γ射线照射与非照射同种异体骨-髌腱-骨重建前交叉韧带的临床前瞻性比较研究

目的 比较研究经γ射线照射与单纯深低温冷冻保存的同种异体骨-髌腱-骨(B-PT-B)重建前交叉韧带(ACL)的临床疗效.方法 将66例ACL断裂患者术前电脑随机抽样分组法分为两组:A组为深低温冷冻保存+γ射线照射34例,B组为单纯深低温冷冻保存32例.两组手术均由同一术者采用标准关节镜技术完成.手术前后通过一般情况比较、膝关节活动度、轴移试验、Lachman试验及前抽屉试验(ADT)、Daniel单腿水平跳跃与Hamer垂直跳跃试验、国际膝关节文献委员会(IKDC)评分及KT-2000检测对临床疗效进行评价.结果 术后63例得到完整随访(A组32例,B组31例),3例失访,A组平均随访38.3个月,B组平均随访37.7个月.B组迟发感染1例.两组住院时间和术后发热天数等一般情况比较差异无统计学意义(P>0.05),但A组术后平均发热时间(8.9 d)与B组(7.8 d)相比有延长的趋势.理学检查:两组伸屈膝差异均无统计学意义(P>0.05);但Lachman试验和ADT结果比较差异有统计学意义(P<0.05);两组轴移试验阳性者分别为12例和3例,差异有统计学意义(P<0.05).KT-2000检测显示A、B两组分别有8例和26例患者术后健患侧对比<3 mm,12例和2例患者>5 mm,两组比较差异均有统计学意义(P<0.05).A组膝关节前后及旋转稳定性均显著降低.Daniel单腿水平跳跃与Hamer垂直跳跃两种功能试验及IKDC评分比较差异无统计学意义(P>0.05),但A组术后患肢功能水平及IKDC评分均有降低的趋势.结论 γ射线照射后的同种异体B-PT-B重建ACL的关节稳定性较差,应慎用.

ACL reconstruction with irradiated versus non-irradiated deep-frozen bone-patellar tendon-bone allograft: a prospective randomized clinical study

Objective To compare the clinical outcomes of irradiated versus non-irradiated deepfrozen bone-patellar tendon-bone (B-PF-B) ullograft in anterior cruciate ligament (ACL) reconstruction. Methods A total of 66 patients undergoing arthroecopic ACL reconstruction were prospectively random-ized consecutively into two groups, ie, Group A ( irradiated deep-frozen allograft, n = 34) and Group B ( non-irradiated deep-frozen allograft, n = 32). All ACL reconstructions were done by the same senior surgeon with the same arthroscopic technique. Before and after surgery, the clinical results were compared in aspects of general conditions, range of motion ( ROM), Pivot shift test, Lachman and Anterior Drawer Test (ADT), Daniel's one-leg hop and Harner's vertical jump tests, overall international knee docu-mentation committee (IKDC) rating and KT-2000 arthrometer testing. Results Of all, 63 patients in-eluding 32 patients in Group A and 31 in Group B were available for a follow-up of average 38 months ( mean 38.3 months in Group A and mean 37.7 months in Group B) and three lost follow-up. There was one patient with late septic infection. While there was no statistical difference in aspects of general condi-tions including hospital stay, duration of fever and complications ( P > 0. 05 ), but there was a trend that the patients in Group A had a longer postoperative duration of fever ( mean 8.9 days ) than Group B (mean 7.8 days). Physical examinations showed no statistical difference upon ROM in both groups ( P > 0. 05), while there was statistical difference between Lachman test and ADT ( P < 0.05 ). The positive Pivot shift test was found in 12 patients in Group A and 3 in Group B, with statistical difference ( P < 0. 05 ). KT-2000 testing showed a side-to-side difference of less than 3 mm in 26 patients in Group B and only 8 in Group A, and a side-to-side difference of more than 5 mm in two patients in Group B and 12 in Group A, with statistical difference (P < 0.05 ). The anterior and rotational stability was decreased sig-nificantly in Group A. No statistical difference was found between two groups in overall IKDC rating, Daniel' s one-leg hop and Harner' s vertical jump tests ( P > 0.05 ). However, the function and IKDC score tended to decrease in Group A. Conclusion The short term clinical outcomes of the ACL reconstruction with irradiated B-PT-B allograft are adversely affected and unsatisfactory, indicating a cautious use.