关节镜下膝关节前后交叉韧带重建：自体移植与异体移植的中远期疗效对比*

背景：关节镜下一期联合重建关节镜下前、后交叉韧带的文献报道不多，尤其是中长期随访研究。目的：关节镜下一期自体肌腱与同种异体肌腱重建前、后交叉韧带的中远期疗效比较。方法：自2002-06/2007-06对45例前后交叉韧带同时断裂患者行一期重建，20例选用自体移植物，25例选用异体移植物，以可吸收挤压钉固定行前后交叉韧带单束重建，同时处理合并伤。结果与结论：33例获随访，随访时间3~8年，关节活动无明显受限。3例前抽屉试验弱阳性，5例后抽屉试验弱阳性；LACHMAN征弱阳性6例，轴移试验弱阳性3例。自体肌腱和同种异体肌腱重建3年后患膝Lysholm评分、Larson评分均明显高于重建前(P < 0.05)。自体肌腱与同种异体肌腱患膝Lysholm评分、Larson评分比较差异均无显著性意义(P > 0.05)。8例出现骨隧道扩大，5例为前交叉韧带胫骨段，3例为后交叉韧带胫骨段。5例出现关节积液，经关节腔穿刺冲洗后缓解，随访期间无韧带再断裂。结果表明关节镜下一期自体肌腱与同种异体肌腱重建前后交叉韧带均可获满意的关节活动度及关节稳定性，中远期疗效好。关键词：膝关节；前交叉韧带；后交叉韧带；重建；关节镜doi:10.3969/j.issn.1673-8225.2012.05.042

One-stage arthroscopic reconstruction of anterior and posterior cruciate ligaments: A mid- and long-term curative effect of autograft versus allograft

BACKGROUND: Few studies on one-stage arthroscopic combined with arthroscopic reconstruction anterior crueiate ligament (ACL) and posterior cruciate ligament (PCL), especially on mid- and long-term follow-up. OBJECTIVE: To introduce one-stage arthroscopic reconstruction of ACL and PCL, and to evaluate the mid- and long-term clinical curative effect.METHODS: From June 2002 to June 2007, 45 patients with ACL and PCL injuries received one-stage arthroscopic reconstruction. Totally 20 cases chosing autografts and 25 cases chosing allografts. The reconstruction with absorbable screw was performed using the single-bundle ACL and PCL technique. Wound was treated simultaneously.RESULTS AND CONCLUSION: Totally 33 patients were followed up for 3 to 8 years. The range of motor was normal. Anterior drawer test of 3 cases were mild-positive, posterior drawer test of 5 cases were mild-positive. LACHMAN test of 6 cases was mild-positive, pivot shift test of 3 cases was mild-positive. Lysholm score and Larson score of autografts and allografts teams after 3 years construction were higher than those of before reconstruction (P < 0.05). There were no difference in Lysholm score and Larson score between the autografts team and the allografts team (P > 0.05). Eight cases were bone tunnel expansion, including 5 cases of ACL tibial segment, 3 cases of PCL tibial segment. Five cases suffered from hydrops articuli, and then treated with paracentesis and clysis, none were broken again. It is indicated that one-stage arthroscopic reconstruction of ACL and PCL with autograft and allograft can both obtain satisfactory motion range, joint stability and well clinical effect of mid-and long-term follow-up.