前侧半腓骨长肌腱混编绳肌腱加强重建膝前交叉韧带的临床观察

Clinical evaluation of anterior cruciate ligament reconstruction by mixture autograft of anterior-half peroneus longus tendon and hamstring tendon

目的针对前交叉韧带(anterior cruciate ligament,ACL)重建术中因绳肌腱强度不足,取前侧半部分的腓骨长肌腱以混编绳肌腱,达到加强重建韧带目的,随访该系列患者的临床结局。方法选择2014年5月至2016年4月,我院收治的膝关节 ACL 完全断裂患者 57 例,男 44 例,女 13 例,平均(33.68±8.31)岁,其中 42 例行关节镜下完全自体绳肌腱移植重建术(对照组);15 例因术中绳肌腱编织腱直径<7 mm,取同侧足前侧半的腓骨长肌腱混编绳肌腱,以加强重建韧带(观察组)。随访治疗前后的 IKDC 评分、Lysholm 评分、Tegner 评分以评估膝关节功能,并比较踝关节功能 AOFAS 评分。结果平均随访(25.47±2.61)个月。术后 2 年 IKDC 评分:观察组(93.27±3.67)、对照组(91.14±3.54);Lysholm 评分:观察组(93.93±3.36)、对照组(92.19±3.82);Tegner 评分:观察组(7.53±1.80)、对照组(6.50±2.53);AOFAS 评分:观察组(96.13±3.15)、对照组(94.50±3.07);以上 4 项功能评分的组间差异无统计学意义(P>0.05)。结论在膝关节镜 ACL 重建术中,若自体绳肌腱强度不足,可取同侧足前侧半的腓骨长肌腱混编绳肌腱,以加强重建韧带。

Objective To evaluate clinical outcomes of anterior cruciate ligament (ACL) reconstruction by mixture autograft of anterior-half peroneus longus tendon and hamstring tendon in patients whose hamstring autograft tendon has no sufficient length and diameter. Methods From May 2014 to April 2016, 57 patients (44 males and 13 females) aged average (33.68±8.31) years were enrolled in this study. Patients underwent unilateral primary ACL reconstruction by hamstring tendon autograft only (control group, n=42), or mixture autograft of anterior-half peroneus longus tendon and hamstring tendon if the hamstring tendon autograft was found insufficient (observation group, n=15). Functional outcomes were evaluated by International Knee Documentation Committee (IKDC) score, Lysholm score and Tegner activity scale. The AOFAS ankle-hindfoot score was administered to measure ankle functions. Results The average follow-up was (25.47±2.61) months. At the final follow-up, postoperative mean value of IKDC scores, Lysholm scores and Tegner activity scale were (93.27±3.67), (93.93±3.36), (7.53±1.80) respectively in the observation group, which were found similar to the results of the control group (91.14±3.54, 92.19 ±3.82, 6.50±2.53) (P>0.05). The average AOFAS score was (96.13±3.15) in the observation group, showing no significant differences compared with the control group (94.50±3.07, P>0.05). Conclusions For patients whose hamstring autograft tendon has no sufficient length and diameter, mixture autograft of anterior-half peroneus longus tendon and hamstring tendon could be an option for ACL reconstruction.