关节镜下半腱肌和半腱肌—股薄肌肌腱单束重建前交叉韧带的临床疗效观察

Observation of Clinical Efficacy of Arthroscopic Semitendinosus andSemitendinosus Gracilis Single-Bundle Reconstruction of Anterior Cruciate Ligament

目的 探讨半腱肌(semitendinosus, ST)与半腱肌-股薄肌(semitendinosus-gracilis, STG)腱肌单束重建前交叉韧带(anterior cruciate ligament, ACL)的临床疗效。方法 回顾性分析新疆医科大学第一附属医院运动医学科2020年1月至2021年1月采用关节镜下自体腘绳肌前交叉韧带单束重建术治疗的82例ACL损伤患者,其中男66例,女16例;年龄15~45岁,平均(28.25±7.30)岁。41例采用单根ST肌腱重建(ST组),男34例,女7例;另41例采用STG肌腱重建(STG组),男32例,女9例。临床评价包括主观标准:Lysholm评分、国际膝关节文献委员会(international knee documentation committee, IKDC)主观评分;重建前交叉韧带再断率;功能评估测试:Lachman试验、轴移试验、单脚跳测试、胫骨内旋角度、站立屈曲角度;膝关节屈曲肌力评估。结果 82例患者随访1年,均未出现重建前交叉韧带再次断裂情况。两组术后Lysholm评分、IKDC评分比较,差异均无统计学差异(P>0.05);两组术后Lachman试验、轴移试验、单脚跳测试、胫骨内旋角度测试比较,差异均无统计学意义(P>0.05)。患侧站立屈曲角度:ST组(119.73±3.91)°,STG组(117.17±2.58)°,差异有统计学意义(P<0.05);两组间患膝屈曲60°时屈曲肌力:ST组(178.34±10.56) N,STG组(177.85±7.57) N,差异无统计学意义(P>0.05);两组间患膝屈曲90°、110°时屈曲肌力:ST组分别为(187.41±8.83) N、(179.12±9.94) N,STG组分别为(173.49±8.12) N、(170.29±7.97) N,差异均有统计学意义(P<0.05)。结论 采用半腱肌肌腱较半腱肌-股薄肌肌腱重建ACL,膝关节功能恢复更好,因此半腱肌肌腱移植更适用于对深屈曲肌力要求更高人群。

Objective To investigate the clinical efficacy of single bundle reconstruction of semitendinosus(ST)and semitendinosus-gracilis(STG)for anterior cruciate ligament(ACL).Methods 82 patients with ACL injuries treated from January 2020 to January 2021 in the Department of Sports Medicine of the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed,and all 82 patients underwent arthroscopic autologous hamstring ACL single-bundle reconstruction.The single ST tendon reconstruction was used in the ST group.This group had 41 cases,and 34 patients were males and 7 were females.The STG group had 41 cases,including 32 males and 9 females,and the patients underwent reconstruction using STG.Clinical evaluation ubjective criteria included Lysholm score,international knee documentation committee(IKDC)subjective score,reconstructed anterior cruciate ligament re-rupture rate,functional assessment tests,Lachman test,pivot shift test,one-legged hop test,tibial internal rotation angle,standing flexion angle;and knee flexion muscle strength assessment.Results Of the 82 patients,no re-rupture of the reconstructed anterior cruciate ligament occurred during follow-up after 1 year.There was no statistical significance in Lysholm score and IKDC score between the two groups(P>0.05).There were no statistical significance in postoperative Lachman test,pivot shift test,one-legged hop test,and tibial internal rotation angle test between the two groups(P>0.05).Standing flexion angles of affected side were(119.73±3.91)°in ST group,(117.17±2.58)°in STG group and the difference had statistical significance(P<0.05).There was no statistical significance in flexion muscle strength at 60°of knee flexion between the two groups(178.34±10.56)N in ST group and(177.85±7.57)N in STG group(P>0.05).The flexion muscle strength of the affected knee at 90°and 110°flexion was(187.41±8.83)N and(179.12±9.94)N in the ST group and(173.49±8.12)N and(170.29±7.97)N in the STG group respectively,and the differences were statistically significant(P<0.05).Conclusion In patients with ACL reconstruction,semitendinosus tendon grafts have better recovery of knee function than semitendinosus-gracilis tendon grafts,so semitendinosus tendon grafts are more suitable for people with higher deep flexion muscle strength requirements.