关节镜下自体肌腱单双束重建后交叉韧带：前瞻性队列研究

背景：有研究认为后交叉韧带损伤在临床疗效上双束重建法并没有表现出其应有的优势，且较单束重建有一些难以克服的缺陷。双束与单束重建孰优孰劣？目前学界还没有给出一个统一的答案。目的：应用前瞻性队列研究探讨自体肌腱单双束重建后交叉韧带的疗效和安全性。方法：后交叉韧带损伤患者81例，按照随机数字表法分为单束重建组41例，双束重建组40例。对比两组患者韧带重建前、重建后24个月关节稳定性、Lysholm及Tegner评分，并比较两组患者住院天数、手术时间、重建后发热天数及需要穿刺的数量。结果与结论：双束重建组患者移动度显著高于单束重建组(F=4.362，P=0.000)；两组患者重建后24个月Lysholm及Tegner评分较重建前均有显著提高(P < 0.05)，但重建前及重建后24个月两组之间差异无显著性意义(P > 0.05)。双束重建组患者手术用时及住院天数及重建后需要行关节腔穿刺的患者数均显著高于单束重建组(P < 0.05)。结果说明关节镜下单双束重建均是治疗后交叉韧带损伤的安全有效的方法，但是双束重建用时长、创伤大，不建议作为首选的修复方式。

Single-and double-bundle posterior cruciate ligament reconstruction under arthroscopy: a prospective cohort study

BACKGROUND:Some studies have shown that the double-bundle posterior cruciate ligament reconstruction is not superior to the single-bundle posterior cruciate ligament reconstruction, and still has some deficiencies difficult to overcome. Which is better, double-bundle reconstruction or single-bundle reconstruction? There is no uniform conclusion. OBJECTIVE: Toperform a prospective cohort study on the clinical efficacy and safety of autologous single- and double-bundle posterior cruciate ligament reconstruction.METHODS:Totally 81 patients with posterior cruciate ligament injury were randomly divided into single-bundle reconstruction group (n=41) and double-bundle reconstruction group (n=40). The knee stability, Lysholm score, Tegner score, hospital stay, operation time, fever days and number of puncture cases were compared between the two groups before and 24 months after reconstruction.RESULTS AND CONCLUSION:Compared with the single-bundle reconstruction group, the knee stability was significantly worse in the double-bundle reconstruction group (F=4.362, P=0.000); the operation time, hospital stay and number of puncture cases were also higher in the double-bundle reconstruction group (P < 0.05). At 24 months after reconstruction, the Lysholm and Tegner scores were both increased significantly in the two groups (P < 0.05), but there was no difference between the two groups (P > 0.05). These findings indicate that both single- and double-bundle reconstruction under arthroscopy is safe and effective treatment for posterior cruciate ligament injury, but the double-bundle reconstruction is not recommended as the preferred surgical procedure because of longer time and larger trauma.