关节镜下2种经胫骨隧道单束和Y形重建后交叉韧带手术方法的疗效比较

Comparison of clinical outcome of endoscopic posterior cruciate ligament reconstruction with single-bundle vs."Y" type double-bundle of tibial tunnel

目的探讨关节镜下采用单束和Y形重建2种重建后交叉韧带手术方法的临床疗效。方法回顾性分析自2010-06—2013-12诊治32例Ⅲ度后交叉韧带损伤的临床资料,均采用自体或异体肌腱,分为单束重建组和Y形重建组,功能评估采用IKDC评分标准进行膝关节功能评分。结果 32例均获得12-20（16.5±1.5）个月随访,Y形重建组手术时间较单束重建组长,2组术后IKDC评分较术前明显提高,差异有统计学意义（P〈0.01）,单束重建组（t=-23.097,P〈0.001）、Y形重建组（t=-28.628,P〈0.001）组内手术前后IKDC评分比较差异均有统计学意义。2组IKDC评分术后比较差异无统计学意义（t=-0.792,P=0.494）。术后膝关节功能明显改善,无重建失败及术后感染等并发症。结论采用关节镜下Y形重建手术复杂,手术时间长,更符合生物力学原理,但早期疗效与单束重建无明显差异,远期疗效有待观察;单束重建具有操作简单,手术时间短,配合正确的功能锻炼后术后康复效果好等优点。

Objective To explore the clinical outcome of endoscopic PCL reconstruction with two methods, single-bundle and ＂Y＂ type double-bundle of tibial tunnel. Methods The clinical data of 32 cases of PCL 3 degree injury from June 2010 to December 2013 were retrospectively analyzed. In this group of cases, autologous or allogeneic tendon was used, and patients were divided into single-bundle group and ＂Y＂ type double-bundle group. IKDC score was used for functional evaluation of knee joint function. Results All 32 cases were followed up for 12-20（16.5±1.5）months. The operation time of the ＂Y＂ type double-bundle group was greater than that of the single-bundle group. The IKDC scores were improved compared with those prior to surgery（P〈0.01）. There were statistically significant differences in IKDC scores between the single-bundle group（ t =-23.097, P〈0.001）and the ＂Y＂ type double-bundle group（t =-28.628, P〈0.001）, before and after surgery. There was no significant difference（t =-0.792, P =0.494） in the IKDC score after the operation between the two groups. The function of knee joint was improved obviously after operation. There were no complications such as operation failure and postoperative infection. Conclusion The ＂Y＂ type double-bundle is complicated and the operation time is long and it is more in accordance with the principle of biomechanics, but there is no significant difference in early curative effect compared with the single-bundle group, the long term curative effect is worth observing. The single bundle reconstruction has the advantages of simple operation, short operation time, and good recovery effect after the operation.