摘要
目的比较自体与γ射线照射和非照射异体骨-髌腱-骨（bone patellar tendon bone，B—PT—B）重建膝关节前十字韧带（anterior cruciate ligament，ACL）的临床疗效。方法107例ACL断裂患者随机分为三组：36例采用自体B—PT—B（自体组），36例采用深低温冷冻保存异体B—PT—B（异体组），35例采用γ射线照射深低温冷冻保存异体B—PT—B（γ射线组）。由同一术者采用标准关节镜技术完成ACL重建。结果自体组（36例）平均随访39．5个月、异体组（34例）36-3个月、1射线组（33例）37．6个月。（1）自体组术中髌骨骨折1例、术后膝前痛2例，异体组出现迟发感染1例。自体组手术时间较异体组、γ射线组长，术后发热天数较异体组、γ射线组短。（2）自体组、异体组轴移试验、Lachman试验或前抽屉试验及KT-2000检测结果的差异无统计学意义，与γ射线组比较差异均有统计学意义。γ射线组ACL重建失败率（36％）高于自体组（8％）、异体组（9％）。三组Daniel单腿水平跳跃试验、IKDC评分及Lysholm—Tegner运动水平评分的差异无统计学意义。结论深低温冷冻异体与自体B-PT—B重建ACL短期疗效接近。经γ射线照射后异体B—PT—B重建ACL的膝关节前后及旋转稳定性均降低。
Objective Analyze the clinical outcomes of arthroscopic anterior cruciate ligament （ACL） reconstruction with bone patellar tendon bone （B-PT-B） allograft or autograft. Methods A total of 107 patients underwent same arthroscopic ACL reconstruction technique were randomized into three groups （A： autograft 36, B： non-irradiated deep-frozen allograft 36, C： irradiated allograft 35）. Before surgery and at follow-up, patients were evaluated by general conditions, pivot shift test, Lachman and Anterior Drawer Test （ADT）, KT-2000 arthrometer testing, Daniel one-leg hop test, overall IKDC rating, Lysholm and Tegner activity score. Results A total of 103 patients were available for full evaluation. The mean follow-up time of A, B and C groups were 39.5, 36.3 and 37.6 months respectively. 1） In A group, patellar fracture occurred in 1 patient and anterior knee pain occurred in 2. In B group, 1 patient had late septic infection. Patients in the B and C groups underwent shorter operation time and longer fever time. There was no difference between the three groups in hospital stay time. 2） According to pivot shift test, Laehman test, ADT, and KT-2000 arthrometer testing, differences were found between C group to A or B groups, while no statistically significant differences between A and B groups. The failure rate in C group （36%） was higher than that with A （8%） and B group （9%）. According to Daniel one-leg hop test, the overall IKDC, Lysholm and Tegner activity score, no differences were found between the three groups. Conclusion Patients underwent ACL reconstruction with B-PT-B non-irradiated deep-frozen allograft or autograft had similar clinical outcomes. Non-irradiated B-PT-B allografl is a reasonable alternative to autografl. While the anterior and rotational stability decreased significantly, when irradiated B-PT-B allograft was used.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2009年第10期934-938,共5页
Chinese Journal of Orthopaedics
基金
山东省自然科学基金重点项目（Z2008C10）
关键词
前交叉韧带
骨-髌韧带-骨组织移植重建术
移植
自体
移植
同种
Γ射线
前瞻性研究
Anterior eruciate ligament
Bone-patellar tendon-bone graft
Transplatation, autologous
Transplatation, homologous
Gamma rays
Prospective studies
