Endobutton-Intrafix与Rigidfix-Intrafix固定自体腘肌腱重建前交叉韧带的临床对照研究  

Comparison between endobutton-intrafix and rigidfix-intrafix in hamstring autograft ACL reconstruction

作　　者：孙健[1,2] 刘畅[3] 郑龙坡[1,2] 

机构地区：[1]上海市第十人民医院骨科 [2]同济大学附属第十人民医院骨科,200072 [3]河北沧州市中心医院骨科

出　　处：《中国矫形外科杂志》2015年第12期1086-1090,共5页Orthopedic Journal of China

摘　　要：[目的]分析采用Endobutton Intrafix系统与Rigidfix Intrafix系统两种固定方法固定自体腘绳肌腱重建膝前交叉韧带的临床疗效分析,探讨悬挂固定与横穿固定临床应用的适应证选择及临床效果的差异。[方法]回顾分析2011年7月~2013年4月本院骨科收治的膝前交叉韧带断裂患者共56例,Endobutton Intrafix固定组31例,Rigidfix Intrafix固定组25例。受伤后至接受重建手术时间1~36个月,平均13个月。所有患者要求术前及术后3、6、12月个来门诊随访,随访采用功能评分及影像学检查方式。功能评分采用Lysholm评分及IKDC2000评分。影像学检查主要采用术后1周膝关节正侧位X线片,术后3、6、12个月行MR检查,分别测量股骨及胫骨骨道各两处骨道长度（股骨内口、股骨中央、胫骨内口、胫骨中央）。两组股骨胫骨骨道增宽进行比较。[结果]临床随访中术后获得完整随访资料的病例共48例,其中Endobutton-Intrafix固定组26例,Rigidfix-Intrafix固定组22例,术后3、6个月两组股骨端骨道增宽差异有统计学意义（P〈0.05）,胫骨端差异无统计学意义（P〉0.05）。术后12个月两组股骨端及胫骨端差异无统计学意义（P〉0.05）。术后3、6、12个月时行IKDC2000膝关节主观评分、Lysholm膝关节评分,比较结果。两组术前、术后评分差异均有统计学意义,但术后两组之间评分差异无统计学意义。[结论]不同的固定股骨端方式在早期（术后6个月内）骨隧道的扩大方面差异有统计学意义,但是骨道的扩大与膝关节功能评分无相关性。采用Endobuton-Intrafix与Rigidfix-Intrafix两种方法都可以保证在膝前交叉韧带重建中坚强固定移植物,在早期康复锻炼恢复膝关节的功能方面无明显差异。[Objective]To compare the clinical outcome and evaluate results of Endobutton- Intrafix and Rigidfix- Intrafix fixation system in hamstring autograft ACL reconstruction,and to find out the difference between suspension fixation and transfemoral fixation and the indications of the two fixation methods. [Method]There were 56 patients who suffered ACL rupture from July 2011 to April 2013. Endobutton- Intrafix group consisted of 31 patients. Rigidfix- Intrafix group included 25 patients. Reconstruction surgery was performed at 1- 36 months（ mean,13 months） after injury. Radiographic and functional evaluation was conducted immediately after operation and at 3,6 and 12 months postoperatively. Lysholm score and IKDC 2000 were adopted for functional evaluation. Normal and lateral X- rays were taken 1 week after surgery. MRI was recommended at 3,6and 12 months postoperatively（ the entrance and center of femoral and tibial bone tunnel）. The widths of femoral and tibial bone tunnel were measured on MRI with registration of the X- plan. The enlargements of femoral and tibial tunnel were compared between the two groups. [Result]Forty-eight patients（ 26 from Endobutton- Intrafix group,22 from Rigidfix- Intrafix group） followed the schedule during the follow- up. The degree of femoral tunnel enlargement of the two groups was statistically different（ P〈0. 05） while no statistical difference was observed on tibial side（ P〉0. 05） at 3 and 6 months. The degree of bone tunnel enlargement was comparable on both femoral and tibial sides at 12 months postoperatively. The scores of IKDC 2000 and Lysholm at 3,6 and 12 months were statistically significant different from those just before operation. However,no statistically significant difference was noted between the two groups at each time point. [Conclusion]Both Endobuton- Intrafix system and Rigidfix- Intrafix fixation system could securely and stably fix the soft tissue graft in the early stage of ACL reconstruction.There is no significant difference between t

关 键 词：前交叉韧带 重建术 自体腘肌腱 固定方式 关节镜 

分 类 号：R687.4[医药卫生—骨科学]