关节镜下自体腓骨长肌腱和腘绳肌腱重建前交叉韧带的对比

Arthroscopic anterior cruciate ligament reconstruction using autologous peroneus longus tendon or hamstring tendon

目的 比较自体腓骨长肌腱和腘绳肌腱重建膝关节前交叉韧带的手术方法和临床效果.方法 （1）实验研究：将16例截肢标本的腓骨长肌腱双股、腘绳肌腱四股与前交叉韧带放入拉力试验机,测试极限拉伸强度、最大变形、刚度.（2）临床应用：单骨道单束重建60例前交叉韧带断裂患者,28例应用腓骨长肌腱,32例应用自体腘绳肌腱.应用Tegner评分表、Lysholm评分表和国际膝关节文献委员会膝关节评估表（I KDC）进行膝关节术前术后功能评估.结果 腓骨长肌腱双股、腘绳肌腱四股与前交叉韧带的极限拉伸强度分别为（4 268±285）、（4090±265）、（2020 ±264） N;最大变形分别为（9.87 ±2.56）、（12.27 ±2.78）、（15.90±3.52） mm;刚度分别为986、776、697 N/mm,差异均无统计学意义（P＞0.05）.两组术后1年Tegner评分A组术前为（2.68±1.02）分,术后为（6.32±0.92）分;B组术前为（2.73±0.91）分,术后为（6.13±1.04）分;Lysholm评分A组术前为（62.80±6.71）分,术后为（94.90 ±4.20）分;B组术前为（62.53±6.13）分,术后为（93.97±8.62）分;IKDC评分A组正常19例,接近正常8例,异常1例;B组正常20例,接近正常9例,异常2例,两组比较差异无统计学意义（P＞0.05）.结论 自体腓骨长肌腱单束和腘绳肌腱单束重建前交叉韧带均能取得优良的初期临床效果.

Objective To compare the surgical procedures and clinical outcomes of reconstruction of the anterior cruciate ligament （ACL） using autograft peroneus longus tendon or hamstring tendon.Methods We compared the ultimate tensile strength,the maximum distortion,inflexibility of peroneus longus tendon,hamstring tendon and ACL.Autograft peroneus longus tendon was used in 28 cases,and autogenous hamstring tendon was used in 32 cases.Tegner score,Lysholm knee score and the the international knee documentation committee knee evaluation form （IKDC） were used to assess the knee function.Results The ultimate tensile strength are （4 268 ± 285）,（4 090 ± 265）,（2 020 ± 264） N; the maximum distortion are （9.87 ±2.56）,（12.27 ±2.78）,（15.90 ±3.52） mm; inflexibility of peroneus longus tendon are 986,776,697 N/mm.Hamstring tendon and ACL,Tegner score of group A,pre-operation 2.68 ± 1.02,post opeation 6.32 ± O.92 ; group B,pre-operation 2.73 ± 0.91,post opeation 6.13 ± 1.04 ; Lysholm score of group A,pre-operation 62.80 ± 6.71,post opeation 94.90 ± 4.20; group B,preoperation 62.53 ± 6.13,post opeation 93.97 ± 8.62 ; IKDC score of group A,19 cases are normal,8 cases are close to normal,1 case is abnormol; IKDC score of group B,20 cases are normal,9 cases are close to normal,2 cases are abnormol; have no significantly difference.Conclusion Reconstruction of ACL with single-bundle autologous peroneus longus tendon or hamstring tendon can both achieve excellent initial clinical results.