自体腘绳肌腱重建前交叉韧带术后早期膝关节屈曲肌力变化观察

Observation of knee flexion and muscle strength after reconstruction of anterior cruciate ligament with autologous hamstring tendons

目的自体腘绳肌腱重建前交叉韧带术后早期膝关节屈曲肌力变化的研究。方法 2015年6月-2016年6月,采用自体腘绳肌腱或同种异体肌腱重建前交叉韧带(ACL)的患者通过筛选本研究共纳入52例同种异体肌腱重建ACL(A组)和66例自体患侧腘绳肌腱重建ACL(B组)术后12个月的患者,分别详细记录12个月随访时的患者的不同屈膝角度时双下肢屈曲肌力变化情况。通过对比两种不同方法重建ACL后膝关节患侧肢体屈曲肌力与健侧肢体的差别,评估自体腘绳肌腱重建ACL后对膝关节屈曲肌力的影响。结果术后12个月时,A组所有随访患者膝关节屈曲45°时双侧屈曲肌力平均差值为1.47N,B组所有随访患者膝关节屈曲45°时双侧屈曲肌力平均差值为1.98N,无明显统计学差异(P>0.05)。A组所有随访患者膝关节屈曲90°时双侧屈曲肌力平均差值为2.23N,B组所有随访患者膝关节屈曲90°时双侧屈曲肌力平均差值为16.41N,差异有统计学意义(P<0.05)。A组所有随访患者膝关节屈曲110°双侧屈曲肌力平均差值为2.11N,B组所有随访患者膝关节屈曲110°时双侧屈曲肌力平均差值为11.46N,差异有统计学意义(P<0.05)。结论自体腘绳肌腱重建ACL与同种异体肌腱重建ACL肢体肌力在45°时双侧膝关节屈曲肌力两种方法无明显统计学差异,但在90°及110°时膝关节屈曲肌力异体肌腱重建的患者较自体肌腱重建的患者肌力恢复更好。

Objective To study the changes of knee flexion muscle force after anterior cruciate ligament reconstruction with autologous hamstring tendons. Methods From June 2015 to June 2016, 52 patients with anterior cruciate ligament(ACL)reconstruction using autologous hamstring tendons or allogenic tendons were enrolled in this study. Sixty-six patients with ACL reconstruction using autologous hamstring tendons were enrolled in the group A, and 66 patients with ACL reconstruction using autologous hamstring tendons were enrolled in the group B. The follow-up time of 12 months was recorded in detail. The flexion and muscle strength of the lower limbs at different knee flexion angles were observed. By comparing the difference of knee flexion strength between affected and healthy knees after ACL reconstruction with two different methods, the effect of knee flexion strength after ACL reconstruction with hamstring tendon was evaluated. Results At 12 months after operation, the average difference of bilateral flexion muscle strength was 1.47N at 45 degrees of knee flexion in group A and 1.98N at 45 degrees of knee flexion in group B. There was no significant difference(P > 0.05). The average difference of bilateral flexion strength was 2.23N in the group A and 16.41N in the group B when knee flexion was 90 degrees, with significant difference(P < 0.05). The average difference of bilateral flexion muscle strength was 2.11N in the group A and 11.46N in the group B(P < 0.05). Conclusion There is no significant difference between ACL reconstruction with hamstring tendon and ACL limb strength reconstruction with allogenic tendon at 45 degrees, but the muscle strength recovery of knee flexor tendon reconstruction with allogenic tendon was better than that with autogenous tendon reconstruction at 90 degrees and 110 degrees.