新型自体半腱肌带状移植物重建术治疗前交叉韧带断裂的早期临床疗效

Early clinical effect of new autologous semitendinosus ribbon-like graft in reconstruction of anterior cruciate ligament tear

目的探讨新型自体半腱肌带状移植物重建术治疗膝关节前交叉韧带(ACL)断裂的早期疗效。方法采用回顾性队列研究分析2019年6月至2021年1月郑州市骨科医院收治的65例膝关节ACL断裂患者的临床资料, 其中男52例, 女13例;年龄16~50岁[(30.5±8.4)岁]。根据重建方式和移植物选择, 将患者分为带状重建组(31例)和圆束重建组(34例)。手术重建方法均为解剖重建, 其中带状重建组采用新型自体半腱肌带状移植物解剖重建ACL, 圆束重建组采用传统圆束状移植物解剖重建ACL。比较两组手术时间、术后即时ACL移植物与原始ACL形态差异、术前及术后3个月Lysholm评分、术后即时及术后3个月Lachman试验和轴移试验、术中及术后并发症发生情况。结果患者均获随访3~15个月[(6.0±3.1)个月]。带状重建组手术时间为(61.6±6.7)min, 圆束重建组为(48.0±6.3)min(P<0.01)。关节镜观察可见原始ACL在关节内为带状, 带状重建组重建移植物主体也是带状, 而传统圆束状移植物主体为束状。关节镜下发现带状移植物重建组术后移植物相比圆束重建组更好模拟了原始ACL的带状结构, 在屈膝时模仿ACL发生自然扭曲。带状重建组术后3个月Lysholm评分为(82.8±5.2)分, 较术前的(47.5±8.7)分显著提高(P<0.01)。圆束重建组术后3个月Lysholm评分为(79.9±7.5)分, 较术前的(44.2±9.4)分显著提高(P<0.01)。两组术前及术后3个月Lysholm评分差异无统计学意义(P均>0.05)。两组术后即时及术后3个月Lachman试验和轴移试验均为阴性。带状重建组术中4例发生克氏针断裂或磨损, 1例发生空心钻变形;圆束重建组术中2例发生克氏针磨损(P>0.05)。术后3个月带状重建组出现1例胫骨切口感染;圆束重建组未出现切口感染, 创面均Ⅰ期愈合;两组均无韧带失效及功能受限发生(P>0.05)。结论新型自体半腱肌带状移植物重建ACL的临床效果与传统圆束移植物相当。然而, 关节镜下发现带状移植物实质部为带状, 更好地模拟了原始ACL的生理形态, 在屈膝时模仿ACL发生自然扭曲, 可能会更好模拟原始ACL的生理功能。

Objective To investigate the early curative effect of the new autologous semitendinosus ribbon-like graft in reconstruction of anterior cruciate ligament(ACL)tear.Methods A retrospective cohort study was conducted to analyze the clinical data of 65 patients with knee ACL tear admitted to Zhengzhou Orthopedics Hospital from June 2019 to January 2021,including 52 males and 13 females,aged 16-50 years[(30.5±8.4)years].According to the reconstruction method and graft selection,the patients were divided into ribbon-like reconstruction group(n=31)and circular bundle reconstruction group(n=34).All patients underwent anatomical ACL reconstruction using the new autologous semitendinosus ribbon-like graft in ribbon-like reconstruction group and the traditional circular bundle graft in circular bundle reconstruction group.The operation time,morphological difference in ACL graft immediately after surgery with original ACL,Lysholm score before and at 3 months after surgery,Lachman test and axial shift test immediately and at 3 months after surgery,and intraoperative and postoperative complications were compared between the two groups.Results All patients were followed up for 3-15 months[(6.0±3.1)months].The operation time was(61.6±6.7)minutes in ribbon-like reconstruction group and was(48.0±6.3)minutes in circular bundle reconstruction group(P<0.01).Under arthroscopic observation,the original ACL was ribbon-shaped in the joint,the graft in ribbon-like reconstruction group was also ribbon-like structure,the graft in circular bundle reconstruction group was bundle structure.Therefore,the grafts in ribbon-like reconstruction group better simulated the ribbon-like structure of the original ACL than those in circular bundle reconstruction group.The ribbon-like graft mimiced the natural twisting of the ACL when the knee was bent.Lysholm score was(82.8±5.2)points in ribbon-like reconstruction group at 3 months after surgery,significantly higher than(47.5±8.7)points before surgery(P<0.01).Lysholm score was(79.9±7.5)points in circular bundle reconstruction group at 3 months after surgery,significantly higher than(44.2±9.4)points before surgery(P<0.01).There were no significant differences in Lysholm score between the two groups before and at 3 months after surgery(all P>0.05).Lachman and axial shift tests were negative in both groups immediately and at 3 months after surgery.The ribbon-like reconstruction group showed breakage or wear of Kirschner wires in 4 patients and hollow drill deformation in 1 intraoperatively.The circular bundle reconstruction group showed wear of Kirschner wires in 2 patients intraoperativley.There was no significant difference in intraoperative complications between the two groups(P>0.05).One patient experienced tibial incision infection in ribbon-like reconstruction group at 3 months after surgery.All wounds were healed at stage I with no incision infection in circular bundle reconstruction group.No patients had ligament failure or function limitation.There was no significant difference in postoperative complications between the two groups(P>0.05).Conclusions The clinical effect of new autogenous semitendinosus ribbon-like graft in ACL reconstruction is comparable to that of traditional circular bundle graft.However,arthroscopic observation reveals that the parenchymal part of the ribbon-like graft is ribbon-shaped,which better simulates the physiological morphology of the original ACL.The natural distortion of the simulated ACL during knee bend may better simulate the physiological function of the original ACL.