膝关节镜下自体腘绳肌腱和髌腱移植重建前交叉韧带近期效果对比临床观察

Clinical Observation on Anterior Cruciate Ligament Reconstruction by Autologous Hamstring and Patellar Tendon Transplant under Knee Arthroscopy

目的:;观察对比关节镜下自体腘绳肌腱和髌腱移植2种不同手术方式重建前交叉韧带的术后近、远期疗效。方法:在手术后第2、3、12个月采用Lysholm膝关节评分法分别进行评分,对2种术式进行比较,并对随访资料进行分析。结果:术后第2月、第3月Lysholm膝关节评分腘绳肌腱组为62.14±11.61、72.18±9.91,髌腱组为63.45±6.41、87.59±11.11,2组比较差异有统计学意义(P<0.05);第12月2组Lysholm评分髌腱组87.59±11.11,腘绳肌腱组86.37±10.76,两者比较差异无统计学意义(P>0.05);手术切口:髌腱组9.50±2.01cm,腘绳肌腱组2.52±1.09cm,2组比较差异有统计学意义(P<0.05)。结论:两者均为目前前交叉韧带重建的主要方法,但患者腘绳肌重建术切口小外观美观,而且术后更能减轻患者伤肢痛苦利于关节早期功能锻炼,腘绳肌重建由于手术创伤小于髌腱重建,且更少破坏骨性结构,更适合青少年前交叉韧带重建,但如果复合内侧副韧带、鹅足腱等损伤出现关节内侧结构不稳,前后交叉同时断裂我们主张采用髌腱重建韧带重建交叉韧带。

Objective：To compare the short-term and long-term curative effects of two different operation modes on anterior cruciate ligament reconstruction.Methods：Lysholm scoring method was performed in the second month,third month and twelfth month respectively after operation to compare the two different operation methods of autologous hamstring-tendon-bone method and hamstring transplant method for anterior cruciate ligament reconstruction.Results： Knee joint score of anterior cruciate ligament reconstruction by hamstring was better than that of patellar tendon group in the second and third month after operation（P〈0.05）,and no significant difference was observed for Lysholm score between the two groups in the twelfth month（P〉0.05）;operative incision of patellar tendon group was longer than that of hamstring group（P〈0.05）.Conclusion：Both methods are the major operation modes for anterior cruciate ligament reconstruction at present,and hamstring reconstruction has advantages over patellar tendon reconstruction such as small incision and beautiful appearance,which is favorable for the early functional exercise of knee joint after operation as patients＇ suffering can be reduced.Compared with patellar tendon reconstruction method,operative wound is smaller and bone structure is less injured in hamstring reconstruction method.Therefore,hamstring reconstruction method is more suitable for anterior cruciate ligament reconstruction among teenagers;in addition,if medial collateral ligament and pes anserinus tendon etc.were injured,and if medial articular structure was unsteady with anterior and posterior cruciate ligament＇s break at the same time,ligamenta cruciata reconstruction should be performed by patellar tendon.