关节镜下不同移植物重建前交叉韧带68例  

RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT WITH DIFFERENT GRAFTS UNDER ARTHROSCOPE IN 68 CASES

作　　者：许永涛[1] 李锋[1] 鲁厚庚 刘铁[1] 陈安民[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030 [2]华中科技大学同济医学院附属荆州医院骨科

出　　处：《中国修复重建外科杂志》2007年第11期1163-1166,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结关节镜下不同移植物重建前交叉韧带(anterior cruciate ligament,ACL)的疗效。方法回顾性分析1999年5月～2005年5月收治的68例ACL损伤患者治疗方法。其中应用自体中1/3骨-髌韧带-骨移植物和界面螺钉固定26例(A组),男16例,女10例;年龄16～45岁,平均26.4岁;左膝14例,右膝12例;损伤至手术时间1周～15个月,平均3.1个月;术前Lysholm评分65.3±4.8分,IKDC主观评分43.5±5.2分。应用4股半腱肌腱内扣式钮扣钢板悬吊固定38例(B组),男24例,女14例;年龄13～48岁,平均24.6岁;左膝27例,右膝11例;损伤至手术时间1周～16个月,平均4.3个月;术前Lysholm评分68.4±5.6分,IKDC主观评分41.4±6.2分。异体中1/3髌韧带界面螺钉固定4例(C组),男3例,女1例;年龄55～65岁;左膝3例,右膝1例;损伤至手术时间2周～28个月,平均7.3个月;术前Lysholm评分60.3±6.7分,IKDC主观评分40.5±3.8分。结果患者获随访12～36个月,其中A组平均随访17.5个月,B组18.5个月,C组16.5个月。均未发现关节内感染、下肢深静脉血栓形成和血管、神经损伤等并发症。A组23例术后膝关节恢复至损伤前运动水平,未发生髌骨骨折;Lysholm评分95.1±4.3分,优18例,良5例,一般3例,优良率88.5%;IKDC评分93.7±3.8分,膝关节功能正常19例(73.1%),一般5例(19.2%),较差2例(7.7%)。B组33例术后膝关节恢复至损伤前运动水平;Lysholm评分93.0±5.9分,优28例,良5例,一般5例,优良率86.8%。IKDC评分95.7±4.7分,膝关节功能正常30例(78.9%),一般5例(13.2%),较差3例(7.9%)。C组4例术后膝关节均基本恢复至损伤前运动水平;Lysholm评分92.4±4.3分,优3例,良1例;IKDC评分94.8±3.6分,膝关节功能正常3例,一般1例,均未见明显关节积液。3组患者手术前后Lysholm评分及IKDC评分差异均有统计学意义(P<0.01),术后评分优于术前;组间差异无统计学意义(P>0.05)。结论骨-髌腱-骨和股薄肌-半腱肌腱,是修复ACL的良好移植物。青少年骨骺未闭患�Objective To study the clinical effect of anterior cruciate ligament （ACL） reconstruction with different grafts under arthroscope. Methods A retrospective analysis was done on 68 cases of ACL injury. ACL reconstruction with bone-patellar tendon-bone autograft and interlace screw fixation were performed in 26 cases （group A ） and quadruple semitendinosus tendon autograft and endobutton plate fixationin in 38 cases （group B）. ACL reconstruction with bone-patellar tendon-bone allograft cryopreserved and interface screw fixation were performed in 4 cases （group C）. There were 16 males and 10 females with an average age of 26.4 years （16-45 years） in group A, 24 males and 14 females with an average age of 24.6 years （13-48 years） in group B, and 3 males and 1 female （55-65 years） in group C. The left knee involved in 14 cases, 27 cases and 3 cases, and the right knee involved in 12 cases, 11 cases and 1 case in groups A, B and C, respectively. The disease courses were 1 week to 15 months （group A）, 1 week to 16 months （group B） and 2 weeks to 28 months （group C）. The intermediate myodynamic recovery, IKDC score and Lysholm score were compared among 3 groups. Results All patients were followed 12-36 months （17.5 months in group A, 18.5 months in group B and 16.5 months in group C）. No intra-articular injection, phlebothrombosis of leg, vascular injury and nerve injury occurred. Lysholm scores was increased from preoperative 65.3± 4.8 to postoperative 95.1±4.3 in group A, from 68.4±5.6 to 93.0±5.9 in group B and from 60.3±6.7 to 92.2±4.3（excellent in 3 casesand good in 1 case） in group C; the excellent and good rates were 88.5% （excellent in 18 cases, good in 5 cases and fair in 3 cases） in group A, 86.8% （excellent in 28 cases, good in 5 cases and fair in 5 cases） in group B, IKDC scores were 93.7±3.8 （group A）, 95.7±4.7 （group B） and 94.8±3.6（group C） ; the knee joint functions were normal in 19 cases （73.1%）, in 30 cases （78.9%） and

关 键 词：前交叉韧带 髌韧带 半腱肌腱 异体移植 修复重建 

分 类 号：R687.2[医药卫生—骨科学]