自体与同种异体组织重建膝关节前交叉韧带的临床对比研究

目的　观察自体与同种异体移植物关节镜下重建膝关节前交叉韧带 (ACL)的疗效与差异。方法　将 5 3例ACLⅢ度损伤患者随机分为自体组织移植组 (A组 ,n =2 5 )和同种异体组织移植组 (B组 ,n =2 8)。A组包括骨 髌腱 骨 15例 ,4股半腱肌腱或半腱加股薄肌腱重建 10例 ;B组包括骨 髌腱 骨 18例 ,6股半腱加股薄肌腱 4例 ,2股胫后肌腱 4例 ,跟腱骨重建 2例。两组患者术前、术后均行理学检查、Lysholm Tegner和IKDC膝关节综合功能评定及关节活动度测量仪 (KT 2 0 0 0 )检测。随访 12～ 31个月 ,平均 19个月。结果　手术前后两组各项指标有显著差异 (P <0 0 5 ) ;但两组间术后除B组手术耗时短和术后发热时间较长外 ,其它各项指标均无明显统计学差异 (P >0 0 5 )。两组术后健、患侧对比 ,胫骨前移小于 3mm分别达 88%和 86 % ;而 >5mm分别占 4 %和 7 1% ;感染率为 0 %和 3 5 %。结论同种异体与自体移植物重建ACL疗效相近 ,对多发韧带损伤、韧带重建翻修及中老年或运动量较少的患者 ,同种异体移植组织仍是重建ACL良好的替代物

A prospective study of the anterior cruciate ligament reconstruction: allograft versus autograft

OBJECTIVE: To compare the clinical outcomes and differences of arthroscopic anterior cruciate ligament (ACL) reconstruction by using allografts and autografts. METHODS: Fifty-three patients with grade III ACL injuries were divided randomly into 2 groups. Twenty-five cases of group A with autografts of patellar bone-tendon-bone (B-PT-B;n = 15) and 4 strands of semitendinosus/gracilis (n = 10); 28 patients of group B with allografts of B-PT-B (n = 18), 4 strands of semitendinosus/2 strands of gracilis tendons (n = 6) and double tibialis posterior (n = 4) as well as Achilles bone-tendon (n = 2). All procedures were performed endoscopically by some surgeons. All patients were followed up for 12 to 31 months, average 19 months. RESULTS: There were statistically significant differences revealed in physical examination. IKDC and Lysholm-Tegner Score as well as KT-2000 testing was used preoperation and postoperation for both group, but there were no significant differences between the two groups except that group B had less time in operation and longer time in postoperative fever comparing with group A. (2-sample t test, P < 0.05). The KT-2000 side to side difference less than 3 mm were 88% and 86% and more than 5 mm were 4% and 7.1% respectively. The infection rates were 0% and 3.5% for the two groups. CONCLUSION: The clinical outcomes of the allografts and autografts in ACL reconstruction is almost the same. Allografts are a reasonably alternative choice for ACL reconstruction in patients over middle ages and for multiple ligament surgery as well as revision procedures.