腓骨长肌腱与腘绳肌腱重建前交叉韧带的疗效比较

EFFECTIVENESS COMPARISON OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION BY LONG FIBULAR MUSCLE TENDON AND HAMSTRING TENDON

目的 比较腓骨长肌腱与腘绳肌腱行关节镜下前交叉韧带（anterior cruciate ligament,ACL）重建的疗效。方法 2010年2月-2012年12月采用关节镜下重建治疗56例ACL断裂患者,其中26例采用腓骨长肌腱重建（A组）,30例采用腘绳肌腱重建（B组）。两组患者性别、年龄、损伤侧别、病程以及术前Lachman试验、Lysholm评分、国际膝关节文献委员会（IKDC）评分等一般资料比较,差异均无统计学意义（P〉0.05）。术后两组处理方法一致。结果 两组术后切口均Ⅰ期愈合,无重要神经血管损伤及膝关节滑膜炎等并发症发生。两组手术时间、住院时间及术后24 h引流量比较,差异均无统计学意义（P〉0.05）。术后两组患者均获2年以上随访,其中A组随访时间为25-32个月,平均28个月;B组为27-37个月,平均31个月。两组供腱区术后均无相关并发症发生。MRI检查重建韧带情况均良好。A组术后6个月Lysholm评分、IKDC评分优于B组（P〈0.05）;术后2年两组以上指标比较,差异均无统计学意义（P〉0.05）。两组术后6个月及2年Lachman试验比较,差异均无统计学意义（P〉0.05）。结论 与腘绳肌腱相比,应用腓骨长肌腱行关节镜下ACL重建术操作简便,早期膝关节功能恢复及患者主观满意度更好。

Objective To compare the effectiveness of anterior cruciate ligament（ACL） reconstruction between by long fibular muscle tendon and by hamstring tendon under arthroscopy after ACL rupture. Methods Between February 2010 and December 2012, 56 cases of ACL rupture underwent ACL reconstruction under arthroscopy. The long fibular muscle tendon was used in 26 cases（group A） and the hamstring tendon was used in 30 cases（group B）. There was no significant difference in gender, age, side, disease duration, and preoperative Lachman test, Lysholm score, and the International Knee Documentation Committee（IKDC） score between 2 groups（P〈0.05）. The treatment after operation was identical in 2 groups. Results Primary healing of incision was obtained after operation in 2 groups. There was no major neurovascular injury and knee synovitis. There was no significant difference in operation time, hospitalization time, and postoperative 24-hour drainage volume between 2 groups（P〈0.05）. The patients were followed up 25-32 months（mean, 28 months） in group A, and 27-37 months（mean, 31 months） in group B. There was no related complication at donor site in 2 groups. MRI examination showed good ACL reconstruction. The Lysholm score and the IKDC score of group A at 6 months after operation were significantly better than those of group B（P〈0.05）, but no significant difference was found between 2 groups at 2 years after operation（P〈0.05）. There was no significant difference in Lachman score between 2 groups at 6 months and 2 years after operation（P〈0.05）. Conclusion The long fibular muscle tendon for arthroscopic reconstruction of ACL has much simpler operation, earlier knee function recovery, and better subjective satisfaction than the hamstring tendon.