关节镜下三种移植物重建后交叉韧带的疗效比较

Comparison of hamstring tendon graft,ligament advanced reinforcement system,and mixed ligament in reconstruction of posterior cruciate ligament

目的:比较腘绳肌腱(HTG)、韧带先进加强系统(LARS)人工韧带及混合韧带重建后交叉韧带(PCL)的疗效。方法:回顾性分析2018年1月至2021年8月期间郑州大学第一附属医院骨科接受关节镜下PCL重建手术的59例患者资料。根据移植物不同分为3组:HTG组21例,男14例,女7例;年龄(37.8±12.6)岁;采用自体HTG重建PCL。LARS组20例,男12例,女8例;年龄(34.3±9.1)岁;采用LARS人工韧带重建PCL。混合组18例,男13例,女5例;年龄(33.2±8.3)岁;采用自体HTG与LARS人工韧带编织的混合韧带重建PCL。比较3组患者术后1年、2年的膝关节Lysholm评分、国际膝关节文献委员会(IKDC)评分及双侧膝关节松弛度差异等。结果:3组患者术前一般资料比较差异均无统计学意义( P>0.05),具有可比性。术后1年,混合组患者IKDC评分[(90.0±6.5)分]显著高于HTG组[(78.1±5.7)分]与LARS组患者[(84.1±7.3)分],膝关节Lysholm评分[(88.9±5.5)分]与双侧膝关节松弛度差异[(2.8±1.7)mm]显著优于HTG组患者[(81.8±4.6)分、(4.7±2.4)mm],差异均有统计学意义( P<0.05)。术后2年,混合组患者膝关节Lysholm评分为(93.0±4.5)分,IKDC评分为(92.5±5.7)分,双侧膝关节松弛度差异为(2.3±1.8)mm,均显著优于HTG组[(88.5±5.5)分、(82.7±5.7)分、(4.2±2.5)mm]和LARS组患者[(89.0±5.2)分、(86.5±7.3)分、(3.8±2.2)mm],差异均有统计学意义( P<0.05)。3组患者术后1年、2年膝关节功能评分和双侧膝关节松弛度差异均较术前显著改善,差异均有统计学意义( P<0.05)。 结论:关节镜下HTG、LARS人工韧带及混合韧带重建PCL均可获得满意的临床效果,后者的疗效优于前二者。

ObjectiveTo compare hamstring tendon graft(HTG),ligament advanced reinforcement system(LARS),and mixed HTG&LARS ligament in reconstruction of posterior cruciate ligament(PCL).MethodsA retrospective study was conducted to analyze the 59 patients with PCL rupture who had been admitted to Department of Orthopedics,The First Affiliated Hospital of Zhengzhou University for arthroscopic PCL reconstruction between January 2018 and August 2021.The patients were divided into 3 groups:in the HTG group of 21 cases[14 males and 7 females aged(37.8±12.6)years],PCL was reconstructed by HTG;in the LARS group of 20 cases[12 males and 8 females aged(34.3±9.1)years],PCL was reconstructed by LARS;in the mixed group of 18 cases[13 males and 5 females aged(33.2±8.3)years],PCL was reconstructed by the mixed HTG&LARS ligament.The 3 groups were compared in terms of Lysholm knee score,International Knee Documentation Committee(IKDC)score,and laxity disparity between bilateral knees at 1 and 2 years after surgery.ResultsThere was no statistically significant difference in the preoperative general data between the 3 groups,indicating comparability(P>0.05).One year after surgery,the mixed group had a significantly higher IKDC score[(90.0±6.5)points]than the HTG group[(78.1±5.7)points]and the LARS group[(84.1±7.3)points],and a significantly higher Lysholm score[(88.9±5.5)points]and a significantly smaller laxity disparity between bilateral knees[(2.8±1.7)mm]than the HTG group[(81.8±4.6)points,(4.7±2.4)mm](P<0.05).Two years after surgery,the mixed group had a Lysholm score of(93.0±4.5)points,a IKDC score of(92.5±5.7)points,and a laxity disparity between bilateral knees of(2.3±1.8)mm,all significantly better than those in the HTG group[(88.5±5.5)points,(82.7±5.7)points,and(4.2±2.5)mm]and in the LARS group[(89.0±5.2)points,(86.5±7.3)points,and(3.8±2.2)mm](P<0.05).In all the 3 groups,the knee function scores and laxity disparities between bilateral knees at 1 and 2 years after surgery were significantly improved compared with the preoperative values(P<0.05).ConclusionsSatisfactory clinical outcomes can be obtained after arthroscopic PCL reconstruction using HTG,LARS or the mixed HTG&LARS ligament.However,the mixed ligament as a graft can achieve better clinical efficacy than the other two grafts.