关节镜下自体、异体骨-髌腱-骨与半腱肌腱3种重建前交叉韧带方法的疗效比较  

Arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone allograft,bone-patellar tendon-bone autograft and semitendinosus tendon autograft:A comparison of therapeutic effects

作　　者：郑小飞[1] 黄华扬[1] 张余[1] 李凭跃[1] 尹庆水[1] 

机构地区：[1]解放军广州军区广州总医院骨科,广东省广州市510010

出　　处：《中国组织工程研究与临床康复》2009年第20期3903-3906,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:关节镜下重建前交叉韧带的移植物的选择存在很多争论。目前两个以上移植物之间的比较研究还比较少见。目的:比较分析膝关节镜下自体、异体骨-髌腱-骨与半腱肌腱3种重建前交叉韧带的疗效。设计、时间及地点:回顾分析,对比观察,于1998-06/2005-06在解放军广州军区广州总医院骨科完成。对象:选择同期收治的前交叉韧带损伤患者142例,其中异体髌腱移植87例,自体髌腱移植34例,自体双股半腱肌21例。方法:回顾分析34例膝关节镜下自体骨-髌腱-骨移植、21例自体半腱肌腱移植和87例异体骨-髌腱-骨移植重建前交叉韧带的情况,随访31～84个月。采用Lysholm膝关节评分、国际膝关节文献编制委员会分级评估标准(IKDC)和KT2000评价疗效,并检测术后住院期间体温。主要观察指标:①各组患者Lysholm评分、IKDC分级。②不良事件及副反应。结果:3组间患者满意度、关节稳定性及功能差异均无显著性意义。自体骨-髌腱-骨重建组膝前痛发生率较异体骨-髌腱-骨、半腱肌腱组高。异体骨-髌腱-骨术后发热时间平均10.1d,自体骨-髌腱-骨和自体半腱肌组分别为4.9d和5.1d,与异体组相比差异有显著性意义。11例异体骨-髌腱-骨出现排斥反应,表现为胫骨隧道外口持续果酱样液体流出。经换药、激素或消炎痛治疗后痊愈。结论:关节镜下自体、异体骨-髌腱-骨与半腱肌腱移植重建前交叉韧带的疗效相同,但各组间供区并发症、排斥反应等并发症之间的差异将影响人们对移植物的选择。BACKGROUND： Debate exists addressing the optimal graft for anterior cruciate ligament （ACL） reconstruction. Studies regarding differences comparison in more than 2 grafts for ACL reconstruction are few. OBJECTIVE： To compare the therapeutic effects of arthroscopic ACL reconstruction with bone-patellar tendon-bone （B-PT-B） autograft, B-TP-B allograft and semitendinosus tendon autograft. DESIGN, TIME AND SETTING： The comparative observation of retrospectively analysis was completed at the Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command from June 1998 to June 2005. PARTICIPANTS： One hundred and forty-two ACL injury patients, including 87 patients treated with B-TP-B allograft, 34 patients treated with B-TP-B autograft and 2t patients treated with semitendinosus tendon autograft. METHODS： The follow-up period for all the patients was 6 84 months to retrospective analyze the construction of ACL with B-TP-B allograft, B-TP-B autograft and semitendinosus tendon autograft. Lysholm scores, International Knee Documentation Committee （IKDC） criteria and KT2000 were used to evaluate the therapeutic effects, and the postoperative temperature was examined. MAIN OUTCOME MEASURES： Lysholm scores, IKDC criteria, adverse events and side effect. RESULTS： Difference was no statistically significant in three groups of patients＇ satisfaction, stability and joint function. Compared with the other two groups, the incidence rate of anterior knee pain was higher in the B-TP-B autograft group. Postoperative fever duration in the B-TP-B allograft was 10.1 days, the durations in the autologous B-TP-B and autologous semitendinosus muscle groups were 4.9 and 5.1 days, respectively, which had significantly difference comparing to the allograft group. The rejections appeared in 11 cases of bone - patellar tendon-bone with the performance of the sustained jam-like liquid outflow from tibial tunnel. After dressing, hormones or indomethacin treatment, the rejection was inhibited. CONCL

关 键 词：前交叉韧带 骨-髌腱-骨 关节镜 移植 

分 类 号：R318[医药卫生—生物医学工程]