应用不同直径5股自体腘绳肌腱单束重建前交叉韧带的临床研究

Different Diameter of Single-bundle Five-strand Hamstring Tendon Autograft for Anterior Cruciate Ligament Reconstruction

目的探讨关节镜下应用自体5股腘绳肌腱单束重建膝关节前交叉韧带(ACL)的临床效果与移植物直径的关系。方法回顾性分析了2008年1月至2015年1月采用自体5股腘绳肌腱移植物进行前交叉韧带重建的163例病例资料。根据术中对所有移植物直径进行测量的结果,将患者分为移植物直径≤8mm和>8mm两组,对两组患者进行术前及术后1和2年膝关节Lysholm评分。随访时拍摄膝关节屈曲90°及行前抽屉试验X线侧位片,观察胫骨相对股骨的前移距离。统计术后2年两组患者的再手术率。结果 163例患者中,112例移植物直径>8mm,51例移植物直径≤8mm。术前两组患者年龄、性别、膝关节的Lysholm评分差异无统计学意义(P>0.05),两组患者术后1和2年Lysholm评分均高于术前,移植物直径>8mm组高于≤8mm组(P均<0.05)。移植物直径>8mm组术后2年再手术率(1.79%)低于直径≤8mm组(13.73%)(P<0.05)。结论采用5股自体腘绳肌腱移植物治疗前交叉韧带损伤,取得了良好的治疗效果。移植物直径>8mm时临床效果更佳,关节稳定性高,术后再手术率低。

Objective To evalute the correlation between the diameter of five-strand Hamsting autograft size and the clinic results. Methods The study was a retrospective analysis. 163 patients of the primary ACL reconstruction with five-strand hamstring tendon autograft were evaluated between january 2008 and january2015. All of the patients were divided into two groups according to the graft diameter. The Lysholm system was used to evaluate the clinic results between pre-operation,1 year postoperation and 2 years postoperation. The postoperative stability was measured using the anterior shifting of tibia under 90°bend knee. The revision rates of 2 years postoperation were also calculated. Results The graft diameter of 112 cases was greater than 8 mm,and that of 51 cases was equal or less than 8 mm. There was no significant difference in age,gender and Lysholm scores of pre-operation between the groups（P〈0.05）. The Lysholm scores of postopertion in the group which the graft diameter was greater than 8 mm,which was significantly better than another group（P〈0.05）. The anterior shifting of tibia in the group which the graft diameter was greater than 8 mm,which was significantly less than another group. The revision rates of 2 years postoperation in two groups were 1.79% and 13.73% respectively,and there was significant difference between 2 groups（P〈0.05）. Conclusion It is believed that the size of 5 strands hamstring autograft is more preferable to ACL reconstruction and has less reoperation rate when the graft size is greater than 8 mm. The technology has good clinical application prospects.