背景:关节镜下重建已成为治疗前交叉韧带损伤的主要治疗手段,在重建时究竟是保留残端疗效好还是清除残端疗效好,目前尚有争议。目的:探讨关节镜下保留残端应用同种异体肌腱移植重建前交叉韧带的近期临床疗效。方法:韧带残端存留的前交叉韧带损伤患者75例,随机分成2组:保留残端组38例行关节镜下保留残端前交叉韧带重建;清除残端组37例行清除残端前交叉韧带重建。两组患者全部应用同种异体肌腱移植,移植后3,6,12,24个月随访,分别进行客观稳定性评估(Lachman试验、轴移试验)、膝关节功能评分(IKDC-2000和Lysholm及Tegner评分)。结果与结论:两组75例患者随访时间均为24个月。Lachman试验、轴移试验两组全部为阴性,在膝关节稳定性方面两组表现无明显差异;保留残端组患者移植后3,6个月IKDC-2000评分显著高于清除残端组(P <0.05),保留残端组患者移植后3,6个月时Lysholm及Tegner评分明显高于清除残端组(P<0.05),而移植后12,24个月IKDC-2000评分、Lysholm及Tegner评分结果两组差异不明显(P>0.05)。结果说明关节镜下保留残端重建膝关节前交叉韧带能更早的恢复患者膝关节的稳定性及运动能力,近期疗效优于清除残端重建。
BACKGROUND:Revascularization under arthroscopy has become the main treatment for anterior cruciate ligament injury, but whether stump retention or removal is better during the reconstruction is stil controversial. OBJECTIVE:To investigate the short-term clinical efficacy of arthroscopic anterior cruciate ligament reconstruction using alogeneic tendon with stump retention. METHODS:Seventy-five patients with anterior cruciate ligament injury were selected and randomly divided into two groups: stump retention group (n=38 cases) undergoing arthroscopic anterior cruciate ligament reconstruction with stump retention, and control group (n=37) undergoing arthroscopic anterior cruciate ligament reconstruction without stump retention. Both two groups were subject to alogeneic tendon transplantation. At 3, 6, 12, 24 months after transplantation, objective stability assessment (Lachman test, pivot shift test) and knee functional scoring (IKDC-200, Lysholm, Tegner scores) were evaluated. RESULTS AND CONCLUSION: Both two groups were folowed for 24 hours. Lachman test and pivot shift test were negative in the two groups, showing there was no difference in the knee joint stability performance between
the two groups. Compared with the control group, the IKDC-200, Lysholm and Tegner scores in the stump retention group were significantly higher at 3, 6 months after transplantaiton (P < 0.05); but there was no difference in these scores between the two groups at 12 and 24 months after transplantation. These findings indicate that arthroscopic anterior cruciate ligament reconstruction with stump retention contributes to earlier recovery of knee joint stability and athletic ability, and has better short-term efficacy than anterior cruciate ligament reconstruction without stump retention.