自体腘绳肌腱单、双束重建前交叉韧带临床比较研究

目的 比较自体腘绳肌腱单、双束重建前交叉韧带的临床效果.方法 2005年5月至12月采用双束重建前交叉韧带患者33例(双束组),单束重建患者41例(单束组),均采用自体半腱肌腱和股薄肌腱.双束组4例失访,随访时间14～22个月,平均18个月;单束组8例失访,随访时间14-21个月,平均18个月.采用国际膝关节评分委员会评分标准(IKDC),Lysholm和Tegner评分、KT-2000及Biodex肌力测试评价.结果 双束组IKDC,Lysholm和Tegner评分分别由术前的60、66、4分显著上升至术后的85、94、6分.KT-2000在134 N下30°和90°位移情况由术前的5.8和2.4 mm减少为术后1.2和1.1 mm(P＜0.01).双束组伤侧膝关节伸膝及屈膝的峰力矩在60°/s下,相对于正常侧分别为81%和87%,120°/s下为76%和85%.各项值均显著低于对侧(P＜0.01).尽管在30°位KT-2000测量值和伸膝肌力的恢复方面,双束重建较单束重建表现出了更好的趋势,但功能评分,KT测量值和BIODEX测量的结果,单、双束组差异无统计学意义.结论 自体胭绳肌腱单、双束重建前交叉韧带均可以恢复膝关节稳定,改善关节功能,双束重建患者在30°位前后稳定性和伸膝肌力方面表现出了较单束重建更好的趋势.

Compare the clinical results of double-bundle with single-bundle anterior cruciate ligament reconstruction

Objeetive To compare the clinical results of double and single bundle anterior cruciate ligament(ACL)reconstruction.Methods From 2005 May to December the data of 33 patients ( 4 lost follow)with double-bundle and 41 patients(8 lost follow)with single-bundle reconstruction of ACL using auto-hamstring tendons was retrospectively investigated.The foilow-up was 14-22 months(average 18 months)of double-bundle group and 14-21 months(average 18 months)of single-bundle group. The IKDC,Lysholm and Tegner scores,KT-2000 and Biodex were used to evaluate the clinical results.Results The IKDC,Lysholm and Tegner scores were increased significantly from 60,66,4 before the operation to 85,94 and 6 respectively after the double-bundle reconstruction. The KT-2000 results showed that at 30 and 90 degree 134 N the anterior-posterior translations were significantly decreased from 5.8 and 2.4 mm to 1.2 and 1.1 mm respectively of the double-bundle group(P＜0.01).The peak torques of the extend and flex muscles of the involved knee at 60°/s and 120°/s were only at 81%,87%,76%and 85% of the centralateral knee of the double-bundle group.And the difierences were statistically significant (P＜0.01).There were no difierences between the two groups of any index,but the KT value at 30 degree and the extensor peak torque of the double-bundle group manifested a better tendency.Conclusions Both doublebundle and single-bundle ACL reconstruction can restore the stability and improve the function of the knee,and the double-bundle group shows a better tendency at the 30 degree stability and the extensor strength.