自体与异体腘绳肌腱移植重建前交叉韧带对比研究

Comparative Research of anterior cruciate ligament reconstruction with allo- or auto-graft hamstring

关键词:  关节镜  前交叉韧带  重建  异体腘绳肌腱

Key words:  arthroscopy  anterior crutiate ligament  reconstruction  allograft hamstring

摘要:

［目的］比较自体与异体腘绳肌腱重建前交叉韧带（ACL）的临床疗效。［方法］回顾性分析2006年1月~2008年1月采用腘绳肌腱重建ACL的患者62例。按照自体与异体腘绳肌腱重建ACL进行分组，其中自体组30例，异体组32例。术后随访时行三维CT、MRI检查，并按照Lysholm 、IKDC、Irgang、Larson、Cincinnati膝关节评分标准进行疗效评价。［结果］62例均获得随访，随访时间16～36个月（平均24个月）。异体组 1例合并内侧副韧带损伤术后3个月屈膝受限（80°），二期行关节镜下松解术；1例因排斥反应关节肿胀、发热，行关节镜冲洗后好转。其余患者随访时移植物位置及关节功能良好。异体组：Lysholm评分（83.2±8.8）分， Irgang评分（77.9±8.3）分，Larson评分（88.4±3.6）分，IKDC评分活动水平正常26例（81.25%）。自体组：Lysholm评分（83.6±9.2），Irgang评分（78.8±8.2），Larson评分（87.6±3.2），IKDC评分活动水平正常23例（76.67%）。两组间比较差异无显著性意义（P>0.05）。Cincinnati膝关节评分中，自体组肿胀评分（8.6±0.6）分，异体组肿胀评分（5.2±1.4）分（P<0.05）；自体组疼痛评分（6.1±1.1）分，异体组疼痛评分（8.1±1.6）分（P<0.05）。自体组由于腘绳肌腱缺失均有不同程度的内旋乏力。 ［结论］自体与异体腘绳肌腱重建ACL均取得显著临床疗效。异体组术后肿胀的并发症高于自体组，但避免了由于取腱而带来的内旋乏力，其近期疗效预示其前景乐观。

Abstract:

［Objective］To evaluate the clinical result of arthroscopic anterior cruciate ligament (ACL) reconstruction with allo- or auto-graft hamstring.［Methods］Sixty-two cases of ACL ruptures who received ACL reconstruction with allo- or auto-graft hamstring were studied retrospectively from January 2006 to January 2008.Patients were divided into 2 groups by graft selection,30 patients with autograft hamstring and 32 with allograft.Clinical results were evaluated according to Lysholm,IKDC,Irgang,Larson and Cincinnati scales.［Results］All of the patients were followed up for 16 to 36 months.In one case with medial collateral ligament (MCL) injury range of movement limited in genuflex (80),3 months after operation,an ACL reconstruction was performed again.In one patient,immunologic response of allograft was treated by irrigating and had little clinical significance.All of others were raduigraphically in good position and had comfortable joint function.In autograft group,Lysholm score was 83.2±8.8,Irgang score was 77.9±8.3,Larson score was 88.4±3.6,and 26 patients obtained normal IKDC Score (81.25%).In allograft group,Lysholm score was 83.6±9.2,Irgang score was 78.8±8.2,Larson score was 87.6±3.2,and 23 patients received normal IKDC score (76.67%).They were nearly equal to each other (P>0.05).Cincinnati Knee Rating System scales showed that swelling of autograft group(8.6±0.6) vs allograft group(5.2±1.4)(P<0.05);pain of autograft group(6.1±1.1) vs allograft group(8.1±1.6)(P<0.05).Autograft group was deficit in internal rotation strength.［Conclusion］Both auto-and allo-graft hamstring in reconstructing ACL achieved significant clinical effect. swelling in allograft group was higher than autograft group,but it avoided deficit in internal rotation strength.The preliminary result of allograft reconstruction might indicate an optimistic application in the future.