三种移植物关节镜下重建前交叉韧带的临床疗效比较

目的比较分析膝关节镜下自体骨-髌腱-骨（B-PT-B）、同种异体跟腱和LARS（1igament advanced reinforce．mentsystem，LARS）人工韧带重建前交叉韧带（anterior cruciate ligament，ACL）的临床疗效差异。方法从2008年2月-2010年11月，对156例膝关节ACL损伤患者行关节镜下ACL重建术，其中自体骨-髌腱-骨（B-PT-B）组39例，同种异体跟腱组53例，LARS人工韧带组64例。通过一般情况、前抽屉试验、Lachman试验、轴移试验、Lysholm、IKDC膝关节评分进行临床疗效评价。结果所有患者随访12-38个月，平均21个月，术后3、6个月各组膝关节Lysholm、IKDC评分，LARS组明显高于其余2组（P〈O．05）。异体跟腱组与自体B-PT-B组相比，差异无统计学意义（P〉0．05）。术后12月及最后随访时，LARS组略高于其余2组，但3组间差异无统计学意义（P〉0．05）。结论在关节镜下应用3种不同移植物重建前交叉韧带的近期疗效均较为满意，LARS组可在术后早期进行膝关节功能活动近期效果优于自体B-PT-B组和异体跟腱组。对于年轻患者．尤其是运动员ACL损伤。LARS人工韧带是一种理想移植材料。

Comparison of clinical efficacy of three graft materials by arthroscopy for ACL reconstruction

Objective To analyze and compare the clinical results of arthroscopic ACL reconstruction with bone-patel- lar tendon-bone （B-PT-B） autograft, achilles tendon allograft and ligament advanced reinforcement system （LARS）. Meth- ods From Feb 2008 to Nov 2010,156 patients with ACL injury were treated under arthroscopic observation. There were 39 cases of bone-patellar tendon-bone （B-PT-B） autograft, 53 cases of achilles tendon-bone allograft, 64 cases of LARS artificial ligament. Before surgery and at follow-up, patients were evaluated to compare the clinical outcomes by general conditions, ante- rior drawer test,Lachman test,pivot shift test,Lysholm,IKDC knee score. Results All patients were followed up for 12 to 38 months,an average of 21 months. There was significant difference that Lysholm score of LARS group was significantly higher than the other two groups in 3,6 month postoperatively （P〈0.05）. Allogeneic Achilles tendon group compared with autologous B- PT-B group, the difference was not statistically significant （P〉0.05）. 12 months after surgery and the last follow-up, LARS was slightly higher than the other two groups, but no statistically significant differences among the three groups （P〉0.05）. Conclu- sion The short-term effect of the application of three different graft reconstruction arthroscopic anterior eruciate ligament are more satisfied.The short-term effect of the LARS group in the early postoperative knee function better than the B-PT-B group of autologous and allogeneic Achilles tendon group.For younger patients, especially athletes ACL injury, LARS artificial ligament is an ideal graft material.