关节镜下同种异体胫前肌腱与自体腘绳肌腱重建前交叉韧带远期效果的比较

目的 :对比同种异体胫前肌腱(tibialis anterior allograft,TAA)与自体腘绳肌腱(hamstring tendon autograft,HTA)重建前交叉韧带(anterior cruciate ligament,ACL)的10年随访临床疗效。方法:回顾分析2007年3月至2010年3月单束重建ACL的107例患者的临床资料,采用同种异体胫前肌腱进行重建48例(TAA组),男26例,女22例,年龄16～38(27.2±6.2)岁;采用自体腘绳肌腱进行重建59例(HTA组),男31例,女28例,年龄16～40(28.0±7.6)岁。观测术前胫骨前移距离、膝关节功能评分及术后10年膝关节稳定性、胫骨前移距离和膝关节功能评分。采用Lachman试验评价膝关节前向稳定性,轴移试验评价膝关节旋转稳定性;采用KT-2000 SSD值衡量胫骨前移距离;采用IKDC评分和Lysholm评分评价膝关节功能。结果:两组患者术后切口均Ⅰ期愈合,无早期术后并发症发生,所有患者均获随访,时间10～13年,随访期间所有患者未发现移植物失效。TAA组和HTA组术后10年KT-2000 SSD值分别为1.9±0.7和1.8±0.6,均较术前的8.8±0.9和8.6±1.0显著改善(P0.05),但两组间比较差异无统计学意义(P0.05)。TAA组和HTA组术后10年Lysholm总分分别为(90.4±4.4)分和(90.7±3.4)分,均较术前的(51.4±13.3)分和(51.2±14.6)分显著提高(P0.05),但两组间比较差异无统计学意义(P0.05)。TAA组和HTA组术后10年IKDC总分分别为(91.5±4.1)分和(90.9±3.2)分,均较术前的(45.8±12.2)分和(47.0±14.5)分显著提高(P0.05),但两组间比较差异无统计学意义(P0.05)。术后10年两组患者Lachman试验、轴移试验组间比较差异无统计学意义(P0.05)。结论:同种异体胫前肌腱与自体腘绳肌腱重建前交叉韧带的远期疗效相当,医生及患者可根据实际情况选择移植物。

Tibialis anterior allograft versus hamstring tendon autograft for anterior cruciate ligament reconstruction: long-term clinical outcomes

Objective: To compare the clinical outcomes of arthroscopic anterior cruciate ligament(ACL) reconstruction(ACLR) with a tibialis anterior allograft (TAA)versus hamstring tendon autograft (HTA) after 10 years follow-up.Methods: A clinical data of 107 patients who underwent arthroscopic ACLR with a single bundle tendon between March 2007 and March 2010 was retrospectively analyzed. Among the patients,48 patients were reconstructed with a tibialis anterior allograft(TAA group),including 26 males and 22 females,ranging in age from 16 to 38 years,with a mean of 27.2±6.2 years;59 patients were reconstructed with a hamstring tendon autograft (HTA group),including 31 males and 28 females,ranging in age from 16 to 40 years,with a mean of 28.0±7.6 years. The preoperative tibial anterior displacement and knee joint function,as well as knee joint stability,tibial anterior displacement and knee joint function at 10 years after operation were observed. Lachman test was used to evaluate the forward joint stability and pivot shift test to evaluate the rotational stability of the knee;KT-2000 side-to-side difference(SSD) was used to measure tibial anterior displacement;International Knee Documentation Committee(IKDC) score and Lysholm score were used to evaluate knee function.Results: The incisions of both groups were healed by first intention,and no early complications occurred after operation. All patients were followed-up 10 to 13 years,the mean time was 11.7 years. There was no graft failure were found during the follow-up period. The KT-2000 SSD of the TAA group and the HTA group at ten years after operation were 1.9±0.7 and 1.8±0.6 respectively,which were significantly improved than 8.8±0.9 and 8.6±1.0 preoperatively(P<0.05),but there were no significant difference between the two groups(P>0.05). The total Lysholm score of the TAA group and the HTA group at ten years after operation were 90.4±4.4 and 90.7±3.4 respectively,which were significantly improved than 51.4±13.3 and 51.2±14.6 preoperatively(P<0.05),but there were no significant difference between the two groups(P>0.05). The total IKDC score of the TAA group and the HTA group at ten years after operation were 91.5±4.1 and 90.9±3.2 respectively,which were significantly improved than 45.8±12.2 and 47.0±14.5 preoperatively(P<0.05),but there were no significant difference between the two groups(P>0.05). No significant difference were found between the two groups in Lachman test and pivot shift test at 10 years after operation(P>0.05).Conclusion: The TAA and HTA have equal long-term effect in ACL reconstruction,doctors and patients can choose the graft according to the actual situation.