采用单侧8股自体腘绳肌腱单束重建前交叉韧带的临床随访研究  

Clinical Outcomes of Single-bundle Anterior Cruciate Ligament Reconstruction with Unilateral 8-strand Hamstring Autograft

作　　者：宋关阳 桂琦[2] 宋山望 郑峒 冯峥 张辉 Song Guanyang;Gui Qi;Song Shanwang;Zheng Tong;Feng Zheng;Zhang Hui(Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;Beijing Luhe Hospital Affiliated to Capital Medical University,Beijing 101149,China;Puyang Guangci Hospital,Puyang 457100,China)

机构地区：[1]首都医科大学附属北京积水潭医院运动损伤科,北京100035 [2]首都医科大学附属北京潞河医院骨中心,北京101149 [3]濮阳广慈医院骨科,濮阳457100

出　　处：《中国运动医学杂志》2023年第5期345-351,共7页Chinese Journal of Sports Medicine

基　　金：国家自然科学基金项目(82002288)。

摘　　要：目的:探究采用单侧8股自体腘绳肌腱行单束前交叉韧带(ACL)重建术的短期临床疗效。方法:回顾性分析2019年1月至2020年1月北京积水潭医院运动损伤科收治的ACL损伤患者43例,男35例,女8例;年龄29.2±7.9岁(15~49岁)。所有患者均采用单侧8股自体腘绳肌腱行单束ACL重建术并完成至少2年随访。术中首先测量腘绳肌腱制备成4股后的直径,然后测量制备成为8股后的直径。随访内容包括术后第2天、术后1年以及末次随访时的序贯核磁(MRI)影像,评估胫骨前移距离及移植物信号分级;术后末次随访时的麻醉下轴移试验分度、KT-1000侧-侧差值以及二次关节镜探查结果;Lysholm主观功能评分、Tegner运动功能评分以及国际膝关节评分委员会(IKDC)客观评级。结果:术中4股腘绳肌腱平均直径为7.3±0.4 mm(6.5~8.5 mm),8股腘绳肌腱平均直径为9.8±0.5 mm(9~11 mm),差异有统计学意义(P<0.05)。术后第2天核磁显示所有患者胫骨前移距离均减小至0 mm。术后1年核磁显示胫骨前移距离为0.5±0.9 mm(0~3 mm),与术后第2天相比差异无统计学意义(t=0.075,P=0.887)。末次随访时核磁显示胫骨前移距离为0.6±1.3 mm(0~4 mm),与术后一年相比差异无统计学意义(t=0.097,P=0.765)。术后第2天核磁影像显示所有患者移植物信号均为Ⅰ级,术后1年和术后末次随访时核磁均显示39例患者移植物信号Ⅰ级,4例患者移植物信号Ⅱ级,差异有统计学意义(χ~2=8.758,P<0.05)。术前KT-1000侧-侧差值为6.9±2.3 mm(4~15 mm),末次随访时KT-1000侧-侧差值为1.5±1.2 mm(0~5 mm),与术前相比差异具有统计学意义(t=12.378,P<0.001)。术前麻醉下轴移试验结果显示28例患者为Ⅰ度,15例患者为Ⅱ度,末次随访时麻醉下轴移试验结果显示39例患者为阴性,4例患者为Ⅰ度,与术前相比差异具有统计学意义(χ~2=15.896,P<0.001)。二次关节镜探查时可见移植物滑膜覆盖结果 A级(75%~100%)40例(93.1%),B级(50%~ObjectiveTo explore the short-term clinical outcomes of single-bundle anterior cruciate ligament reconstruction(ACLR) with unilateral 8-strand hamstring autograft.MethodsTotally 43 patients(including 35males and 8 females) undergoing primary single-bundle ACLR with unilateral 8-strand hamstring autograft between January 2019 and January 2020 were analyzed retrospectively.They ranged in age from 15 to 49 years old,with an average of 29.2 ± 7.9,and were followed up no less than 2 years.During the operation,the diameters of the hamstring tendon being prepared into four and eight strands were measured,respectively.During the postoperative 2-day,1-year,and final follow-up visits,the anterior tibial translation(ATT) and intra-articular graft signal intensity were evaluated using the serial magnetic resonance imaging(MRI).Moreover,the pivotshift result,KT-1000 side-to-side difference(SSD),second-look arthroscopic evaluations,subjective Lysholm score,Tegner activity score,and International Knee Documentation Committee(IKDC) objective grading were also assessed.ResultsThe mean diameter of 8-strand ACL graft was 9.8 ± 0.5 mm(9~11 mm),significantly larger than that of 4-strand ACL graft,7.3 ± 0.4 mm(6.5~8.5 mm)(P0.05).Moreover,the average ATT 2days post-operatively reduced to 0 mm,then increased to 0.5 ± 0.9 mm(0~3 mm) 1 year after the operation(t=0.075,P=0.887),and was 0.6 ± 1.3 mm(0~4 mm) at the final follow-up(t=0.097,P=0.765),without showing significant differences among themselves.The MRI signals of all ACL graft were grade I on the 2ndday after the operation,while at the follow-up one and two years later,39 were of grade Ⅰ and 4 of grade Ⅱ,showing significant differences(χ~2=8.758,P0.05).Meanwhile,the average KT-1000 SSD decreased significantly from preoperative 6.9 ± 2.3 mm(4~15 mm) to 1.5 ± 1.2 mm(0~5 mm) at the final follow-up(t=12.378,P0.001).Moreover,39 patients were of negative,and 4 of grade Ⅰ pivot-shift at the final follow-up visit,with significant differences compared to the pre-operative statu

关 键 词：前交叉韧带 自体8股腘绳肌腱 单束重建 临床疗效 

分 类 号：R687.4[医药卫生—骨科学]