关节镜下异体跟腱单双束重建后交叉韧带的随机对照

背景：关节镜下重建后交叉韧带主要有单束重建和双束重建两种方式。 目的：随机对比应用异体跟腱单双束重建后交叉韧带损伤的临床疗效。 方法：选择青岛市市立医院骨科2006-01/2009-01的后交叉韧带损伤患者共70例，随机分为单束重建组和双束重建组，分别行异体跟腱单束重建及双束重建。 结果与结论：术后顺利完成康复计划并获得随访的病例共52例。双束重建组手术时间较单束重建组长，行关节腔穿刺的病例数较单束重建组多(P < 0.05)。手术后18个月随访结果显示，单束组重建及双束重建组的膝关节活动度、Lysholm评分、IKDC评分与术前比较有明显提高(P  < 0.05)，两组膝关节屈曲30°和90°时用KNEELAX3测量胫骨端后移距离明显低于术前(P  < 0.05)。两组术后Lysholm评分、 IKDC评分、两组膝关节屈曲30°和90°时用KNEELAX3测量胫骨端后移距离未见明显差别(P > 0.05)。说明与单束重建比较，双束重建后的早期临床疗效无明显提高，且双束重建的手术创伤大，手术时间长，术后关节肿胀重，故不推荐作为首选手术方式，其远期疗效优待进一步观察。

Endoscopic posterior cruciate ligament reconstruction using achilles tendon allografts: single-bundle versus double-bundle

BACKGROUND:Endoscopic posterior cruciate ligament reconstruction using achilles tendon allografts has been primarily performed by single-bundle and double-bundle types. OBJECTIVE:To compare the clinical outcome of single-bundle and double-bundle endoscopic posterior cruciate ligament reconstruction using achilles tendon allograft. METHODS:A total of 70 patients with single posterior cruciate ligament injury who received treatment at the Department of Orthopedics, Qingdao Municipal Hospital between January 2006 and January 2009 were included in this study. All patients were randomly divided into two groups: single-bundle group and double-bundle group. The single-bundle group had single-bundle reconstruction using achilles tendon allograft, and the double-bundle group had double-bundle reconstruction. RESULTS AND CONCLUSION:After surgery, 52 patients were successfully healed and followed up. The surgery time and the number of patients who need joint puncture were greater in the double-bundle group than in the single-bundle group (P < 0.05). At 18 months after surgery, the stability and range of motion of the knee joint, Lysholm and IKDC scores were improved in each group compared with prior to surgery (P < 0.05). The tibial backward distance tested by KNEELAX3 when the knee joint flexed at 30° and 90° was significantly improved compared with prior to surgery (P < 0.05). There was no significant difference in the range of motion of the knee joint, Lysholm and IKDC scores, and the tibial backward distance tested by KNEELAX3 when the knee joint flexed at 30° and 90° between the single-bundle and double-bundle groups (P > 0.05). Compared with single-bundle reconstruction, double-bundle reconstruction resulted in poor improvement in early clinical curative effects and greater surgical trauma, required long surgery time, and lead to swelling of the knee joint. Therefore, double-bundle reconstruction should not be the preferred protocol for posterior cruciate ligament reconstruction and its long-term effects need to be further investigated.