前交叉韧带重建四股腘绳肌腱移植物的测量

Measurements of quadrupled hamstring tendon autograft for anterior cruciate ligament reconstruction

[目的]测量前交叉韧带(ACL)重建四股自体腘绳肌腱移植物的直径与强度,从而指导前交叉韧带重建手术移植物直径的选择,降低相关手术失败风险。[方法]选取20例新鲜尸体,取ACL和腘绳肌腱,制备四股腘绳肌腱移植物,测量标本的直径和最大拉伸毁损载荷。此外,对2017年1月~2018年1月70例应用自体腘绳肌腱移植重建前交叉韧带损伤患者,男52例,女18例,测量术中所取腘绳肌腱长度,制备成四股移植物测量其直径。[结果]20例尸体标本测量表明:随四股腘绳肌腱移植物的直径增加,其最大拉伸毁损载荷显著增加,不同直径的四股腘绳肌腱间最大拉伸毁损载荷的差异有统计学意义(P<0.05)。四股腘绳肌腱移植物的最大拉伸毁损载荷与其直径呈正相关(r=0.990,P<0.001)。70例患者四股腘绳肌移植物直径为(7.20±0.54)mm:其中6例为6.5 mm,占8.57%;40例为7.0 mm,占57.14%;15例为7.5 mm,占21.43%;7例为8.0 mm,占10.00%;2例为8.5 mm,占2.86%。[结论]四股腘绳肌腱移植物的最大拉伸毁损载荷与其直径呈正相关,多数国人四股腘绳肌腱移植物直径多数≤7 mm,易发生重建术失败,应引起重视。

[Objective]To measure the diameter and strength of quadrupled hamstring tendon autograft for anterior cruciate ligament(ACL)reconstruction to provide evidence for graft preparation and reduce the risk of surgical failure.[Methods]A total of 20 fresh cadaver specimens were used to measure the diameter and maximal axial pulling to failure load of quadrupled hamstring tendon autografts.In addition,70 patients who underwent arthroscopic ACL reconstruction from January 2017 to January 2018,including 52 males and 18 females,were enrolled into this study for measurement of the diameter of quadrupled hamstring tendon autografts.[Results]With respect to cadaveric study,the maximal axial pulling to failure load of quadrupled hamstring tendon autografts significantly increased as increase of their diameters(P<0.05),which proved statistically significant among grafts with different diameters(P<0.05).There was a significantly positive correlation between the diameter and the maximal axial pulling to failure load(r=0.990,P<0.001).In term of clinical measurement,the diameter of quadrupled hamstring tendon autograft was of(7.20±0.54)mm on average in the 70 patients.Of them,6 patients had graft in diameter of 6.5 mm,accounting for 8.57%;40 in diameter of 7.0 mm,accounting for 57.14%;15 in diameter of 7.5 mm,accounting for 21.43%,7 in diameter of 8.0 mm,accounting for 10.00%and 2 in diameter of 8.5 mm,accounting for 2.86%.[Conclusion]The maximal strength of the quadrupled hamstring tendon autograft is positively related to its diameter.Most of Chinese persons have graft diameter less than or equal to 7 mm,which maybe at risk of failure of ACL reconstruction and should be pay attention.