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关节镜下不同移植物重建前交叉韧带68例
引用本文:许永涛,李锋,鲁厚庚,刘铁,陈安民.关节镜下不同移植物重建前交叉韧带68例[J].中国修复重建外科杂志,2007,21(11):1163-1166.
作者姓名:许永涛  李锋  鲁厚庚  刘铁  陈安民
作者单位:1. 华中科技大学同济医学院附属同济医院骨科,武汉,430030
2. 华中科技大学同济医学院附属荆州医院骨科,武汉,430030
摘    要:目的总结关节镜下不同移植物重建前交叉韧带(anterior cruciate ligament,ACL)的疗效。方法回顾性分析1999年5月~2005年5月收治的68例ACL损伤患者治疗方法。其中应用自体中1/3骨-髌韧带-骨移植物和界面螺钉固定26例(A组),男16例,女10例;年龄16~45岁,平均26.4岁;左膝14例,右膝12例;损伤至手术时间1周~15个月,平均3.1个月;术前Lysholm评分65.3±4.8分,IKDC主观评分43.5±5.2分。应用4股半腱肌腱内扣式钮扣钢板悬吊固定38例(B组),男24例,女14例;年龄13~48岁,平均24.6岁;左膝27例,右膝11例;损伤至手术时间1周~16个月,平均4.3个月;术前Lysholm评分68.4±5.6分,IKDC主观评分41.4±6.2分。异体中1/3髌韧带界面螺钉固定4例(C组),男3例,女1例;年龄55~65岁;左膝3例,右膝1例;损伤至手术时间2周~28个月,平均7.3个月;术前Lysholm评分60.3±6.7分,IKDC主观评分40.5±3.8分。结果患者获随访12~36个月,其中A组平均随访17.5个月,B组18.5个月,C组16.5个月。均未发现关节内感染、下肢深静脉血栓形成和血管、神经损伤等并发症。A组23例术后膝关节恢复至损伤前运动水平,未发生髌骨骨折;Lysholm评分95.1±4.3分,优18例,良5例,一般3例,优良率88.5%;IKDC评分93.7±3.8分,膝关节功能正常19例(73.1%),一般5例(19.2%),较差2例(7.7%)。B组33例术后膝关节恢复至损伤前运动水平;Lysholm评分93.0±5.9分,优28例,良5例,一般5例,优良率86.8%。IKDC评分95.7±4.7分,膝关节功能正常30例(78.9%),一般5例(13.2%),较差3例(7.9%)。C组4例术后膝关节均基本恢复至损伤前运动水平;Lysholm评分92.4±4.3分,优3例,良1例;IKDC评分94.8±3.6分,膝关节功能正常3例,一般1例,均未见明显关节积液。3组患者手术前后Lysholm评分及IKDC评分差异均有统计学意义(P<0.01),术后评分优于术前;组间差异无统计学意义(P>0.05)。结论骨-髌腱-骨和股薄肌-半腱肌腱,是修复ACL的良好移植物。青少年骨骺未闭患者,半腱肌腱移植是较好的方式;老年患者为减少取移植物的并发症,深低温保存的同种异体髌韧带移植也是一个可以选择的途径。

关 键 词:前交叉韧带  髌韧带  半腱肌腱  异体移植  修复重建
修稿时间:2007-03-16

RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT WITH DIFFERENT GRAFTS UNDER ARTHROSCOPE IN 68 CASES
XU Yongtao, LI Feng, LU Hougeng,et al..RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT WITH DIFFERENT GRAFTS UNDER ARTHROSCOPE IN 68 CASES[J].Chinese Journal of Reparative and Reconstructive Surgery,2007,21(11):1163-1166.
Authors:XU Yongtao  LI Feng  LU Hougeng  
Institution:Department of Orthopaedics of Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan Hubei, 430030, PR China. xyt7512@medmail.com
Abstract:OBJECTIVE: To study the clinical effect of anterior cruciate ligament (ACL) reconstruction with different grafts under arthroscope. METHODS: A retrospective analysis was done on 68 cases of ACL injury. ACL reconstruction with bone-patellar tendon-bone autograft and interface screw fixation were performed in 26 cases (group A) and quadruple semitendinosus tendon autograft and endobutton plate fixationin in 38 cases (group B). ACL reconstruction with bone-patellar tendon-bone allograft cryopreserved and interface screw fixation were performed in 4 cases (group C). There were 16 males and 10 females with an average age of 26.4 years (16-45 years) in group A, 24 males and 14 females with an average age of 24.6 years (13-48 years) in group B, and 3 males and 1 female (55-65 years) in group C. The left knee involved in 14 cases, 27 cases and 3 cases, and the right knee involved in 12 cases, 11 cases and 1 case in groups A, B and C, respectively. The disease courses were 1 week to 15 months (group A), 1 week to 16 months (group B) and 2 weeks to 28 months (group C). The intermediate myodynamic recovery, IKDC score and Lysholm score were compared among 3 groups. RESULTS: All patients were followed 12-36 months (17.5 months in group A, 18.5 months in group B and 16.5 months in group C). No intra-articular infection, phlebothrombosis of leg, vascular injury and nerve injury occurred. Lysholm scores was increased from preoperative 65.3+/-4.8 to postoperative 95.1+/-4.3 in group A, from 68.4+/-5.6 to 93.0+/-5.9 in group B and from 60.3+/-6.7 to 92.2+/-4.3 (excellent in 3 cases and good in 1 case) in group C; the excellent and good rates were 88.5% (excellent in 18 cases, good in 5 cases and fair in 3 cases) in group A, 86.8% (excellent in 28 cases, good in 5 cases and fair in 5 cases) in group B, IKDC scores were 93.7+/-3.8 (group A), 95.7+/-4.7 (group B) and 94.8+/-3.6 (group C); the knee joint functions were normal in 19 cases (73.1%), in 30 cases (78.9%) and in 3 cases, were fair in 5 cases (19.2%), in 5 cases (13.2%) and in 1 cases in groups A, B and C respectively. CONCLUSION: The transplantation of bone-patellar tendon-bone autograft , quadruple semitendinosus tendon autograft and bone-patellar tendon-bone allograft all can reconstruct and strengthen the stability of knee joint. Bone-patellar tendon-bone allograft is better selection for the ACL injury in elder and quadruple semitendinosus tendon autograft is suitable to adolescent patients with disrupted ACL.
Keywords:Anterior cruciate ligament Patellar tendon Semitendinosus tendon Allograft Repair and reconstruction
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