自体与异体肌腱微创重建踝关节外侧韧带的临床对比研究

 目的 比较应用自体半腱肌腱与同种异体肌腱微创移植重建踝关节外侧韧带的临床疗效。方法 回顾性分析2006年9月至2011年6月采用微创手术治疗慢性踝关节外侧不稳患者资料。其中应用自体半腱肌腱重建踝关节外侧韧带（自体组）32例，男19例，女13例；年龄17～62岁，平均32.4岁。同期应用同种异体肌腱重建踝关节外侧韧带（异体组）36例，男22例，女14例；年龄15～67岁，平均34.2岁。两组患者均采用相同的手术方法重建距腓前韧带及跟腓韧带。结果 自体组手术时间（85.5±11.5） min］长于异体组（58.1±10.2）min］，发热天数异体组（5.5±1.5）d］长于自体组（2.5±1.2）d］。自体组23例随访（33.5±6.7）个月，异体组26例随访（28.5±6.7）个月。美国足踝外科协会（AOFAS）踝与后足评分，自体组术前（62.3±8.2）分，术后（95.1±7.5）分；异体组术前（60.2±8.4）分，术后（94.8±5.5）分。5例患者（自体组3例、异体组2例）在不平地面行走时，踝关节有残余不稳定。自体组1例患者平整地面行走踝关节有残余不稳定。自体组无一例膝部肌腱供区功能障碍。术后AOFAS评分自体组16例为优，5例为良，2例为差；异体组17例为优，5例为良，4例为差。应力位X线片示自体组距骨倾斜角平均由14.0°减少到3.8°，异体组平均由13.0°减少到3.6°；距骨前移距离自体组平均由12.3 mm减少到4.6 mm，异体组平均由11.5 mm减少到4.3 mm。结论 自体肌腱与同种异体肌腱移植重建踝关节外侧韧带的临床疗效无差异，但自体肌腱愈合时间较异体肌腱快，而异体肌腱具有损伤小，手术简便等优点。

Comparison of semitendinosus tendon autograft and tendon allograft for reconstruction of the ligaments of the lateral ankle via minimally invasive method

Objective To study on the different results of a minimally invasive method to reconstruct the ligaments of the lateral ankle using semitendinosus tendon autograft and tendon allograft. Methods Data of 68 patients with chronic ankle instability who had undergone lateral ligament reconstruction from September 2006 to June 2011 were retrospectively analyzed. In the group of semitendinosus autograft, there were 32 patients （19 males, 13 females） with an average age of 32.4 years old. Semitendinosus was harvested through 2 small knee incisions. While in the group of tendon allograft, there were 36 patients （22 males, 14 females） with an average age of 34.2 years old. For the ankle reconstruction, 4 small incisions of 5 mm each were made at the medial and lateral side of the fibular tip, the talar neck, and the middle of the calcaneus. Anatomical reconstruction of the anterior talofibular ligament and calcaneofibular ligament was then performed through these small incisions. AOFAS questionnaires were used to measure clinical outcomes, donor site morbidity and patients' satisfaction. Preoperative and postoperative stress tests were performed and radiographic parameters were measured. Results The average operation time of the autograft group 85.5±11.5 min was significantly longer than that in the allograft group 58.1±10.2 min, but the fever days in the latter 5.5±1.5 d was significantly longer than in the former 2.5±1.2 d. In autograft group, 23 patients got followed up, and the mean period of follow-up was 33.5±6.7 months. The mean AOFAS score increased from 62.3±8.2 to 95.1±7.5. In allograft group, 26 patients got followed up, and the mean period of follow-up was 28.5±6.7 months. The mean AOFAS score increased from 60.2±8.4 to 94.8±5.5. There were 5 patients （3 of autugraft group and 2 of allograft group） with residual instability on uneven ground. One case of the autologous group had instability in daily life. No patient presented weakness or disability in the donor site. The satisfaction level of the autograft group was excellent in 16, good in 5 and bad in 2. Significant improvement in stress radiographic parameters was noted for the talar tilt angle, with reduction from a mean of 14.0° to 3.8°; anterior talar displacement reduced from a mean of 12.3 to 4.6 mm. The satisfaction level of the allograft group was excellent in 17, good in 5 and bad in 4. The talar tilt angle reduced from 13.0° to 3.6°; anterior talar displacement reduced from 11.5 to 4.3 mm. Conclusion There is no differences in efficacy could we found in using these 2 kinds of materials. The process of healing and rehabilitation of tendon autograft is slightly faster than the tendon allograft, but the allograft tendon has many advantages such as limited injury, simple procedure andavoiding of donor site morbidity.