关节镜下同种异体半腱肌腱重建前交叉韧带单束与双束解剖重建的近期疗效比较

Double-bundle versus single-bundle in arthroscopic anatomical reconstruction of anterior cruciate ligament with semi-tendinosus allografts

关键词:  关节镜  前交叉韧带  同种异体  解剖重建

Key words:  arthroscopy  anterior cruciate ligament  allografts  anatomic reconstruction

摘要:

[目的] 比较关节镜下采用同种异体半腱肌腱单束与双束解剖重建前交叉韧带（anterior cruciate ligament，ACL）的近期临床疗效。[方法] 回顾性分析2010年1月—2011年1月间，在中国医科大学附属盛京医院关节骨科接受ACL重建的病例及随访资料。根据手术方式的不同将病例分为单束组（n=32）和双束组(n=31)，分别比较两组病例术前、术后的关节稳定度及活动度，功能评分，康复情况。[结果] 63例患者术后于3~6个月(首次)和12~18个月（末次）获得随访。KNEELAX3：单束组平均为（2.14±1.30）mm (首次)、（1.97±1.28）mm （末次），双束组为（1.78±0.98）mm (首次)、（1.46±0.73）mm （末次）；Lachman试验：与健侧相比，单束组正常者(-)占81.25％(首次)、81.25％（末次），双束组占83.87％(首次)、87.10％（末次）；IKDC评分：单束组正常者(A级)占62.50％(首次)、68.75％（末次），双束组占77.42％(首次)、80.65％（末次）；Tegner评分：末次随访时单束组为6.03±0.54，双束组为6.00±0.58；以上数据双束组与单束组比较差异无显著性意义（P>0.05）。轴移试验：与健侧相比，单束组正常者(-)占62.50％(首次)、68.75％（末次），双束组占87.10％(首次)、90.32％（末次）；Lysholm评分：单束组为85.66±5.94（首次）、93.28±3.87（末次），双束组为88.77±6.13（首次）、96.23±2.64（末次）；Tegner评分：首次随访时单束组为3.78±0.79，双束组为4.26±1.00；以上数据双束组与单束组比较差异有显著性意义（P<0.05）。[结论] 双束解剖重建ACL能够更好地恢复患者膝关节的稳定性；能够更早地恢复患者的运动水平；相对于单束解剖重建，双束解剖重建ACL更有助于恢复膝关节的旋转稳定性。

Abstract:

[Objective] To compare the clinical results of double and single bundle anterior cruciate ligament (ACL) reconstruction with semi-tendinosus allografts.[Methods] The clinical data of 63 patients were reviewed who had received double-bundle or single-bundle arthroscopic ACL reconstruction with semi-tendinosus allografts from January 2010 through January 2011 in Shengjing hospital and had undergone complete follow-up．Patients were divided into 2 groups for the surgical methods, the single-bundle and the double-bundle group. To evaluate the outcomes, Lachman and Pivot Shift exams, KNEELAX3, Lysholm, Tegner and IKDC(International Knee Documentation Committee)scores were adopted. [Results] The 63 patients received 2 follow-ups at about 3 to 6 months and 12 to 18 months after operation, respectively．KNEELAX3 test showed a mean of （2.14±1.30）mm(follow-up 1), （1.97±1.28）mm（follow-up 2）in the single-bundle group and a mean of （1.78±0.98）mm(follow-up 1), （1.46±0.73）mm（follow-up 2）in the double-bundle group；The Lachman test showed 81.25％(follow-up 1)，81.25％(follow-up 2) were norma1 in the single-bundle group and 83.87％(follow-up 1)，87.10％(follow-up 2) were normal in the double-bundle group；IKDC showed 62.50％ (follow-up 1)， 68.75％(follow-up 2) were norma1 in the single-bundle group and 77.42％(follow-up 1)，80.65％(follow-up 2) were normal in the double-bundle group; Tegner score was 6.03±0.54 (follow-up 2) in the single-bundle group and 6.00±0.58 (follow-up 2) in the double-bundle group. There were no significant differences between the 2 groups in the above data （P>0.05）. The pivot-shift test showed 62.50％(follow-up 1)， 68.75％(follow-up 2) were norma1 in the single-bundle group and 87.10％(follow-up 1)， 90.32％(follow-up 2) were normal in the double-bundle group. Lysholm score was 85.66±5.94(follow-up 1)，93.28±3.87 (follow-up 2) in the single-bundle group and 88.77±6.13 (follow-up 1)，96.23±2.64 (follow-up 2) in the double-bundle group； Tegner score was 3.78±0.79 (follow-up 1) in the single-bundle group and 4.26±1.00 (follow-up 1) in the double-bundle group. These values above were significantly different between the 2 groups (P<0.05)． [Conclusion] Anatomic double-bundle ACL reconstruction could do better in restoring knee stability; And could restore the patient's sport level earlier than single-bundle. Compared to the single-bundle anatomic reconstruction, anatomic double-bundle ACL reconstruction could do more help to restore the rotational stability of knee.