自体腘绳肌腱与股四头肌腱前交叉韧带重建比较  

Hamstring tendon versus quadriceps tendon autografts for arthroscopic anterior cruciate ligament reconstruction

作　　者：许正文[1] 李振[1] 苏长征[1] 侯振扬[1] 朱彪[1] XU Zheng-wen;LI Zhen;SU Chang-zheng;HOU Zhen-yang;ZHU Biao(Tengzhou Central People's Hospital of Tengzhou City,Tengzhou 277500,China)

机构地区：[1]滕州市中心人民医院,山东滕州277500

出　　处：《中国矫形外科杂志》2023年第14期1259-1264,共6页Orthopedic Journal of China

摘　　要：[目的]比较自体腘绳肌腱(hamstring tendon,HT)与股四头肌肌腱(quadriceps tendon,QT)重建前交叉韧带(ante⁃rior cruciate ligament,ACL)的临床效果。[方法]2016年11月—2019年l0月本院镜下单束ACL重建86例患者。依据医患沟通结果,43例采用HT移植物重建ACL,另外43例采用QT重建ACL术。比较两组围手术期、随访与影像资料。[结果]两组患者均顺利完成手术,术中探查两组合并半月板损伤的差异无统计学意义(P>0.05),行半月板成形术。两组手术时间、取腱切口长度、术中失血量、下地行走时间、切口愈合等级和术后住院时间差异均无统计学意义(P>0.05)。所有患者平均随访(25.1±2.4)个月,HT组完全负重活动时间显著早于QT组[(45.2±2.4)d vs(47.1±1.4)d,P<0.05]。随时间推移,两组患者Lysholm评分、IKDC2000评分显著增加(P<0.05),KT-1000侧侧差值显著减少(P<0.05)。相应时间点,两组Lysholm评分、IKDC2000评分差异均无统计学意义(P>0.05);术前两组间KT-1000侧侧差值差异无统计学意义(P>0.05),但是术后QT组KT-1000侧侧差值均显著小于HT组[术后6个月,(2.7±0.7)mm vs(3.3±0.6)mm,P<0.05;术后12个月,(3.0±0.7)mm vs(3.6±0.6)mm,P<0.05;术后24个月,(3.2±0.6)mm vs(3.6±0.5)mm,P<0.05]。影像方面:与术后4、12个月相比,术后24个月两组股骨隧道扩大显著增加(P<0.05),术后24个月QT组股骨隧道扩大显著少于HT组[0/1/2/3:(25/18/0/0)vs 0/1/2/3:(15/28/0/0),P<0.05]。[结论]对于镜下单束移植物重建ACL,QT移植物在术后膝关节前向松弛、股骨隧道扩大显著优于HT移植物。[Objective]To compare the clinical outcomes of arthroscopic single-bundle anterior cruciate ligament(ACL)reconstruc⁃tion with hamstring tendon(HT)versus quadriceps tendon(QT)autografts.[Methods]A total of 86 patients received arthroscopic singlebundle ACL reconstruction in our hospital from November 2016 to December 2019.Based on doctor-patient communication,43 patients had HT used for ACL reconstruction,while the remaining 43 patients had QT used.The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups had ACL reconstructed successfully without a statistically significant differ⁃ence regarding combined meniscus injuries confirmed intraoperatively(P>0.05),which were treated by partial meniscectomy.There were no significant differences in operation time,tendon incision length,intraoperative blood loss,postoperative ambulation time,incision heal⁃ing grade and postoperative hospital stay between the two groups(P>0.05).All patients were followed up for a mean of(25.1±2.4)months,and the HT group resumed full weight-bearing activity significantly earlier than that in the QT group[(45.2±2.4)days vs(47.1±1.4)days,P<0.05].The Lysholm and IKDC2000 scores increased significantly(P<0.05),while the side to side difference of KT-1000 test significantly reduced in both groups over time(P<0.05).Although there were no significant differences in Lysholm and IKDC2000 scores between the two groups at any time points accordingly(P>0.05),and no a significant difference the side to side difference of KT-1000 test between the two groups before surgery(P<0.05),the QT group proved significantly less side to side difference of KT-1000 test than the HT group post⁃operatively[6 months after surgery,(2.7±0.7)mm vs(3.3±0.6)mm,P<0.05;12 months after surgery,(3.0±0.7)mm vs(3.6±0.6)mm,P<0.05;24 months after surgery,(3.2±0.6)mm vs(3.6±0.5)mm,P<0.05].Radiographically,the femoral tunnel enlargement significantly in⁃creased in both groups at 24 months compared with those 6 an

关 键 词：前交叉韧带重建 腘绳肌腱 股四头肌腱 自体移植物 临床疗效 

分 类 号：R687[医药卫生—骨科学]