自体胭绳肌腱和骨-髌腱-骨移植重建前交叉韧带的比较

目的前瞻性、随机对照研究应用自体胭绳肌腱、骨-髌腱-骨移植重建前交叉韧带的临床效果。方法选择2008年1月至2010年1月青岛市市立医院（东院区）骨科、莱阳市中心医院骨科确诊的前交叉韧带损伤患者137例为研究对象，随机分为A、B两组。A组采用自体骨-髌腱-骨移植，B组采用自体胭绳肌腱移植，随访两组患者的手术情况、手术前后膝关节活动度、膝关节稳定性、Lysholm评分、国际膝关节评分委员会评分及应用KNEELEX3测试膝关节屈曲30。和90。时胫骨端前移的距离，并进行统计学分析。结果共111例患者获得超过2年完整随访。两组患者术前情况未见明显差异（P〉0．05）。术后2年，两组患者的膝关节活动度、膝关节稳定性、Lysholm评分、国际膝关节评分委员会评分及应用KNEELEX3测试膝关节屈曲30°和90°时胫骨端前移的距离未见明显差异（P〉0．05）。B组患者的手术时间、术后并发症的发生情况显著低于于A组（P〈0．05）。结论应用自体胭绳肌腱移植重建前交叉韧带可以达到应用自体骨-髌腱-骨重建的临床疗效，但其髌前疼痛等并发症的发生率却显著低于自体骨-髌腱-骨，故此，从早期疗效来看，应用自体胴绳肌腱重建前交叉韧带比自体骨-髌腱-骨具有更大的优势。

Hamstring Tendon Autograft Versus Bone-patellar Tendon-bone Autograft for Reconstruction of Anterior Cruciate Ligament

Objective To compare the clinical outcome of reconstruction of anterior cruciate ligament by hamstring tendon autograft and bone-patellar tendon-bone autograft. Methods 137 patients with single anterior cruciate ligament injury between January 2008 and January 2010 were included in this study. All the patients were randomLy divided into two groups ：Oroup A, bone-patellar tendon-bone autograft group,Group B, hamstring tendon autograft group. After operation the operation condition,the stability of the knee ,the ROM of the knee ,the Lysholm and IKDC scores,the tibial forwards distances tested by KNEELEX3 when the joint flexed at 30° and 90° were recorded. All the data were analyzed. Results Total 111 patients were successfully healed and followed up. There was no significantly difference between the two groups in general conditions before operation. Two years after operation, there were no significantly difference between the two groups in the stability of the knee,the ROM of the knee,the Lysholm and IKDC scores and the tibial forwards distances tested by KNEELEX3 when the joint flexed at 30~ and 90°. The opera tion time and the complications in group B were significant less than group A. Conclusion The clinical effect of ante rior cruciate ligament reconstruction by hamstring tendon autograft was as well as bone-patellar tendon-bone autograft, but the complications was less. Therefore ,hamstring tendon autograft should be the preferred choice for anterior cruciate ligament reconstruction.