关节镜下单束与双束同种异体腱重建前交叉韧带的临床观察

Clinical study of single bundle vs double-bundle reconstruction of anterior cruciate ligament with allograft tendons by arthroscopy

目的比较关节镜下运用Intrafix单隧道双束解剖重建系统和Rigidfix＋Intrafix系统治疗前交叉韧带（ACL）断裂的临床疗效。方法 2011年6月至2013年6月,我院使用同种异体腘绳肌腱重建ACL患者60例,根据固定方式的不同,分为Intrafix组（30例）和Rigidfix＋Intrafix（30例）。比较两组患者手术前后膝关节活动度、KT-1000（屈膝70°30磅）、前抽屉实验、Lachman实验、Lysholm膝关节评分及患膝症状。结果 Intrafix组患者随访12~36个月,平均（20.61±8.20）个月。手术前后Lysholm膝关节评分的差异有统计学意义（t=-29.2,P〈0.05）。Rigidfix＋Intrafix组患者随访12~36个月,手术前后Lysholm膝关节评分的差异具有统计学意义（t=-25.8,P〈0.05）。术后Intrafix组与Rigidfix＋Intrafix组间Lysholm膝关节评分无统计学意义（t=0.538,P〉0.05）。Intrafix组有1例患者Lachman试验阳性,Intrafix＋Rigidfix组有1例患者前抽屉试验阳性,所有患者无伸膝受限现象。关节活动度和KT-1000均在正常范围。结论短期内Intrafix单隧道双束解剖重建与Rigidfix＋Intrafix单束重建均为可靠的同种异体腱重建ACL方法,长期结果需进一步观察。

Objective To compare the clinical effects of arthroscopic single tunnel double-bundle reconstruction anatomy system（ Intrafix system） vs Rigidfix plus Intrafix system on the treatment of anterior cruciate ligament（ ACL） rupture. Methods From June 2011 to June 2013,60 patients underwent ACL reconstruction with hamstring tendon allograft in Jinhua central hospital. According to the fixation method,the patients were divided into the Intrafix group（ 30 cases） and the Rigidfix plus Intrafix group（ 30cases）. The range of motion（ ROM） of the knee joint was compared before and after the knee surgery,as well as KT-1000（ flexion 70° 30 lbs）,anterior drawer test,Lachman test,Lysholm knee score and the symptoms of the involved knee. Results The Intrafix group were followed up for 12 to 36 months,20. 61 ±8. 20 months in average. The difference between the preoperative Lysholm knee score and the postoperative one was statistically significant（ t =-29. 2,P 0. 05）. The Rigidfix plus Intrafix group were followed up for 12 to 36 months. The difference between the preoperative and postoperative Lysholm knee scores was statistically significant（ t = 0. 538,P 0. 05）. The difference of the postoperative Lysholm knee score between the Intrafix group and the Rigidfix plus Intrafix group was not statistically significant（ t = 0. 538,P 0. 05）. In the Intrafix group,Lachman test was positive in one patient,and in the Intrafix plus Rigidfix group,the anterior drawer test was positive in one patient. No extension deficit was observed. The ROM and KT-1000 measurement results were normal. Conclusion According to the short-term results,the single tunnel double-bundle reconstruction with Intrafix system and the anatomic single-bundle reconstruction with Rigidfix plus Intrafix are both reliable methods for the ACL reconstruction with allograft tendons. The long-term results need further follow-up.