自体腘绳肌腱单束及双束重建治疗后交叉韧带损伤的回顾性临床对比研究

Comparison of single and double bundle isolate posterior cruciate ligament reconstruction with hamstring autograft

目的对比研究单束重建及双束重建治疗单纯后交叉韧带（PCL）损伤的临床效果。方法回顾性研究2007年6月至2009年6月22例单束重建PCL（单束重建组）及24例双束重建PCL（双束重建组）患者的临床资料。单束重建组男性16例，女性6例；年龄16—54岁，平均（37±13）岁。双束重建组男性18例，女性6例，年龄17—52岁，平均（37±10）岁。两组患者年龄、性别构成、受伤时间等差异均无统计学意义（P〉0．05）。在术后膝关节正侧位x线片上测量股骨和胫骨骨道的位置并进行评估分析。随访患者的IKDC、Lysholm和Tegner评分及KT2000测量屈膝90°最大力下后向位移度。结果患者随访时间24—55个月，平均（29±9）个月。双束重建组手术时间为（92±8）min，长于单束重建组的（78±13）rain（t=2．474，P〈0．05）。两组患者术后的IKDC、Lysholm和Tegner评分均较术前提高，差异有统计学意义（单束重建组：t=9．578、13．115和8．165，P〈0．05；双束重建组：t=4．390、5．522和4．314，P〈0．05）。术后KT2000测量屈膝90。最大力下后向位移度双束重建组为（1．5±1．5）mm，较单束重建组（4．0±2．9）mm减小（t=2．538，P=0．019）。双束重建组IKDC分级正常（A级）的患者比例明显优于单束重建组（16／24比7／22，）（x2=5．576，P=0．018）。结论单束及双束重建治疗单纯PCL损伤均可以显著地提高关节的稳定性和临床效果，两者在临床评分方面没有明显的差异，但在关节稳定性上，双束重建较单束重建更佳。

Objective To determine if double bundle hamstring autograft posterior cruciate ligament （PCL） reconstruction could bring better outcomes than single bundle. Methods From June 2007 to June 2009 ,there were 22 subjects, including 16 male and 6 female patients with an average （37 ± 13 ） years old （16-54 years old） were reconstructed with single bundle PCL reconstruction （single bundle group）, 24 subjects, including 18 male and 6 female patients with an average （37 ± 10） years old （ 17-52 years old） were reconstructed with double bundle PCL reconstruction （double bundle group）. There were no differences between the two groups on patients＇ demographics and the duration from the injury to the operation （P 〉 0. 05 ）. Clinical outcomes, KT2000 and tunnel placements of all the patients were measured and analyzed. Results The two groups were retrospectively studied and compared with a （29 ± 9 ）months （24-55 months） follow-up. Operation duration of double bundle group was （92 ± 8 ） minutes which was significantly longer than the single bundle group （78 ± 13 ）minutes （t = 2. 474, P 〈 0. 05 ）. IKDC, Lysholm and Tegner scores were all significantly improved at the last follow-up of both groups （ single bundle group ： t =9. 578,13. 115 and 8. 165 ,P 〈0. 01 ;double bundle group：t =4. 390,5. 522 and 4. 313 ,P 〈0. 05）. Post operative KT2000 side-to-side difference of the double bundle group was significantly smaller than that of the single bundle group under maximum posterior force with the knee in 90° flexion （ （ 1.5 ± 1.5 ） mm vs. （ 4. 0 ± 2. 9 ） mm, t = 2. 538, P = 0. 019 ）. There were 66. 7% of the patients of double bundle group were normal which was significantly higher than 31.8% of the single bundle group on the IKDC knee examination form （X2 = 5. 576, P = 0. 018 ）. Conclusions Single or double bundle PCL reconstruction could restore the knee＇s stability and function satisfied. There are no differences between two groups in clinical scores, butdouble group manifestes a better anterior-posterior stability.