不同直径混合肌腱重建前交叉韧带对膝关节运动学特征影响

目的评估不同直径混合肌腱(同种异体肌腱加强自体肌腱)重建前交叉韧带(ACL)对膝关节运动学特征影响。 方法回顾性分析2017年8月至2018年6月在南方医科大学第三附属医院使用混合肌腱行ACL重建术的57例患者资料。纳入标准：单侧膝ACL损伤并使用直径8 mm或9 mm混合肌腱重建ACL患者；年龄18至55岁并且有影像学证据显示骨骺闭合。排除标准：X片提示膝骨关节炎；术前膝关节活动受限；其他膝关节手术史；膝关节其他韧带损伤；需同时行半月板移植及软骨修复者。根据移植物直径大小不同分为：8 mm组(32例)、9 mm组(25例)。患者在术前、术后6个月、1年、2年完成随访，分析患侧膝关节6自由度的活动度及胫股运动学改变(以对侧膝关节为对照组)、移植物信号/噪声商(SNQ)值、Lysholm评分。各组术前及术后指标比较采用重复测量方差分析。 结果8 mm组(6.3%)、9 mm组(0%)的手术失败率差异无统计学意义(P＝0.499)。8 mm组在术后6个月的屈曲角度、术后1年的外旋角度比9 mm组高，差异具有统计学意义(F＝3.507，P＝0.034；F＝4.563，P＝0.013)；8 mm组在术后6月的外侧位移、术后2年的外旋角度比对照组高，差异具有统计学意义(F＝3.596，P＝0.031；F＝9.997，P<0.001)。相较术后6个月、1年，两组在术后2年的移植物近端、中段、远端的SNQ值均呈下降趋势(F＝9.634、8.593、7.636，均为P<0.001)。9 mm组的Lysholm评分比8 mm组高，差异具有统计学意义(F＝6.116，P＝0.017)。 结论直径8 mm、9 mm的混合肌腱重建前交叉韧带有相似的手术失败率和移植物成熟度，但后者的膝关节运动学特征比前者更接近正常膝关节。

Knee kinematic alterations of anterior cruciate ligament reconstruction with different diameter hybrid grafts

ObjectiveTo evaluate the effect of hybrid grafts (augmenting autografts with allograft tissue) with different diameters on the knee kinematic characteristics after anterior cruciate ligament reconstruction (ACLR). MethodsThe data of 57 patients were retrospectively analyzed who had undergone ACL reconstruction using hybrid graft in the Third Affiliated Hospital of Southern Medical University from August 2017 to June 2018. Inclusion criteria: patients with unilateral knee ACL injury and ACL reconstruction with eight-or nine-minimeter-diameter hybrid graft; the age were 18 to 55 years and radiographic evidence showed epiphyseal closure. Exclusion criteria: X-ray suggested osteoarthritis of the knee; the preoperative knee movement was limited; other knee surgery history; injury of other ligaments of knee joint; the patients requiring meniscus transplantation and cartilage repair simultaneously. According to the diameter of grafts, they were divided into the eight-millimeter group (32 cases) and nine-millimeter group (25 cases). The patients were followed up preoperatively and in postoperative six months, one and two years. The rang of motion (ROM) in six degrees of freedom (6DOF) and tibiofemoral kinematics of the involved knee (the contralateral knee joint was used as control), the graft signal/noise quotient (SNQ) value, and Lysholm score were analyzed. Preoperative and postoperative data of each group were compared by repeated measure ANOVA. ResultsThere was no statistically significant difference in the failure rate between the eight-millimeter group (6.3%) and the nine-millimeter group (0%) (P=0.499). In the eight-millimeter group, flexion in the postoperative six months and external rotation in the postoperative one years were higher than those in the nine-millimeter group, and the differences were statistically significant (F=3.507, P=0.034; F=4.563, P=0.013). In the eight-millimeter group, lateral displacement in the postoperative six months and external rotation in the postoperative two years were higher than those in the control group, and the differences were statistically significant (F=3.596, P=0.031; F=9.997, P<0.001). Compared with the data of postoperative six months and one year, graft SNQ values in both groups showed a decreasing trend in the postoperative two years (F=9.634, 8.593, 7.636, all P < 0.001). Lysholm score in the nine-millimeter group was higher than that in the eight-millimeter group, and the difference was statistically significant (F=6.116, P=0.017). ConclusionHybrid grafts with diameters of eight millimeters and nine millimeters have a comparable rerupture rate and similar graft maturity after ACLR, but the knee kinematics of the latter are more similar to that of the normal knee than the former.