余切口均一期愈合。末次随访时,自体健侧腘绳肌腱和同种异体肌腱重建患者的Lysholm评分均显著提高,双侧膝关节前向松弛度差值显著减少,且两种方法比较差异无显著性意义（P〉0.05）。说明应用自体健侧腘绳肌腱与同种异体肌腱重建膝关节前交叉韧带疗效相当,效果满意。

BACKGROUND：There are mostly three kinds of grafts used in ansterior cruciate ligament reconstruction, such as autografts, allograft and artificial ligaments, each of which has its own advantages and disadvantages. There are a lot of debates on selections of grafts. OBJECTIVE：To evaluate the therapeutic effects of hamstring tendon autograft and tendon allograft used in reconstruction of anterior cruciate ligament （ACL）. METHODS：Seventy knees with ACL tear in 70 patients, verified by arthroscopy at the Department of Orthopedics in the Affiiliated Hospital of Chengde Medical College from January 2007 to January 2009, were divided into two groups, and all the damaged ansterior cruciate ligaments were reconstructed under arthroscopy with hamstring tendon autograft or tendon allograft respectively. The value of KT-1000 and the Lysholm scores were recorded before operations and during follow-ups. RESULTS AND CONCLUSION：All of them were followed up for 18 to 24 months with an average of 20.1 months except two were missing. No severe complication, such as vascular nerve injury, infection and rupture of graft occurred in early stage after operations in the patients followed. Wound around canal orifice of drainage tube exuded continuely in two cases of allograft group, which were cured successfully by changing dressings after half a month. Lysholm scores of both groups increased, side-side difference of the postoperative anterior laxity decreased significantly, and there was no statistical significance in the above-mentioned data between these two group （P0.05）. These findings suggest that the therapeutic effects in the two groups are satisfactory equally.