中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2013年
1期
44-48
,共5页
毕海勇%孙秀江%慕宏杰%张国栋%杨勇
畢海勇%孫秀江%慕宏傑%張國棟%楊勇
필해용%손수강%모굉걸%장국동%양용
前交叉韧带重建%移植,自体%移植,同种%腱%关节镜检查%前瞻性研究
前交扠韌帶重建%移植,自體%移植,同種%腱%關節鏡檢查%前瞻性研究
전교차인대중건%이식,자체%이식,동충%건%관절경검사%전첨성연구
Anterior cruciate ligament reconstruction%Transplantation,autologous%Transplantation,homologous%Tendons%Arthroscopy%Prospective studies
目的 前瞻性对比研究采用自体与同种异体肌腱进行关节镜下重建膝关节前交叉韧带(ACL)的临床疗效.方法 2006年3月至2009年4月采用手术治疗86例ACL断裂患者,其中男性60例,女性26例,年龄22 ～ 56岁,平均(32±7)岁.其中根据采用移植物不同术前应用电脑随机抽样方法将患者随机分为自体肌腱组(44例,自体腘绳肌)和异体肌腱组(42例,深冻同种异体肌腱).两组一般资料比较差异均无统计学意义(P＞0.05),两组患者均由同一组术者采用标准关节镜技术、同一术式完成ACL重建.通过术后随访测量关节活动度和胫骨前移距离,进行Lachman试验、轴移试验、Daniel单腿水平跳跃试验、IKDC综合功能评分、Lysholm-Tegner运动水平评分评估疗效.组间比较采用独立样本t检验,对计数资料采用非参数检验,其余采用x2检验.结果 79例患者获得随访,自体肌腱组41例,平均随访39.6个月；异体肌腱组38例,平均随访37.4个月.自体肌腱组术后出现深静脉血栓3例,异体肌腱组出现伤口迟发感染1例.自体肌腱组手术时间平均为(87±11) min长于异体肌腱组的(55±10) min(t=15.732,P＜0.05)；自体肌腱组术后发热时间为(3.2±1.4)d短于异体肌腱组的(7.6 ±5.3)d(t =5.740,P＜0.05).白体肌腱组术前及末次随访时Lysholm评分为(42±7)和(89±8)分,异体肌腱组分别为(44±6)和(87±9)分,差异均具有统计学意义(t=13.534和17.768,P＜0.05)；两组间术前及末次随访比较差异均无统计学意义(P＞0.05).自体肌腱组术前及末次随访时Tegner评分为(2.9±2.1)和(7.7±1.2)分,异体肌腱组为(2.7±1.4)和(7.1±1.6)分,差异均具有统计学意义(t=16.004和12.338,P＜0.05)；两组间术前及末次随访比较差异均无统计学意义(P＞0.05).KT2000测量术前及末次随访胫骨前移,自体肌腱组分别为(10.7±3.5)和(5.0 ±2.7)mm,异体肌腱组分别为(10.9±2.9)和(6.5±2.4)mm,差异均具有统计学意义(t=16.354和13.296,P＜0.05)；两组间术前及末次随访比较差异均无统计学意义(P＞0.05).IKDC综合功能评分显示,两组末次随访均较术前明显改善.结论 同种异体肌腱重建ACL术后患者膝关节功能、稳定性及运动水平与自体肌腱重建ACL相近,是重建ACL良好的移植物.
目的 前瞻性對比研究採用自體與同種異體肌腱進行關節鏡下重建膝關節前交扠韌帶(ACL)的臨床療效.方法 2006年3月至2009年4月採用手術治療86例ACL斷裂患者,其中男性60例,女性26例,年齡22 ～ 56歲,平均(32±7)歲.其中根據採用移植物不同術前應用電腦隨機抽樣方法將患者隨機分為自體肌腱組(44例,自體腘繩肌)和異體肌腱組(42例,深凍同種異體肌腱).兩組一般資料比較差異均無統計學意義(P＞0.05),兩組患者均由同一組術者採用標準關節鏡技術、同一術式完成ACL重建.通過術後隨訪測量關節活動度和脛骨前移距離,進行Lachman試驗、軸移試驗、Daniel單腿水平跳躍試驗、IKDC綜閤功能評分、Lysholm-Tegner運動水平評分評估療效.組間比較採用獨立樣本t檢驗,對計數資料採用非參數檢驗,其餘採用x2檢驗.結果 79例患者穫得隨訪,自體肌腱組41例,平均隨訪39.6箇月；異體肌腱組38例,平均隨訪37.4箇月.自體肌腱組術後齣現深靜脈血栓3例,異體肌腱組齣現傷口遲髮感染1例.自體肌腱組手術時間平均為(87±11) min長于異體肌腱組的(55±10) min(t=15.732,P＜0.05)；自體肌腱組術後髮熱時間為(3.2±1.4)d短于異體肌腱組的(7.6 ±5.3)d(t =5.740,P＜0.05).白體肌腱組術前及末次隨訪時Lysholm評分為(42±7)和(89±8)分,異體肌腱組分彆為(44±6)和(87±9)分,差異均具有統計學意義(t=13.534和17.768,P＜0.05)；兩組間術前及末次隨訪比較差異均無統計學意義(P＞0.05).自體肌腱組術前及末次隨訪時Tegner評分為(2.9±2.1)和(7.7±1.2)分,異體肌腱組為(2.7±1.4)和(7.1±1.6)分,差異均具有統計學意義(t=16.004和12.338,P＜0.05)；兩組間術前及末次隨訪比較差異均無統計學意義(P＞0.05).KT2000測量術前及末次隨訪脛骨前移,自體肌腱組分彆為(10.7±3.5)和(5.0 ±2.7)mm,異體肌腱組分彆為(10.9±2.9)和(6.5±2.4)mm,差異均具有統計學意義(t=16.354和13.296,P＜0.05)；兩組間術前及末次隨訪比較差異均無統計學意義(P＞0.05).IKDC綜閤功能評分顯示,兩組末次隨訪均較術前明顯改善.結論 同種異體肌腱重建ACL術後患者膝關節功能、穩定性及運動水平與自體肌腱重建ACL相近,是重建ACL良好的移植物.
목적 전첨성대비연구채용자체여동충이체기건진행관절경하중건슬관절전교차인대(ACL)적림상료효.방법 2006년3월지2009년4월채용수술치료86례ACL단렬환자,기중남성60례,녀성26례,년령22 ～ 56세,평균(32±7)세.기중근거채용이식물불동술전응용전뇌수궤추양방법장환자수궤분위자체기건조(44례,자체객승기)화이체기건조(42례,심동동충이체기건).량조일반자료비교차이균무통계학의의(P＞0.05),량조환자균유동일조술자채용표준관절경기술、동일술식완성ACL중건.통과술후수방측량관절활동도화경골전이거리,진행Lachman시험、축이시험、Daniel단퇴수평도약시험、IKDC종합공능평분、Lysholm-Tegner운동수평평분평고료효.조간비교채용독립양본t검험,대계수자료채용비삼수검험,기여채용x2검험.결과 79례환자획득수방,자체기건조41례,평균수방39.6개월；이체기건조38례,평균수방37.4개월.자체기건조술후출현심정맥혈전3례,이체기건조출현상구지발감염1례.자체기건조수술시간평균위(87±11) min장우이체기건조적(55±10) min(t=15.732,P＜0.05)；자체기건조술후발열시간위(3.2±1.4)d단우이체기건조적(7.6 ±5.3)d(t =5.740,P＜0.05).백체기건조술전급말차수방시Lysholm평분위(42±7)화(89±8)분,이체기건조분별위(44±6)화(87±9)분,차이균구유통계학의의(t=13.534화17.768,P＜0.05)；량조간술전급말차수방비교차이균무통계학의의(P＞0.05).자체기건조술전급말차수방시Tegner평분위(2.9±2.1)화(7.7±1.2)분,이체기건조위(2.7±1.4)화(7.1±1.6)분,차이균구유통계학의의(t=16.004화12.338,P＜0.05)；량조간술전급말차수방비교차이균무통계학의의(P＞0.05).KT2000측량술전급말차수방경골전이,자체기건조분별위(10.7±3.5)화(5.0 ±2.7)mm,이체기건조분별위(10.9±2.9)화(6.5±2.4)mm,차이균구유통계학의의(t=16.354화13.296,P＜0.05)；량조간술전급말차수방비교차이균무통계학의의(P＞0.05).IKDC종합공능평분현시,량조말차수방균교술전명현개선.결론 동충이체기건중건ACL술후환자슬관절공능、은정성급운동수평여자체기건중건ACL상근,시중건ACL량호적이식물.
Objective To study the clinical effect of arthroscopic anterior cruciate ligament (ACL) construction with different transplants.Methods From March 2006 to April 2009,86 patients including 60 male and 26 female undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into autograft group (44 patients,using autogeneic hamstring tendons) and allograft group (42 patients,using allogenic lower extremity tendons).The age of those patients were 22-56 years,averaging (32 ±7) years.The operations were made by the same doctor with the standard technology.The postoperative effects were assessed by the range of motion and tibia forward distance,Lachman test,pivot shift test,Daniel test,IKDC scores systems,Lysholm-Tegner scores.Results Seventy-nine patients were followed up,41 patients in autograft groups averaged 39.6 months and 38 patients in allograft group averaged 37.4 months.The operation time of autograft group was (87 ± 11) minutes,that of allograft group was (55 ±10) minutes (t =15.732,P ＜ 0.05).The time of postoperative fever of autograft group was (3.2 ±1.4) days,that of allograft groups was (7.6 ± 5.3) days (t =5.740,P ＜ 0.05).The Lysholm scores of autograft group was 42 ± 7 before operation,and 89 ± 8 at final follow-up.The Lysholm scores of allograft group was 44 ± 6 before operation,and 87 ± 9 at final follow-up.There was statistic difference in both groups between before operation and final follow-up (t =13.534 and 17.768,P ＜0.05).But no statistic difference existed between the two groups (P ＞ 0.05).The Tegner scores of autograft group was 2.9 ± 2.1 before operation,and 7.7 ± 1.2 at final follow-up.The Tegner scores of allograft group was 2.7 ± 1.4 before operation,and 7.1 ± 1.6 at final follow-up.There was statistic difference in both groups between before operation and final follow-up (t =16.004 and 12.338,P ＜ 0.05).No statistic difference existed between the two groups (P ＞ 0.05).The KT2000 results showed that the anterior displacement of autograft groups was (10.7 ±3.5) mm before operation and (5.0 ± 2.7) mm at final follow-up,the anterior displacement of allograft groups was (10.9 ± 2.9) mm before operation and (6.5 ± 2.4) mm at final follow-up,there was statistic difference between before and after operation in anterior displacement in two groups (t =16.354 and 13.296 P ＜ 0.05).There was no difference between two groups before operation and at final follow-up.Compared to before operation,the IKDC scores were improved greatly after operation (P ＜ 0.05).Conclusion The clinical effect of arthroscopic ACL construction with allograft transplants is near to autograft.
