CAJ | 학술논문

目的探讨腓骨长肌腱前半部(anterior half of the peroneus longus tendon,AHPLT)作为自体肌腱移植材料重建膝关节韧带的可行性及疗效.方法 2007年7月至2008年1月采用AHPLT作为自体肌腱移植材料的膝关节韧带损伤患者100例,男33例,女67例；年龄16～62岁,平均32.3岁.关节镜下内侧髌股韧带重建49例、多条韧带重建19例、后十字韧带双束重建18例和前十字韧带双束重建14例.切取AHPLT作为全部(49例)或部分(51例)重建材料,采用单切口或双切口技术,重建韧带用螺钉挤压固定.术后评估膝关节Kujala评分、Lysholm评分、Marx评分、国际膝关节文献委员会(International Knee Documentation Committee,IKDC)膝关节主观评估表和客观等级评定、踝关节足踝功能障碍指数(Foot and Ankle Disability Index,FADI)及美国足踝外科学会(American Orthopedic Foot and Ankle Society,AOFAS)评分.结果 92例获得2年以上随访.术后2年,不同韧带重建组患者膝关节IKDC主观评分、Kujala评分、Lysholm评分及Marx评分均高于重建术前.多条韧带重建、后十字韧带双束重建和前十字韧带双束重建术后IKDC客观等级评定结果达到正常及接近正常者分别为17例、15例和12例,优良率分别为89.5％(17/19)、93.7％(15/16)和100％(12/12).全部患者手术前后AO-FAS评分分别为(97.4±2.0)分和(97.2±1.6)分,FADI评分分别为(96.8±2.2)分和(96.9±2.5)分,差异均无统计学意义.患者均未出现腓神经损伤、腓骨长肌腱断裂等并发症.结论 AHPLT作为自体肌腱移植材料重建膝关节韧带具有操作可行性,近期临床疗效好,切取肌腱后对踝关节功能影响小.
목적 탐토비골장기건전반부(anterior half of the peroneus longus tendon,AHPLT)작위자체기건이식재료중건슬관절인대적가행성급료효.방법 2007년7월지2008년1월채용AHPLT작위자체기건이식재료적슬관절인대손상환자100례,남33례,녀67례；년령16～62세,평균32.3세.관절경하내측빈고인대중건49례、다조인대중건19례、후십자인대쌍속중건18례화전십자인대쌍속중건14례.절취AHPLT작위전부(49례)혹부분(51례)중건재료,채용단절구혹쌍절구기술,중건인대용라정제압고정.술후평고슬관절Kujala평분、Lysholm평분、Marx평분、국제슬관절문헌위원회(International Knee Documentation Committee,IKDC)슬관절주관평고표화객관등급평정、과관절족과공능장애지수(Foot and Ankle Disability Index,FADI)급미국족과외과학회(American Orthopedic Foot and Ankle Society,AOFAS)평분.결과 92례획득2년이상수방.술후2년,불동인대중건조환자슬관절IKDC주관평분、Kujala평분、Lysholm평분급Marx평분균고우중건술전.다조인대중건、후십자인대쌍속중건화전십자인대쌍속중건술후IKDC객관등급평정결과체도정상급접근정상자분별위17례、15례화12례,우량솔분별위89.5％(17/19)、93.7％(15/16)화100％(12/12).전부환자수술전후AO-FAS평분분별위(97.4±2.0)분화(97.2±1.6)분,FADI평분분별위(96.8±2.2)분화(96.9±2.5)분,차이균무통계학의의.환자균미출현비신경손상、비골장기건단렬등병발증.결론 AHPLT작위자체기건이식재료중건슬관절인대구유조작가행성,근기림상료효호,절취기건후대과관절공능영향소.
Objective To evaluate availability and outcomes of using anterior half of the peroneus longus tendon (AHPLT) in knee ligament reconstruction as an autograft source.Methods From July 2007 to January 2008,100 patients with knee ligament injuries were recruited in this study.There were 33 males and 67 females aging from 16 to 62 years (mean,32.3 years).49 cases had undergone medial patellofemoral ligament reconstruction,19 cases multiligament reconstruction,18 cases double-bundle posterior cruciate ligament (PCL) reconstruction and 14 cases double-bundle anterior cruciate ligament (ACL) reconstruction.AHPLT was used as sole (49 cases) or part (51 cases) of reconstruction materials.One-incision or two-incision striping techniques were adopted to harvest AHPLT.Ligaments were fixed with screws.Post-operative assessments included Kujala knee score,Lysholm knee score,Marx knee score,International Knee Documentation Committee (IKDC) subjective evaluation form and objective evaluation grade,the Foot and Ankle Disability Index (FADI) and the American Orthopedic Foot and Ankle Society (AOFAS) scale.Results 92 cases were followed up for more than 24 months.Postoperative Kujala score,IKDC subjective score,Lysholm score and Marx score were improved significantly in all four groups of patients.According to IKDC objective evaluation grade,the number of patients reaching Grade A (normal) or Grade B (near-normal) in multiligament,PCL and ACL reconstruction were 17,15 and 12,with an excellent rate of 89.5％ (17/19),93.7％ (15/16) and 100％ (12/12),respectively.Preoperative and postoperative AOFAS scores were 97.4±2.0 and 97.2±1.6,respectively,while the FADI scores preoperatively and postoperatively were 96.8±2.2 and 96.9±2.5,respectively.These results had no statistical significance.No signs of peroneal nerve injury or peroneus longus tendon rupture was found.Conclusion It is acceptable to use AHPLT as an autograft due to its feasibility to harvest,good clinical outcome,and low rate of donor site morbidity at a minimum of two-year follow-up.