异体肌腱保留残端重建前交叉韧带的前瞻性随机对照研究

AIIograft reconstruction of anterior cruciate ligament with remnant preservation： a prospective, ran-domized, controlled study

目的比较使用异体肌腱保留残端重建前交叉韧带（ACL）和标准ACL重建术的临床疗效。方法前瞻性地将2008年8月至2010年4月收治的符合纳入和排除标准的ACL损伤患者随机分为2组，分别使用保留残端的ACL重建术（保残组，45例）和切除残端的ACL重建术（对照组，45例），移植物均使用4股异体肌腱。两组患者术前一般资料比较差异均兀统计学意义（P〉0．05），具有可比性。比较两组患者术后Lysholm评分、IKDC分级、稳定性检查（Lachman试验、轴移试验和KT－1000测量）、滑膜覆盖情况及本体感觉测试结果。结果保残组和对照组分别有39例和41例患者完成至少2年（平均25．7个月）的随访。保残组和对照组患者Lysholm评分分别为（96．04±6．0）分和（93．0±7．5）分，分别有97．4％（38／39）和97．6％（40／41）的患者评为IKDCA级或B级、97．4％（38／39）和97．6％（40／41）的患者Lachman试验阴性、94．9％（37／39）和87．8％（36／41）的患者轴移试验阴性、刚i1000侧．侧差值分别为（1．6±I．7）mm和（1．8±1．8）mm、滑膜覆盖分型为A或B的分别有71．4％（20／28）和70．4％（19／27）、关节位置觉侧．侧差值分别为3．6°±1．8°和3．9°±2．2°，以上指标两组比较差异均无统计学意义（P〉0．05）。保残组受伤至手术时问与Lysholm评分、KT-1000侧-侧差值、移植物滑膜覆盖隋况和关节位置觉侧-侧差值无明显相关性（P〉0．05）。结论使用异体肌腱时，保留残端重建ACL与标准的ACL重建术相比，对膝关节术后稳定性、移植物滑膜覆盖及膝关节本体感觉恢复等无明显促进作用。

Objective To compare the short-term clinical outcomes of remnant-preserving anterior cruciate ligament （ACL） reconstruction with allografts and standard ACL reconstruction. Methods A prospective randomized controlled study was performed in 90 eligible consecutive patients with ACL rupture who were equally assigned into 2 groups frum August 2008 through April 2010. Group A （ n =45） received ACL reconstruction with remnant preservation technique and group B （ n = 45） the standard ACL reconstruc- tion. 4-strand allografts were used for all cases. The Lysholm score, International Knee Documentation Committee （IKDC） grading, and stability assessments （Laehman test, piw）t shift test and KT-1000 side-to-side differences） were evaluated pre- and post-operatively. Synovial coverage of the graft and proprioceptiou evaluation were esti- mated pnstoperation. Results Thirty-nine patients in group A and 41 in group B were followed up for at least 2 years（mean, 25.7 months）. At the last follow-up, the mean Lysholm score was 96.0 ±6.0 in group A and 93.0 ±7.5 in group B; there were 38 cases of IKDC grading A or B in group A and 40 in group B; 97.4% （38/39） in group A and 97.6% （40/41） in group B had negative Laehman test results; 94.9% （37/39） in group A and 87.8% （36/41） in group B had negative pivot-shift tests; the KT-1000 side-to-side differences averaged 1.6 ＋- 1.7 mm in group A and 1.8 ± 1.8 mm in group B; the synovial coverage of grade A or B was 7 I. 4% （20/28） in group A and 70.4% （19/27） in group B; the passive angle reproduction test at 15° was 3.6° ±1.8°in group A and 3.9°±2.2° in group B. There were no significant differences between the 2 groups regarding all the above indexes （ P 〉 0.05） . Conclusion In the allograft ACL reconstruction, compared with standard ACL re- construction, remnant-preserving ACL reconstruction may not result in significant improvements in postoperative stability, synovial coverage and proprioceptive recovery of the knee joint.