LARS韧带与自体腘绳肌腱加高强线保残重建后交叉韧带疗效比较

目的：比较关节镜下后交叉韧带(posterior cruciate ligament,PCL)保残重建术中应用先进韧带加强系统(ligament advanced reinforcement system,LARS)韧带与自体腘绳肌腱加高强线的临床效果。方法：选择 2019 年 8 月至2021 年 12 月行关节镜下 PCL 保残重建术治疗的 96 例单纯 PCL 损伤,其中男 78 例,女 18 例;年龄 20~56(32.50±8.68)岁;左侧 40 例,右侧 56 例。根据术中移植物不同分为两组。LARS 韧带保残重建组(LARS 韧带组)52 例,其中男42 例,女 10 例;年龄(31.84±8.62)岁;身体质量指数(body mass index,BMI)为(24.73±2.29) kg·m^-2;采用 7 mm LARS 韧带保残重建 PCL。自体腘绳肌腱加高强线组(自体肌腱组)44 例,其中男 36 例,女 8 例;年龄(33.06±8.99)岁;BMI 为(23.52±2.16) kg·m^-2; 采用 4 股腘绳肌腱加 3 根爱惜邦缝线加强技术保残重建 PCL。术后 3、6、12 个月通过 KT-1000测量膝关节的松弛度客观评价膝关节的稳定性,采用 Lysholm、Tegner、国际膝关节文献委员会(International Knee Doc-umentation Committee,IKDC)评分进行主观评分评价膝关节的功能。收集两组患者术前及术后 3、6、12 个月时随访的数据,比较两组患者术后康复情况及韧带松弛度的差异性。结果：96 例患者获得随访,时间为 12 个月。膝关节 KT-1000 测量值自体肌腱组及 LARS 韧带组术前[(10.73±1.46)分 vs (10.55±1.53)分]、术后 6 个月[(3.02±0.75)分 vs(2.35±0.60)分]、12 个月[(3.77±1.76)分 vs(2.44±0.60)分],术后 6、12 个月组间比较差异有统计学意义(P<0.05);术后3 个月,两组比较,差异无统计学意义(P>0.05)。自体肌腱组、LARS 韧带组术前及术后 12 个月 Lysholm 总分[(40.6±16.8)、(91.25±6.35)分 vs (51.92±18.52)、(92.35±5.30)分],Tegner 评分[(1.8±0.7)、(5.8±0.6)分 vs (1.7±0.8)、(5.7±0.7)分],IKDC 总分[(54.50±6.33)、(83.90±3.93)分 vs (54.40±4.24)、(83.62±3.64)分],术后 12 个月与术前比较,差异均有统计学意义 (P<0.05)。自体肌腱组与 LARS 韧带组术后 3、6 个月,Lysholm 总分[(65.86±11.54)、(74.60±6.46) 分 vs(73.46±6.42)、(86.73±4.62)分],Tegner 评分[(2.5±0.6)、(3.5±0.5)分 vs (4.3±0.7)、(5.0±1.4)分],IKDC 总分[(55.78±2.68)、(70.62±4.74)分 vs (65.31±4.60)、(79.71±2.93)分],两组比较,差异有统计学意义(P<0.05),但术后 12 个月,两组比较,差异无统计学意义(P>0.05)。结论：自体腘绳肌腱加高强线与 LARS 韧带保残重建 PCL 均可明显改善膝关节功能和稳定性,术后效果满意,但 LARS 韧带术后稳定性更佳。

Comparison of the efficacy of LARS ligament and autogenous hamstring tendon plus high-strength suture in posterior cruciate ligament reconstruction

Objective To compare the clinical efficacy of ligament advanced reinforcement system (LARS) and autogenous hamstring tendon plus high-strength suture in arthroscopic reconstruction of posterior cruciate ligament (PCL).

Methods A total of 96 patients with simple PCL injury treated with arthroscopic posterior cruciate ligament reconstructive surgery admitted to our hospital between August 2019 and December 2021 were selected for complete follow-up. There were 78 males and 18 females,40 cases of left leg and 56 cases of right leg,the aged from 20 to 56 years old with an average of (32.50±8.68) years old. The transplants were divided into two groups:LARS group (52 cases) and autogenous hamstring tendon plus high-strength suture group (44 cases). In the LARS group,there were 42 males and 10 females;with an average age of (31.84±8.62) years old;body mass index (BMI) was (24.73±2.29) kg﹒m^-2;7 mm LARS was used to reconstruct PCL. In the autologous tendon group,there were 36 males and 8 females,with an average age of (33.06±8.99) years old,BMI was (23.52±2.16) kg·m^-2,and the PCL was reconstructed with four strands of hamstring tendons and three pieces of Ethibond suture. All patients underwent functional rehabilitation guided exercise and were followed up regularly after surgery to objectively evaluate the stability of the knee joint by KT-1000 measurement of knee relaxation,and subjective evaluation of knee function by Lysholm score,Tegner score,and International Knee Documentation Council (IKDC) score. Data from preoperative,3,6,and 12 month follow-up were collected and analyzed by SPSS software to compare postoperative recovery and ligament relaxation between the two groups of patients.

Results Ninety six patients were followed up for 12 months. KT-1000 measurement of knee joint in autogenous tendon group and LARS group before operation[(10.73±1.46) points vs (10.55±1.53) points],6 months after operation[(3.02±0.75) points vs (2.35±0.60) points],12 months after operation[(3.77±1.76) points vs (2.44±0.60) points]. There was significant difference between the two groups at 6 and 12 months after operation (P<0.05),but there was no significant difference between the two groups at 3 months after operation (P>0.05). In the autogenous tendon group and LARS group,before operation and 12 months after operation,total Lysholm score[(40.6±16.8),(91.25±6.35) points vs (51.92±18.52),(92.35± 5.30) points],Tegner score[(1.8±0.7),(5.8±0.6) points vs (1.7±0.8)、(5.7±0.7) points] and total IKDC score[(54.50± 6.33),(83.90±3.93) points vs (54.40±4.24),(83.62±3.64) points],the differences were statistically significant (P<0.05), indicating that the knee function of the two groups was improved after surgery. At 3 and 6 months after operation in the autogenous tendon group and LARS group,the total Lysholm score[(65.86±11.54),(74.60±6.46) points vs (73.46±6.42),(86.73± 4.62) points],Tegner score[(2.5±0.6),(3.5±0.5) points vs (4.3±0.7),(5.0±1.4) points],the total scores of IKDC[(55.78± 2.68),(70.62±4.74) points vs (65.31±4.60),(79.71±2.93) points]. The difference between two groups was statistically significant (P<0.05). The results showed that the function of the knee joint in the LARS group was better than that the autologous tendon group. However,at 12 months after the operation,there was no significant difference in the score of knee joint function between the two groups (P>0.05). The results showed that the stability of LARS group was better than that of autologous tendon group.

Conclusion Both the autogenous hamstring tendon plus high-strength suture and LARS reconstruction can significantly improve the knee function and stability,with satisfactory postoperative results. Howervr the LARS provides superior postoperative stability.