自体腘绳肌腱和同种异体半腱肌腱双束重建前十字韧带的比较研究

目的 对比自体腘绳肌腱和同种异体半腱肌腱双束重建前十字韧带的初期临床疗效.方法 2006年2月至8月,对单纯前十字韧带完全断裂患者分别采用自体腘绳肌腱(简称自体组,38例)和同种异体半腱肌腱(简称异体组,23例)行前十字韧带双束重建手术.客观指标包括:双侧膝关节前向松弛度差异、Lachman试验、轴移试验和双下肢周径差别;应用Tegner评分表、Lysholm评分表和IKDC评分表进行膝关节功能的主观评估.结果 自体组平均随访27个月,异体组平均随访26个月.末次随访时Lachman试验:自体组35例阴性,3例Ⅰ度阳性;异体组20例阴性,2例Ⅰ度阳性,1例Ⅲ度阳性.两组各有1例轴移试验阳性.双侧膝关节前向松弛度差异:自体组34例差异范围0～2 mm,4例3～5mm;异体组20例0～2mm,2例3～5 mm,1例>10 mm.双下肢周径差别:自体组(0.62±0.43)cm,异体组(0.57±0.42)cm.Tegner评分:自体组(6.21±0.84)分,异体组为(6.17±1.15)分.Lysholm评分:自体组(95.00±4.40)分.异体组(94.57±8.83)分.IKDC评分:自体组(90.26±2.92)分,异体组(89.48±7.27)分.结论 应用自体腘绳肌腱和同种异体半腱肌腱双束重建前十字韧带均能取得优良的初期临床结果.

Comparative study of double-bundle anterior cruciate ligament reconstruction with hamstring tendon autografts versus semitendinosus allografts

Objective To compare the primary clinical results of double-bundle anterior crueiate ligament reconstruction (ACLR) with hamstring tendon autografts versus semitendinosus allografts. Methods From February to August of 2006,61 patients with isolated ACL rupture were treated with hamstring tendon autografts (38 patients) and with semitendinosus allografts (23 patients). To all the patients" objective clinical examinations, including stability of the knee, Lachman test, Pivot Shift Test and leg circumference were taken. International Knee Documentation Committee (IKDC) scores, Tegner scores and Lysholm scores were used to evaluate the clinical results. At 2 years follow-up, MR imaging of the operated knee were taken to evaluate the grafts. Results In autograft group the Laehman test was negative in 35 patients, one plus in 3 patients. In allograft group the Lachman test was negative in 20 patients, one plus in 2 patients, three plus in 1 patient. The pivot test was one plus in one patient of both group. In Autograft group the anterior-posterior transmission side-to-side difference (KT-1000,134 N)was 0-2 mm in 34 patients, and 3-5 mm in 4 patients. In allograft group the side-to-side difference was 0-2 mm in 20 patients (86.96%), 3-5 mm in 2 patients, over 10 mm in 1 patient. IKDC subjective scores in autograft group were 90.26±2.92 versus 89.48±7.27 in allograft group. Lysholm scores was 95.00±4.40 versus 94.57±8.83. Tegner scores was 6.21±0.84 versus 6.17±1.15. The difference of leg circumference in autograft group was (0.62±0.43) cm versus (0.57±0.42) cm in allograft group. Conclusion Double-bundle ACLR with hamstring tendon autografts and semitendinosus allografts have similar excellent results.