CAJ | 학술논문

目的：比较自体与同种异体肌腱关节镜下重建前交叉韧带（anterior cruciate ligament，ACL）的临床疗效。方法：回顾性分析64例行关节镜下重建 ACL 患者的病例资料，其中32例采用自体肌腱（自体肌腱组），其余32例采用同种异体肌腱（异体肌腱组）。比较2组患者的手术时间、术后发热时间、住院时间、膝关节稳定性、患膝国际膝关节文献委员会（the international knee doc-umentation committee，IKDC）评分及 Lysholm 评分，膝关节稳定性采用 Lachman 试验、中立位前抽屉试验（anterior drawer test，ADT）评定。结果：2组患者术后均出现发热，自体肌腱组术后发热时间比异体肌腱组短[（2．0±1．5）d，（4．0±1．7）d，t ＝5．043，P ＝0．000]，手术时间比异体肌腱组长[（79±15）min，（60±13）min，t ＝5．405，P ＝0．000]；2组住院时间比较，差异无统计学意义[（14±3）d，（14±4）d，t ＝0．000，P ＝1．000]。术前及术后6个月时2组患者 Lachman 试验和中立位 ADT 试验阳性率比较，组间差异均无统计学意义（χ2＝0．000，P ＝1．000；χ2＝0．000，P ＝1．000；χ2＝0．087，P ＝0．768；χ2＝0．000，P ＝1．000）；与术前相比，术后6个月时2组患者的 Lachman 试验和中立位 ADT 试验阳性率均降低（χ2＝42．416，P ＝0．000；χ2＝42．250，P ＝0．000；χ2＝34．724， P ＝0．000；χ2＝37．312，P ＝0．000）。术前及术后6个月时2组患者的 IKDC 评分和 Lysholm 评分比较，组间差异均无统计学意义[（41．52±3．47）分，（40．33±3．41）分，t ＝1．381，P ＝0．172；（82．01±1．50）分，（81．92±1．30）分，t ＝0．305，P ＝0．762；（39．82±3．23）分，（40．03±2．69）分，t ＝0．302，P ＝0．764；（89．56±1．86）分，（89．50±1．72）分，t ＝0．140，P ＝0．889]；与术前相比，术后6个月时2组患者的 IKDC 评分和 Lysholm 评分均增加（t ＝61．218，P ＝0．000；t ＝70．920，P ＝0．000；t ＝63．114，P ＝0．000；t ＝94．223，P ＝0．000）。结论：与采用自体肌腱相比，采用同种异体肌腱重建 ACL 手术时间短，但存在免疫排斥反应，而二者的临床疗效相当。目的：比較自體與同種異體肌腱關節鏡下重建前交扠韌帶（anterior cruciate ligament，ACL）的臨床療效。方法：迴顧性分析64例行關節鏡下重建 ACL 患者的病例資料，其中32例採用自體肌腱（自體肌腱組），其餘32例採用同種異體肌腱（異體肌腱組）。比較2組患者的手術時間、術後髮熱時間、住院時間、膝關節穩定性、患膝國際膝關節文獻委員會（the international knee doc-umentation committee，IKDC）評分及 Lysholm 評分，膝關節穩定性採用 Lachman 試驗、中立位前抽屜試驗（anterior drawer test，ADT）評定。結果：2組患者術後均齣現髮熱，自體肌腱組術後髮熱時間比異體肌腱組短[（2．0±1．5）d，（4．0±1．7）d，t ＝5．043，P ＝0．000]，手術時間比異體肌腱組長[（79±15）min，（60±13）min，t ＝5．405，P ＝0．000]；2組住院時間比較，差異無統計學意義[（14±3）d，（14±4）d，t ＝0．000，P ＝1．000]。術前及術後6箇月時2組患者 Lachman 試驗和中立位 ADT 試驗暘性率比較，組間差異均無統計學意義（χ2＝0．000，P ＝1．000；χ2＝0．000，P ＝1．000；χ2＝0．087，P ＝0．768；χ2＝0．000，P ＝1．000）；與術前相比，術後6箇月時2組患者的 Lachman 試驗和中立位 ADT 試驗暘性率均降低（χ2＝42．416，P ＝0．000；χ2＝42．250，P ＝0．000；χ2＝34．724， P ＝0．000；χ2＝37．312，P ＝0．000）。術前及術後6箇月時2組患者的 IKDC 評分和 Lysholm 評分比較，組間差異均無統計學意義[（41．52±3．47）分，（40．33±3．41）分，t ＝1．381，P ＝0．172；（82．01±1．50）分，（81．92±1．30）分，t ＝0．305，P ＝0．762；（39．82±3．23）分，（40．03±2．69）分，t ＝0．302，P ＝0．764；（89．56±1．86）分，（89．50±1．72）分，t ＝0．140，P ＝0．889]；與術前相比，術後6箇月時2組患者的 IKDC 評分和 Lysholm 評分均增加（t ＝61．218，P ＝0．000；t ＝70．920，P ＝0．000；t ＝63．114，P ＝0．000；t ＝94．223，P ＝0．000）。結論：與採用自體肌腱相比，採用同種異體肌腱重建 ACL 手術時間短，但存在免疫排斥反應，而二者的臨床療效相噹。
목적：비교자체여동충이체기건관절경하중건전교차인대（anterior cruciate ligament，ACL）적림상료효。방법：회고성분석64례행관절경하중건 ACL 환자적병례자료，기중32례채용자체기건（자체기건조），기여32례채용동충이체기건（이체기건조）。비교2조환자적수술시간、술후발열시간、주원시간、슬관절은정성、환슬국제슬관절문헌위원회（the international knee doc-umentation committee，IKDC）평분급 Lysholm 평분，슬관절은정성채용 Lachman 시험、중립위전추체시험（anterior drawer test，ADT）평정。결과：2조환자술후균출현발열，자체기건조술후발열시간비이체기건조단[（2．0±1．5）d，（4．0±1．7）d，t ＝5．043，P ＝0．000]，수술시간비이체기건조장[（79±15）min，（60±13）min，t ＝5．405，P ＝0．000]；2조주원시간비교，차이무통계학의의[（14±3）d，（14±4）d，t ＝0．000，P ＝1．000]。술전급술후6개월시2조환자 Lachman 시험화중립위 ADT 시험양성솔비교，조간차이균무통계학의의（χ2＝0．000，P ＝1．000；χ2＝0．000，P ＝1．000；χ2＝0．087，P ＝0．768；χ2＝0．000，P ＝1．000）；여술전상비，술후6개월시2조환자적 Lachman 시험화중립위 ADT 시험양성솔균강저（χ2＝42．416，P ＝0．000；χ2＝42．250，P ＝0．000；χ2＝34．724， P ＝0．000；χ2＝37．312，P ＝0．000）。술전급술후6개월시2조환자적 IKDC 평분화 Lysholm 평분비교，조간차이균무통계학의의[（41．52±3．47）분，（40．33±3．41）분，t ＝1．381，P ＝0．172；（82．01±1．50）분，（81．92±1．30）분，t ＝0．305，P ＝0．762；（39．82±3．23）분，（40．03±2．69）분，t ＝0．302，P ＝0．764；（89．56±1．86）분，（89．50±1．72）분，t ＝0．140，P ＝0．889]；여술전상비，술후6개월시2조환자적 IKDC 평분화 Lysholm 평분균증가（t ＝61．218，P ＝0．000；t ＝70．920，P ＝0．000；t ＝63．114，P ＝0．000；t ＝94．223，P ＝0．000）。결론：여채용자체기건상비，채용동충이체기건중건 ACL 수술시간단，단존재면역배척반응，이이자적림상료효상당。
Objective:To compare the clinical curative effects of autologous tendon versus allogeneic tendon in arthroscopic anterior cruciate ligament(ACL)reconstruction.Methods:The medical records of 64 patients that were treated with arthroscopic ACL reconstruction were analyzed retrospectively.Thirty two patients(autologous tendon group)were treated with autologous tendon,while the others(allogeneic tendon group)were treated with allogeneic tendon.The operation time,postoperative duration of fever,hospital stay,knee joint stability,the international knee documentation committee(IKDC)scores and Lysholm scores were compared between the two groups.The knee joint sta-bility were evaluated by Lachman test and anterior drawer test(ADT)in neutral position.Results:Patients had fever after the surgery in both of the two groups,and the postoperative duration of fever was shorter in autologous tendon group compared to allogeneic tendon group (2.0 +/-1.5 vs 4.0 +/-1.7 days,t =5.043,P =0.000),while the operation time was longer in autologous tendon group compared to al-logeneic tendon group(79 +/-15 vs 60 +/-13 min,t =5.405,P =0.000).There was no statistical difference in the hospital stay between the 2 groups(14 +/-3 vs 14 +/-4 days,t =0.000,P =1.000).There was no statistical difference in positive rate of Lachman test and neu-tral position ADT between the 2 groups before the surgery and at 6 months after the surgery(χ2 =0.000,P =1.000;χ2 =0.000,P =1.000;χ2 =0.087,P =0.768;χ2 =0.000,P =1.000).The positive rate of Lachman test and neutral position ADT decreased in both of the 2 groups at 6 months after the surgery(χ2 =42.416,P =0.000;χ2 =42.250,P =0.000;χ2 =34.724,P =0.000;χ2 =37.312,P =0.000). There was no statistical difference in IKDC scores and Lysholm scores between the 2 groups before the surgery and at 6 months after the sur-gery(41.52 +/-3.47 vs 40.33 +/-3.41 points,t =1.381,P =0.172;82.01 +/-1.50 vs 81.92 +/-1.30 points,t =0.305,P =0.762;39.82 +/-3.23 vs 40.03 +/-2.69,t =0.302,P =0.764;89.56 +/-1.86 vs 89.50 +/-1.72 points,t =0.140,P =0.889).The IKDC scores and Lysholm scores increased in both of the 2 groups at 6 months after the surgery(t =61.218,P =0.000;t =70.920,P =0.000;t =63.114,P =0.000;t =94.223,P =0.000).Conclusion:The allogeneic tendon ACL reconstruction has shorter operative time compared to autologous tendon ACL reconstruction,while they are similar to each other in clinical curative effects,but the former can incur immuno-logical rejection.