自体腘绳肌腱与LARS韧带重建前交叉韧带中期疗效比较

Medium-term outcomes of anterior cruciate ligament reconstruction with hamstring tendon autograft versus LARS artificial ligament

[目的]回顾性比较前交叉韧带(ACL)重建术中使用自体腘绳肌腱(HTAG)与LARS人工韧带作为移植物的中期临床疗效。[方法]2009年1月~2011年12月,本科采用HTAG重建ACL 33例,采用LARS韧带重建ACL 29例。使用VAS、IKDC、Lysholm、Tegner评分等评价临床效果,KT-2000测量膝关节稳定性。[结果]HTAG组重返运动的时间(20.21±5.40)周,而LARS组为(13.13±4.29)周,LARS组明显早于HTAG组,两组间差异有统计学意义(P<0.05)。患者平均随访时间为(75.31±7.70)个月。术前各项评分结果两组间差异无统计学意义(P>0.05)。末次随访时与术前相比较,两组的上述各指标的差异均显著改善,差异均有统计学意义(P<0.05)。末次随访时HTAG组与LARS组比较,VAS评分[(1.41±0.56)vs(1.38±0.62)],IKDC评分[(92.21±1.39)vs(92.29±1.71)],Lysholm评分[(92.36±3.56)vs(92.81±2.62)],Tegner运动评分[(6.06±0.30)vs(6.14±0.43)],两组间差异均无统计学意义(P>0.05)。KT-2000测量结果 [(3.16±0.35)mm vs(3.12±0.33)mm],HTAG组与LARS组之间差异无统计学意义(P>0.05)。[结论]HTAG和LARS人工韧带重建ACL均可恢复膝关节稳定性与功能,两组中期随访效果相似。但LARS能够使患者更早期重返运动。

[Objective] To retrospectively compare the medium-term clinical outcomes of anterior cruciate ligament（ACL）reconstruction by hamstring tendon autograft（HTAG） versus LARS artificial ligament. [Methods] From January 2009 to December 2011, 33 patients had arthroscopic ACL reconstruction performed with HTAG, while 29 patients underwent arthroscopic ACL reconstruction with LARS artificial ligament. The clinical outcomes were evaluated using visual analogue scale（VAS） of pain, International Knee Documentation Committee（IKDC） score, Lysholm and Tegner score. The objective knee stability was assessed by side to side difference of KT-2000 arthrometer. [Results] The time elapsed postoperatively to return sport was（20.21±5.40） weeks in the HTAG group, whereas（13.13±4.29） weeks in the LARS group, where existed a statistical difference between them（P〈0.05）. The patients were followed up for（75.31±7.70） months on average. Before operation, no statistically significant differences were noted in any aforesaid parameter between the two groups（P〉0.05）. Compared the data at the latest follow up with those before operation, both groups got significant improvement regarding to VAS of pain, IKDC, Lysholm and Tegner scores with statistical differences（P〈0.05）. However, compared the HTAG group with the LARS group at the latest follow up,the VAS was of [（1.41±0.56） versus（1.38±0.62）], IKDC score of [（92.21±1.39） versus（92.29±1.71）],Lysholm score of [（92.36±3.66） versus（92.81±2.62）], and Tegner sore of [（6.06±0.30） vs（6.14±0.43）], there were no statistical differences between the two groups（P〉0.05）. In term of objective knee stability measured by KT-2000 arthrometer, the side to side difference proved[（3.16±0.35） mm vs（3.12±0.33） mm], without statistical difference between the HTAG group and the LARS group（P〉0.05）. [Conclusion] Both the HTAG graft and the LARS graft are effective for ACL reconstruction to regain knee stability and function with similar medium-term clinical consequences. However, the LARS takes an advantage of earlier return to sport over the HTAG.