关节镜下自体腘绳肌腱联合锚钉缝合带增强重建前交叉韧带的临床研究

Arthroscopic reinforced reconstruction of anterior cruciate ligament with autologous hamstring tendon and anchor suture band

目的探讨关节镜下自体腘绳肌腱联合锚钉缝合带增强重建前交叉韧带(anterior cruciate ligament,ACL)的疗效。方法2016年2月—2018年3月,选取60例拟行关节镜下重建ACL治疗且符合选择标准的患者纳入研究。其中,采用自体腘绳肌腱联合锚钉缝合带增强重建30例(试验组),单纯腘绳肌腱重建30例(对照组)。两组患者性别、年龄、病程、致伤原因、损伤侧别以及术前膝关节Lysholm评分、Tegner评分、国际膝关节文献委员会(IKDC)评分等一般资料比较,差异均无统计学意义(P>0.05)。重建术后试验组允许早期开始膝关节屈伸活动,无需佩戴支具;对照组患者需佩戴可调支具12周。比较两组患者术后膝关节功能(Lysholm评分、Tegner评分、IKDC评分)及稳定性(Lachman试验、轴移试验)。结果试验组移植物直径与对照组比较,差异无统计学意义(t=1.061,P=0.115);手术时间与对照组比较,差异有统计学意义(t=4.924,P=0.000)。两组术后切口均Ⅰ期愈合;对照组2例出现患肢小腿肌间静脉内血栓形成。两组患者均获随访18个月。两组患者术后各时间点膝关节Lysholm评分、Tegner评分及IKDC评分均较术前明显升高(P<0.05);术后3、6、9个月试验组上述评分均明显优于对照组(P<0.05),术后18个月组间比较差异无统计学意义(P>0.05)。两组术后各时间点Lachman试验结果比较差异均无统计学意义(P>0.05);术后6个月轴移试验结果比较差异有统计学意义(P<0.05),其余时间点组间比较差异无统计学意义(P>0.05)。结论采用自体腘绳肌腱联合锚钉缝合带增强重建ACL的早期疗效满意,与单纯自体腘绳肌腱重建相比,具有更好的初始强度和关节稳定性,有利于术后膝关节早期功能锻炼和功能恢复。

Objective To investigate the effectiveness of arthroscopic reinforced reconstruction of anterior cruciate ligament(ACL) with autologous hamstring tendon combined with anchor suture band. Methods Between February 2016 and March 2018, 60 patients who were to be treated with arthroscopic ACL reconstruction and met the selection criteria were selected in the study. Among them, 30 cases were reconstructed with autologous hamstring tendon combined with anchor suture band(trial group), and 30 cases were reconstructed with simple autologous hamstring tendon(control group). There was no significant difference in gender, age, disease duration, cause of injury, injury side,and preoperative Lysholm score, Tegner score, and International Knee Documentation Committee(IKDC) score between the two groups(P>0.05). After reconstruction, the patients in the trial group were allowed to start knee flexion and extension activities early without wearing an adjustable brace, while the patients in the control group were required to wear an adjustable brace for 12 weeks. The knee joint function(Lysholm score, Tegner score, IKDC score) and stability(Lachman test and pivot shift test) were compared between the two groups after operation. Results There was no significant difference in graft diameter between the two groups(t=1.061, P=0.115). Compared with the control group, the operation time of the trial group was significantly different(t=4.924, P=0.000). All incisions healed primarily. In the control group, the intramuscular venous thrombosis occurred in 2 cases after operation. Both groups were followed up 18 months. The Lysholm score, Tegner score, and IKDC score of the two groups at each time point after operation were significantly higher than those before operation(P<0.05);the above scores in the trial group were significantly higher than those in the control group at 3, 6, and 9 months after operation(P<0.05);there was no significant difference between the two groups at 18 months after operation(P>0.05). There was no significant difference in Lachman test results between the two groups at each time point after operation(P>0.05). There was a significant difference in pivot shift test results at6 months after operation between the two groups(P<0.05);but there was no significant difference at other time points(P>0.05). Conclusion The effectiveness of ACL reinforced reconstruction with autologous hamstring tendon combined with anchor suture band is satisfactory. Compared with using autologous hamstring tendon alone, it has better initial strength and joint stability, and is more conducive to early postoperative functional exercise and functional recovery of knee joint.