关节镜下带跟骨异体跟腱单束单隧道重建前交叉韧带  

The single-bundle and single-tunnel reconstruction of anterior cruciate ligament using achilles tendon allograft with attached calcaneus under arthroscopy

作　　者：冯会成[1] 黄迅悟[1] 孙继桐[1] 常青[1] 毕龙[2] 余方圆[1] 

机构地区：[1]中国人民解放军第309医院骨科,北京100091 [2]第四军医大学西京医院全军骨科研究所,西安710032

出　　处：《中国骨与关节杂志》2013年第3期123-127,共5页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金(30901532)

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,探讨带跟骨异体跟腱重建ACL促进腱-骨愈合的作用。方法选择2008年1月至2009年12月收治并符合纳入标准的41例ACL损伤患者,随机分为两组,其中21例采用带跟骨异体跟腱重建ACL(试验组),20例采用单纯同种异体肌腱重建ACL(对照组)。两组患者年龄、性别、损伤原因、病程及术前功能评分等一般资料差异均无统计学意义(P>0.05),具有可比性。两组均采用单束单隧道技术重建ACL。结果术后2周两组所有患者切口均Ⅰ期愈合。两组患者均获随访,试验组随访时间24～28个月,平均26个月;对照组24～30个月,平均28个月。术后2年,试验组Lachman试验阴性率71.4%(15例),前抽屉试验阴性率76.2%(16例);对照组2个试验的阴性率分别为70.0%(14例)和75.0%(15例)。术后2年,试验组Lysholm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)。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,但试验组(4/21,19.0%)的骨隧道扩大率明显小于对照组(8/20,40.0%)(P<0.05)。膝关节松弛度检测显示:试验组关节前向松弛度为(1.82±0.90)mm,明显小于对照组的(2.29±0.77)mm。结论与采用单纯同种异体肌腱重建ACIL相比,采用带跟骨异体跟腱重建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 investigate the effectiveness of anterior cruciate ligament （ACL） reconstruction using achilles tendon allograft with attached calcaneus in promoting the tendon-bone healing through comparing with that of ACL reconstruction using simple tendon allograft under arthroscopy. Methods From January 2008 to December 2009, 41 patients with ACL injuries in accordance with the inclusion criteria were treated. They were randomly divided into 2 groups according to different treatment methods. In the trial group, ACL reconstruction using achilles tendon allograft with attached calcaneus was performed on 21 patients. In the control group, ACL reconstruction using simple tendon allograft was performed on 20 patients. There were no significant differences in such general data as the age, gender, cause of injury, disease duration, preoperative functional score and so on between the 2 groups （P〉0.05）, which were comparable. The single-bundle and single-tunnel ACL reconstruction was performed in both groups. Results All the incisions in both groups were healed by the first intention 2 weeks postoperatively. The patients were followed up for an average period of 26 months （range; 24-28 months） in the trial group, and 28 months （range; 24-30 months） in the control group. 2 years after the operation, 15 cases （71.4%） were negative in the Lachman test, and 16 cases （76.2%） were negative in the anterior drawer test in the trail group. In contrast, 14 cases （70.0%） and 15 cases （75.0%） were negative respectively in the control group. There were no significant differences in the Lysholm score and International Knee Documentation Committee （IKDC） score between the 2 groups 2 years after the operation （P〉0.05）. The CT exam showed the bone tunnel diameter was enlarged in different degrees in both groups 2 years after the operation, when compared with that 1 month postoperatively. However, the rate of bone tunnel enlargement in the trial group （4/21, 19.0%） was obviously less tha

关 键 词：关节镜 前交叉韧带 同种异体肌腱 带跟骨跟腱 韧带重建 

分 类 号：R687.2[医药卫生—骨科学]