自体与异体骨-髌腱-骨移植物重建膝前十字韧带的远期疗效观察

目的 比较自体与异体骨-髌腱-骨(bone-patella tendon-bone,B-PT-B)移植物关节镜下重建膝关节前十字韧带(anterior cruciate ligament,ACL)的远期临床疗效.方法 对66例膝ACL断裂患者分别采用自体与异体B-PT-B移植物重建,其中自体组31例,异体组35例;观察两组手术前后生化、免疫学指标的变化以及全身和膝关节局部反应,以Lysholm评分及Larson评分比较术后疗效.结果 自体组29例获随访,随访时间5～10年,平均7年;异体组32例获随访,随访时间5～6.5年,平均6年.术后两组发热时间无明显差异,术后生化、免疫学指标均无明显异常.Lysholm评分:自体组(93.28±3.12)分,异体组(93.15±3.22)分,两组比较差异无统计学意义(P＞0.05).Lamon评分:自体组(93.12±2.15)分,异体组(92.75±3.25)分,两组比较差异无统计学意义(P＞0.05).术后复查X线片及MRI示:自体组5例出现骨隧道扩大,异体组6例出现骨隧道扩大.术后两组均有1例发生化脓性关节炎;异体组9例冈出现不同程度排斥反应而行镜下冲洗或穿刺冲洗,但无一例取出移植物;异体组1例患者术后移植物发生断裂而行重建术.结论 异体与自体B-PT-B移植物重建ACL远期临床疗效相近,可以获得较为满意的关节活动度及关节稳定性,均为重建ACL的良好移植物.

Bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction: allograft versus autograft

Objective To compare the clinical curative effect between autograft and allograft bone patella tendon-bone (B-PT-B) transplant to reconstruct anterior cruciate ligament (ACL) arthroseopically.Methods ACL reconstruction using autograft and allograft B-PT-B were performed in 66 patients in the study,autograft group had 31 cases,allograft group had 35 cases; observe the biochemistry,immunology and the response of knee joint pre-and postoperation,observe the therapeutic effect after operation,Lysholm and Larson were used to compare the knee function pre-and postoperation.Results Twenty-nine cases in autograft group were followed up for 5 to 10 years,7 years in average and 32 cases in allograft group for 5 to 6.5 years,6 years in average.The time of generating heat had no significant deviation,biochemistry,immunology after operation had no significant deviation; Lysholm score were 93.28+3.12 (autograft group),93.15±3.22 (allograft group).Difference had not statistically significant (P ＞0.05); Larson score were 93.12±2.15(autograft group),92.75±3.25(allograft group),difference had not statistically significant; the X-ray and MRI results after operation: autograft group had 5 cases of bone tunnel expansion,allograft group had 6 cases of bone tunnel expansion; postoperative complications: both of two groups had one cases of suppurative arthritis,9 cases in allograft group suffered reject reaction,and need clysis under arthroscope or by paracentesis,but none need take out the graft; 1 patient of allograft group was broken and reconstruction.Conclusion Autograft and allograft B-PT-B transplant have the same clinical curative effect in ACL reconstruction,and can make satisfactory motion and stability of joint,and both are nice grafts.