关节镜下3种方法重建前交叉韧带的对比研究

目的:探讨关节镜下应用自体腘绳肌腱(HT)或异体胫前肌腱(ATT)配合两种不同固定方法重建前交叉韧带(ACL)的手术方法与疗效.方法:2007年9月～2010年6月收治60例单侧膝关节单纯ACL损伤患者,根据ACL重建时移植物与固定方法的不同,分成3组.A组12例,采用自体HT、双桩固定；B组23例,采用自体HT、Endobutton、可吸收界面螺钉固定；C组25例,采用异体ATT、Endobutton、可吸收界面螺钉固定.术后平均随访13.6个月,根据Lysholm膝关节评分和KT- 2000关节测量仪测定稳定性评价临床疗效.结果:Lysholm评分、KT2000测试,3组手术前后各项指标差异均有统计学意义(P＜0.01),但3组间术后各项指标差异均无统计学意义(P＞0.05).结论:关节镜下采用四股自体HT或异体ATT配合两种不同固定方法重建膝ACL,早期0.5～1.5年随访效果,疗效满意,不良反应发生率低.其中采用自体HT、双桩固定重建ACL的方法,具有取材方便、并发症少、疗效确切、医疗费用低等优点,值得临床推广应用.

Comparative Study on Arthroscopic Anterior Cruciate Ligament(ACL) Reconstruction with Three Kinds of Methods

Objective:To compare the Surgical method and clinical effects of hamstring tendons autograft And anterior tibialis tendon allograft with two fixation techniques in anterior cruciate ligament(ACL) reconstruction after ACL injury.Methods:From September 2007 to June 2010,60 cases with simple ACL injury of unilateral knee were reconstructed.According to the graft and fixation method used for ACL reconstruction,60 patients were divided into group A,group B and group C.Twelve cases reconstructed with autogenous hamstring tendon in group A were fixed by two piles,twenty-three cases reconstructed with autogenous hamstring tendon in group B were fixed in formal tunnel by endo-button and in tibia tunnel by interface screw.and twenty-five cases reconstructed with allogenous anterior tibialis tendon in group C were fixed in formal tunnel by endo-button and in tibia tunnel by interface screw.The average follow up was 13.6 months.The early clinical results were evaluated according to Lysholm knee score pre-and postoperatively and KT-2000 arthrometer evaluating ACL ligament stability.Results:There were statistically significant differences in Lysholm and KT2000 results between pre-and post-operation in three groups(P<0.01).But no statistically significant difference was found between three groups after operation(P>0.05).Conclusions:From 0.8~1.6 years early-term follow up,there are satisfactory clinical effects and less complications in ACL reconstruction using quadruple hamstring tendons autograft And anterior tibialis tendon allograft With two fixation teconiques.The teconique in ACL reconstruction with quadruple hamstring tendons autograft plus two piles fixation have several advantages over other form of method.Such as: draw materials convenient,complication little,curative effect precise,hospitalization cost low grade et al.It is worthy to be popularized in clinic.