腓骨长肌腱与腘绳肌腱行前十字韧带重建术治疗前十字韧带损伤疗效比较

Comparison of the efficacy of anterior cruciate ligament reconstruction using peroneus longus tendon and hamstring tendon in the treatment of anterior cruciate ligament injury

目的比较腓骨长肌腱与腘绳肌腱行前十字韧带(ACL)重建术治疗前十字韧带损伤的疗效。方法选择2016年5月至2019年5月于中国人民解放军联勤保障部队第987医院行ACL重建术治疗的ACL损伤患者106例为研究对象,根据移植材料将患者分为腓骨长肌腱组(n=56)和腘绳肌腱组(n=50)。腓骨长肌腱组患者采用自体腓骨长肌腱移植行ACL重建术,腘绳肌腱组患者采用自体腓骨长肌腱移植行ACL重建术。记录2组患者的手术时间、术中出血量、术后24 h引流量和住院时间。分别于术前及术后6个月,采用Lysholm评分量表评估2组患者的膝关节功能,采用Tegner膝关节运动评分评估2组患者的膝关节运动水平。记录2组患者术后住院期间并发症发生情况,并计算并发症发生率。结果腓骨长肌腱组患者的手术时间显著长于腘绳肌腱组(P<0.05);腓骨长肌腱组与腘绳肌腱组患者的术中出血量、术后24 h引流量及住院时间比较差异无统计学意义(P>0.05)。2组患者术前Lysholm评分量表中的跛行、支持、绞锁、不稳定、肿胀程度、上楼能力、下蹲能力、疼痛程度评分及总分比较差异无统计学意义(P>0.05);2组患者术后6个月Lysholm评分量表中的跛行、支持、绞锁、不稳定、上楼能力、肿胀程度、下蹲能力、疼痛程度评分及总分显著高于术前(P<0.05);术后6个月,腓骨长肌腱组患者Lysholm评分量表中的跛行、支持、不稳定、下蹲能力评分及总分显著高于腘绳肌腱组(P<0.05)。2组患者术前Tegner评分比较差异无统计学意义(P>0.05);2组患者术后6个月Tegner评分均显著高于术前(P<0.05);术后6个月,腓骨长肌腱组患者的Tegner评分显著高于腘绳肌腱组(P<0.05)。腘绳肌腱组和腓骨肌腱组患者术后并发症发生率分别为2.00%(1/56)、5.36%(3/56),2组患者的术后并发症发生率比较差异无统计学意义(χ^(2)=1.037,P>0.05)。结论相较于腘绳肌腱,应用腓骨长肌腱对ACL损伤患者行ACL重建术手术时间较长,但术后膝关节功能尤其是膝关节运动功能恢复效果更好,且未增加术后并发症。

Objective To compare the efficacy of anterior cruciate ligament(ACL)reconstruction using peroneus longus tendon and hamstring tendon in the treatment of ACL injury.Methods A total of 106 patients with ACL injury who underwent ACL reconstruction from May 2016 to May 2019 in the 987^(th) Hospital of PLA Joint Logistics Support Force were selected as the research objects,and the patients were divided into the peroneus longus tendon group(n=56)and the hamstring tendon group(n=50)according to the graft material.The patients in the peroneus longus tendon group were treated with ACL reconstruction using autologous peroneus longus tendon transplantation,and the patients in the hamstring tendon group were treated with ACL reconstruction using autologous peroneus longus tendon transplantation.The operation time,intraoperative blood loss,drainage volume within 24 hours after operation and hospitalization time of patients in the two groups were recorded.Before operation and 6 months after operation,the knee joint function of patients in the two groups was evaluated by the Lysholm scale;the knee joint movement function of patients in the two groups was evaluated by the Tegner knee joint movement score.The incidence of complications of patients during postoperative hospitalization in the two groups was recorded,and the incidence of complications was calculated.Results The operation time of the patients in the peroneus longus tendon group was significantly longer than that in the hamstring tendon group(P<0.05).There was no significant difference in intraoperative blood loss,drainage volume within 24 hours after operation and the hospitalization time of patients between the peroneus longus tendon group and the hamstring tendon group(P>0.05).Before operation,there was no significant difference in the Lysholm scale of claudication,support,twist,instability,swelling degree,ability to go upstairs,ability to squat,pain degree scores and total score of patients between the two groups(P>0.05).The claudication,support,hinge,instability,degree of swelling,ability to go upstairs,ability to squat,degree of pain scores and the total score in the Lysholm scale of patients in the two groups after 6 months of operation were significantly higher than those before operation(P<0.05);after 6 months of operation,the claudication,support,instability,squatting ability scores and total score in the Lysholm score of patients in the peroneus longus tendon group were significantly higher than those in the hamstring tendon group(P<0.05).Before operation,there was no significant difference in the Tegner score of patients between the two groups(P>0.05);the Tegner scores of patients in the two groups after 6 months of operation were significantly higher than those before operation(P<0.05);after 6 months of operation,the Tegner score of patients in the peroneus longus tendon group was significantly higher than that in the hamstring tendon group(P<0.05).The incidence of postoperative complication in the hamstring tendon group and the peroneus tendon group were 2.00%(1/56)and 5.36%(3/56),respectively;there was no significant difference in the incidence of postoperative complication of patients between the two groups(χ^(2)=1.037,P>0.05).Conclusion Compared with the hamstring tendon,the peroneus longus tendon for ACL reconstruction in patients with ACL injury has longer operation time,but the postoperative recovery of knee joint function,especially the knee joint motor function is better,and the incidence of postoperative complications is not increased.