关节镜下同种异体骨-髌腱-骨双束重建膝关节前交叉韧带的临床比较研究

Comparison between Double-and Single-bundle Arthroscopic Anterior Cructiate Ligament Reconstruction Using Bone-patellar Tendon-bone Allograft

目的探讨关节镜下同种异体骨-髌腱-骨(bone-patellar tendon-bone,BPTB)移植物双束重建膝关节前交叉韧带(anterior cruciate ligament,ACL)的中期临床效果。方法 2003年7月～2007年7月,61例ACL断裂患者接受关节镜下BPTB重建ACL手术,按术式和移植物分为3组:异体BPTB双束组(20例),异体BPTB单束组(21例),自体BPTB单束组(20例)。3组平均随访时间分别为(41.6±3.0)、(42.3±3.9)、(42.5±2.7)月。通过膝关节查体、IKDC2000主观评分、Lysholm评分、Tegner评分、膝前痛、常规KT-2000、后推KT-2000及Biodex等速肌力测试系统评估手术效果。结果 3组间的IKDC2000、Lysholm、Tegner评分、大腿围度差值、肌力和常规KT-2000等指标差异无显著性(P>0.05)。异体双束组的Pivotshift阳性发生率(5%,1/20)是异体单束组的1/6(29%,6/21),自体单束组的1/4(20%,4/20)。异体双束组的后推KT-200030°位前移度(中位数15磅0.5 mm,20磅0.5 mm,30磅0.9 mm)明显低于其他两组(P<0.05)。异体双束组(15%,3/20)和异体单束组(10%,2/21)的膝前痛发生率明显低于自体单束组(75%,15/20)(χ2=24.201,P=0.000)。结论同种异体BPTB双束重建ACL能够更好地恢复膝关节整体前向及旋转稳定性,减少并发症,可以作为髁间窝较宽的患者ACL初次解剖重建的理想手术方法。

Objective To evaluate the mid-term clinical results of arthroscopic double-bundle anterior cruciate ligament （ACL） reconstruction with bone-patellar tendon-bone （BPTB） allograft. Methods The study was carried on 61 patients with broken ACL, who received arthroscopic ACL reconstruction by using BPTB between July 2003 and July 2007. According to the operation and graft types, the patients were divided into 3 groups： BPTB double-bundle allograft group （20 patients）, BPTB single- bundle allograft group （21 patients） , and BPTB single-bundle autograft group （20 patients）. Median follow-up were （41.6 ± 3.0） , （42.3 ± 3.9）, and （42.5 ±2.7） months respectively in the 3 groups. At the follow-up, the clinical outcome of the patients was evaluated by assessing the International Knee Documentation Committee （IKDC） 2000 subjective scores, Lysholm scores, Tegner scores, anterior knee pain, routine KT-2000 and back-pushing KT-2000 side-to-side difference, thigh circumference difference and Biodex isokinetic dynamometer system. Results No significant difference was found in terms of the IKDC2000 scores, Lysholm scores, Tegner scores, thigh circumference difference, muscle strength and routine KT-2000 side..to-side difference （P 〉 0.05）. The Pivot-shift positive rate （5% ,1/20） of the BPTB double-bundle allograft group was 1/6 of that of the BPTB single-bundle allograft group （29% , 6/21 ） and 1/4 of that of the BPTB single-bundle autograft group （20% , 4/20）. Compared to the single-bundle groups, significant less back-pushing KT-2000 anterior laxity at 30° （median： 15 dl-0. 5 mm, 20 dl-0. 5 mm, and 30 dl-O. 9 mm） was revealed in the BPTB double-bundle allograft group （P 〈 0.05）. The BPTB double-bundle allograft group （15% , 3/20） and the BPTB single-bundle allograft group （ 10% , 2/21 ） showed significant less anterior knee pain than that of the BPTB single-bundle autograft group （75% , 15/20, X2 = 24. 201, P = 0. 000）. Conclusions The double-bundle ACL reconstruction with BPTB allograft showed better total A-P stability, rotatory stability and less donor site morbidity. It is an alternative of primary doubule-bundle ACL reconstruction for the patients with wider intercondylar fossa.