双束与单束重建后交叉韧带对膝关节稳定性和膝关节骨关节炎的对比研究

Comparative study of effects of double bundle and single bundle posterior cruciate ligament on knee joint stability and osteoarthritis of knee joint

目的比较双束自体肌腱重建后交叉韧带(posterior cruciate ligament,PCL)与单束自体肌腱重建后交叉韧带的临床效果。方法将53例已行后交叉韧带重建的患者分为2组:采用双束重建后交叉韧带的患者26例;采用单束重建后交叉韧带的患者27例。记录术前和术后3、12、36个月IKDC评分、Lysholm评分、KT-1000值、膝关节后抽屉试验情况。术后第36个月X线检查评估膝关节骨性关节炎情况。结果术后Lysholm评分和IKDC评分,2组均呈现不断升高的趋势,在时点间差异有统计学意义(P<0.05),在组间和组间·时点间交互作用差异均无统计学意义(P>0.05)。术后KT-1000值,2组均呈现不断升高的趋势,但均低于术前,在组间和时点间差异均有统计学意义(P<0.05),在组间·时点间交互作用差异无统计学意义(P>0.05)。术后3个月,2组膝关节后抽屉试验转阴率差异无统计学意义(P>0.05),术后12个月和36个月转阴率差异均有统计学意义(P<0.05)。随访36个月,双束组X线分级0级和Ⅰ级占比多,而单束组Ⅰ级和Ⅱ级占比多,2组差异有统计学意义(P<0.05)。结论双束重建和单束重建后交叉韧带均可获得良好术后效果,但双束重建后交叉韧带在维护膝关节稳定性和降低继发性膝关节骨性关节炎方面优于单束重建。

Objective To compare the clinical effects of posterior cruciate ligament reconstruction using double bundle autologous tendon versus single bundle autologous tendon.Methods Fifty-three cases patients who underwent posterior cruciate ligament reconstruction were randomly divided into 2 groups:26 patients received double-bundle reconstruction(DBR),27 patients received single-bundle reconstruction(SBR).Clinical outcomes were composed of the Lysholm score,IKDC score,KT-1000 value,posterior drawer test,and patients were followed up at 3,12 and 36monthes after operation.X-ray was performed at 36 months postoperatively to evaluate the arthritic change.Results The preoperative and postoperative Lysholm score and IKDC score showed an increasing trend in the 2 groups,and the difference was statistically significant between each time points(P<0.05),while there was no significant difference in interaction between groups and group·time points(P>0.05).The postoperative KT-1000 value,which was lower than of before surgery,showed an increasing trend in 2 groups,the difference was statistically significant between groups and time points(P<0.05),while there was no significant difference in interaction in group·time points(P>0.05).Posterior drawer test revealed that there was no significant difference in 3 months after operation in 2 groups(P>0.05),while there were significant differences in 12,36 months after operation(P<0.05).The difference showed statistically significant 36 months postoperatively.According to the X-ray classification 36 months postoperatively,patients with grade 0 andⅠoccupied the majority in the DBR,while patients with gradeⅠandⅡoccupied the majority in the SBR,the difference between 2 groups was significantly significant(P<0.05).Conclusion The DBR and SBR of posterior cruciate ligament can obtain satisfactory results.However,the DBR is superior to the SBR in terms of stability and osteoarthritis of the knee.