Endo-button系统关节镜下自体肌腱与同种异体肌腱重建膝关节前叉韧带的近期临床疗效观察

发布时间：2018-08-18 12:31

【摘要】：背景：近年来膝关节前交叉韧带(anterior cruciate ligament, ACL)损伤逐渐增多,而传统疗法并不能恢复其正常的解剖关系,长期以后可能导致膝关节不稳、半月板损伤、关节软骨磨损退变和继发退行性关节炎等并发症。ACL是膝关节中最重要的静力稳定结构之一,兼有协助膝关节生理运动和限制非生理运动的双重功能。镜下重建ACL的技术日渐成熟,临床上采用关节镜手术治疗ACL损伤的患者也越来越多。关节镜下ACL重建术具有创伤小、手术时间短、可同时处理术中其它关节内合并伤、定位准确、术后功能恢复快以及并发症少等优点,目前被国内外广泛采用。膝关节前交叉韧带重建的效果受诸多因素的影响,其中自体组织移植物和同种异体移植物在目前临床上应用最为广泛。尽管近年来前交叉韧带重建移植物的选择以及术后疗效的对比在国内外已有大量研究,但至今尚无定论。目的：回顾性对比分析Endo-button系统关节镜下分别应用自体肌腱与同种异体肌腱重建膝关节前叉韧带的近期临床疗效,为前交叉韧带重建中韧带重建材料的选择提供临床依据。方法：回顾性分析2012年5月至2014年5月于成都中医药大学附属医院我院骨科因ACLⅢ度损伤而行前交叉韧带重建术的患者40例,其中A组自体肌腱组22例和B组同种异体肌腱组18例。A组选用自体胭绳肌肌腱,B组采用同种异体胫骨前肌腱,股骨端全部应用Endo-button悬吊固定,胫骨端生物型挤压螺钉和普通螺钉栓桩双重固定。全部在术前及术后3个月、6个月、12个月记录患者关节活动度、Lachman试验结果,并进行Lysholm、IDKC膝关节功能综合评定。术后6个月、12个月复查患侧膝关节X片及MRI。结果：两组患者术后切口均为I／甲愈合,无感染及关节腔内积血等并发症发生。同种异体组患者均无明显排异反应。两组患者均获随访,随访时间12-18个月,平均13.5个月。术后12个月,前抽屉试验、Lachman试验、轴移试验均为阴性。各组膝关节活动度、IKDC评分及Lysholm评分与术前比较,差异均有统计学意义(P0.05)各指标两组间比较差异均无统计学意义(P0.05)。结论：ACLⅢ度损伤的患者膝关节的稳定性已经遭到严重损害,具有明确的手术指征。关节镜下应用Endobutton系统重建前交叉韧带可以恢复膝关节的稳定性及运动功能；自体胭绳肌肌腱和同种异体胫骨前肌肌腱在作为移植材料重建ACL时临床疗效确切,术后两者对比分析近期临床疗效无明显差异,自体肌腱在恢复膝关节本体感觉方面早期有优势,可以根据患者病情及手术医生偏好选择合适的重建材料。
[Abstract]:Background: in recent years, the (anterior cruciate ligament, ACL) injury of anterior cruciate ligament of the knee is increasing gradually, but the traditional therapy can not restore its normal anatomical relationship, which may lead to instability of the knee joint and meniscus injury in the long run. Articular cartilage wear and degeneration and secondary degenerative arthritis. ACL is one of the most important statically stable structures in the knee joint and has the dual functions of assisting the knee joint physiological movement and restricting the non-physiological movement. The technique of ACL reconstruction is becoming more and more mature, and more patients are treated with arthroscopy for ACL injury. Arthroscopic ACL reconstruction is widely used at home and abroad because of its advantages of less trauma, shorter operation time, more accurate positioning, faster functional recovery and fewer complications. The effect of anterior cruciate ligament reconstruction of knee joint is affected by many factors, among which autologous tissue grafts and allografts are most widely used in clinic. Although the choice of anterior cruciate ligament (ACL) graft reconstruction and the comparison of postoperative outcomes have been studied in recent years, there is no conclusion yet. Objective: to compare and analyze the recent clinical effects of arthroscopic reconstruction of anterior cruciate ligament (ACL) with autogenous tendon and allogeneic tendon under Endo-button system respectively, so as to provide clinical basis for the selection of reconstruction materials for ACL reconstruction. Methods: from May 2012 to May 2014, 40 patients underwent anterior cruciate ligament reconstruction in Department of Orthopaedics, affiliated Hospital of Chengdu University of traditional Chinese Medicine, who underwent anterior cruciate ligament reconstruction due to ACL grade 鈪，

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