自体骨膜包裹同种异体肌腱重建前交叉韧带的前瞻性研究  

A PROSPECTIVE CLINICAL STUDY ON AUTOLOGOUS PERIOSTEUM WRAPPING TENDON ALLOGRAFT FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

作　　者：王智慧[1] 陈百成[1] 张晓阳[1] 孙然[1] 刘虎[1] 谢磊[1] 朱超华[1] 

机构地区：[1]河北医科大学第三医院关节骨科,石家庄050051

出　　处：《中国修复重建外科杂志》2011年第10期1256-1260,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的通过与关节镜下单纯采用同种异体肌腱重建前交叉韧带(anterior cruciate ligament,ACL)比较,探讨自体骨膜包裹同种异体肌腱重建ACL对腱-骨愈合的影响。方法选择2008年3月-11月收治并符合纳入标准的68例ACL损伤患者,随机分为两组,其中31例采用自体骨膜包裹同种异体肌腱重建ACL(试验组),37例单纯采用同种异体肌腱重建ACL(对照组)。两组患者性别、年龄、损伤原因、病程及术前功能评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。两组均采用单束解剖重建ACL。结果两组术后2周各1例胫骨隧道切口处出现少量渗出,经对症处理后切口愈合;其余患者术后切口均Ⅰ期愈合。两组患者均获随访,试验组随访时间24～29个月,平均26个月;对照组24～32个月,平均27个月。CT检查示,术后2年两组骨隧道直径均较术后1个月有不同程度增加,但骨隧道扩大率试验组(5/31,16.1%)小于对照组(14/37,37.8%),差异有统计学意义(χ2=3.948,P=0.047)。术后2年,试验组23例(74.2%)Lachman试验阴性,25例(80.6%)轴移试验阴性;对照组分别为26例(70.3%)及30例(81.1%)。KT-1000检测显示,试验组关节前向松弛度为(1.74±0.88)mm,小于对照组的(2.36±0.83)mm,差异有统计学意义(t=—2.979,P=0.004)。术后2年,试验组Lysholm评分、美国特种外科医院(HSS)评分、Tegner评分、国际膝关节文献委员会(IKDC)评分与对照组比较,差异均无统计学意义(P>0.05)。结论与单纯采用同种异体肌腱重建ACL相比,采用自体骨膜包裹同种异体肌腱重建ACL可在一定程度上降低骨隧道扩大率,促进腱-骨愈合,近期疗效较好。Objective To study the effectiveness of anterior cruciate ligament（ACL） reconstruction using autologous periosteum wrapping tendon allograft by comparing with using simple tendon allograft.Methods Between March 2008 and November 2008,68 patients with ACL injury were treated,who were in accordance with the inclusion criteria.They were divided into 2 groups randomly according to different treatment methods： ACL was reconstructed with autologous periosteum wrapping tendon allograft in 31 patients（test group） and with simple tendon allograft（control group） in 37 patients.There was no significant difference in gender,age,disease duration,the cause of injury,and functional score preoperatively between 2 groups（P 〉0.05）.Anatomic single-bundle ACL reconstruction was performed in 2 groups.Results Little exudation at tibial tunnel incision was found in 1 case respectively in both groups at 2 weeks after operation and was cured by dressing change and antibiotics.The other incisions healed by first intention.The patients were followed up 24-29 months（mean,26 months） in the test group and 24-32 months（mean,27 months） in the control group.CT showed bone tunnel enlargement in both groups at 2 years after operation,but the rate of the tunnel enlargement was less in the test group（5/31,16.1%） than in the control group（14/37,37.8%）,showing significant difference（χ2=3.948,P=0.047）.At 2 years after operation,the results of Lachman test and pivot shift test were negative in 23 cases（74.2%） and 25 cases（80.6%） of the test group,and in 26 cases（70.3%） and 30 cases（81.1%） of the control group,respectively.KT-1000 examination showed the displacement of the test group [（1.74 ± 0.88） mm] was less than that of the control group [（2.36 ± 0.83） mm],showing significant difference（t= —2.979,P=0.004）.There was no significant difference in Lysholm score,Hospital for Special Surgery（HSS） score,Tegner score,and International Knee Documentation Committee（IKDC） score bet

关 键 词：关节镜 前交叉韧带 同种异体肌腱 自体骨膜 韧带重建 

分 类 号：R687.2[医药卫生—骨科学]