关节镜下后交叉韧带单束与双束重建的中期临床效果比较  

Comparison of middle-term outcomes of arthroscopic single-bundle versus double-bundle reconstruction of posterior cruciate ligament

作　　者：王思哲 王宾 郭强 滕学仁 WANG Si-zhe;WANG Bin;GUO Qiang;TENG Xue-ren(Orthopaedic Department, People＇s Hospital of Chengyong District, Qingdao 266109, China;Department of Orthopaedics, Qingdao Municipal Hospital, Qingdao 266000, China)

机构地区：[1]青岛市城阳区人民医院,青岛266109 [2]青岛市立医院(集团),青岛266000

出　　处：《中国矫形外科杂志》2018年第10期913-918,共6页Orthopedic Journal of China

摘　　要：[目的]比较关节镜下自体腘绳肌腱(hamstring tendons,HT)单束重建与应用异体跟腱"Y"形双束重建后交叉韧带(posterior cruciate ligament,PCL)的中期临床效果。[方法]回顾性分析2007年10月～2011年10月在青岛市立医院诊治的后交叉韧带损伤行PCL重建病例80例。其中,HT单束重建组40例,异体跟腱Y形双束重建组40例。比较两组患者术前、末次随访时的Lysholm评分、膝关节活动度(ROM),并用Kneelax3评估膝关节屈曲30°和90°时的稳定性。[结果]所有患者均获得5年以上的随访。单束组与双束组Lysholm评分分别由术前[(43.50±3.25)versus(44.28±3.36),P>0.05],分别提高至[(92.73±3.70)versus(93.76±3.88),P>0.05],相同时间点两组间差异均无统计学意义,但各组两时间点间的差异有统计学意义(P<0.050)。膝关节ROM分别由术前[(95.08±9.20)oversus(92.10±8.80)o,P>0.05],分别提高至[(125.15±6.50)oversus(124.18±7.50)o,P>0.05],相同时间点两组间差异均无统计学意义,但各组两时间点间的差异均有统计学意义(P<0.050)。屈膝30°位Kneelax3测量由术前[(13.35±2.56)mm versus(13.35±2.66)mm,P>0.05],分别减少至[(3.05±0.28)mm versus(2.85±0.22)mm,P>0.05],相同时间点两组间差异均无统计学意义,但各组两时间点间的差异均有统计学意义(P<0.050)。屈膝90°位Kneelax3测量由术前[(13.55±2.75)mm versus(13.95±3.12)mm,P>0.05],分别减少至[(3.15±0.32)mm versus(2.80±0.25)mm,P>0.05],相同时间点两组间差异均无统计学意义,但各组两时间点间的差异均有统计学意义(P<0.050)。[结论]HT单束及异体跟腱"Y"形双束重建PCL均能提高术后中期的膝关节功能及稳定性,但双束重建与单束相比并无明显优势。[Objective] To compare the mid-term clinical outcomes of arthroscopic reconstruction of the posterior cruciate ligament（PCL）with single-bundle autograft of quadrupled hamstring tendons（HT）versus the Y-shaped double-bundle allograft of Achilles tendon.[Methods]A retrospective study was conducted on 80 patients received arthroscopic PCL reconstruction in Qingdao Municipal Hospital from October 2007 to October 2011.Among them,40 patients had the ligament reconstructed with single-bundle autograft of quadrupled hamstring tendons（the single-bundle group）,while the remaining 40 patients received PCL reconstruction using the Y-shaped double-bundle allograft of Achilles tendon.The Lysholm scores and knee range of motion were used to evaluate the clinical consequences,while the stability of knees at 30°and 90°flexion was assessed with Kneelax3.[Results]All patients were followed up more than 5 years.The Lysholm scores significantly increased from[（43.50±3.25）in the single-bundle group versus（44.28±3.36）in double-bundle group,P〈0.05]before operation to[（92.73±3.70）versus（93.76±3.88）,P〈0.05]at the latest follow up,in which there were statistical differences in both group between the two time points（P〈0.05）,despite no statistical significances between the two groups at corresponding time points.In addition,the ROM considerably enhanced from[（95.08±9.20）oversusP〈0.05]preoperatively tosusP〈0.05]at the latest follow up,with statistically significant differences in both group between time points（P〈0.05）.However,the side to side differences measured at30oof flexion by Kneelax3 remarkably reduced from[（13.35±2.56）mm versus（13.35±2.66）mm,P〈0.05]prior to surgery to[（3.05±0.28）mm versus（2.85±0.22）mm,P〈0.05]at the latest interview,similarly the differences at 90oof knee flexion substantially diminished from[（13.55±2.75）mm versus（13.95±3.12）mm,P〈0.05]preoperatively to[（3.15±0.32）mm versus（2.80±0.25）mm,P〈0.05]at the final follow-up

关 键 词：后交叉韧带 单束重建术 双束重建术 自体腘绳肌腱 异体跟腱 关节镜 

分 类 号：R687[医药卫生—骨科学]