关节镜下LARS人工韧带与自体腘绳肌腱重建膝关节后交叉韧带早期疗效比较

doi:10.3760/cma.j.issn.2095-7041.2014.06.012

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摘要目的探讨先进韧带加强系统(LARS)人工韧带与自体四股腘绳肌腱(ST/G)重建后交叉韧带(PCL)手术的早期临床疗效。方法回顾性分析徐州医学院附属医院骨科2008年7月—2013年5月收治的58例膝关节后韧带损伤患者的临床资料。其中LARS人工韧带重建PCL(LARS组) 30例,两端均采用挤压螺钉固定;ST/G重建PCL(ST/G组)28例,股骨端使用Endobutton固定,胫骨端采取Intrafix挤压螺钉+门型钉固定。采用Lysholm评分、Tegner评分、国际膝关节文献委员会(IKDC)评分对两组患者术前和术后3、6、9、12个月时患侧膝关节功能进行评分。结果所有患者均顺利完成手术。均获随访12～18个月,平均14.5个月。LARS组患者术后扶拐下地、去拐行走、恢复轻量化运动时间[(12.4±4.3)h、(40.3±5.7)h、(3.4±0.6)h]均少于ST/G组[(23.5±6.6)h、(60.4±7.6)h、(7.2±1.3)h],差异均有统计学意义(t′=7.532、t=11.445、 t′=14.127, P值均<0.05)。LARS组在术后3、6、9个月时,Lysholm评分和IKDC评分均高于ST/G组,Tegner评分在术后3、6个月时高于ST/G组,差异均有统计学意义(P值均<0.05);在术后12个月时 LARS组3种膝关节功能评分与ST/G组比较,差异均无统计学意义 (P值均>0.05)。结论采用LARS人工韧带重建PCL具有手术创伤更小、术后恢复更快等优势,早期临床效果优于ST/G重建PCL手术;但远期临床效果需要进一步长期研究观察。

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	沈振宇
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	卢文海
	史思峰
	郭开今

关键词 ：后交叉韧带, 人工韧带, 自体四股腘绳肌腱, 重建

Abstract：Objective To compare the early clinical outcome of posterior cruciate ligament (PCL) reconstruction using the autogenous four-strand hamstring tendons (ST/G) and the ligament advanced reinforcement system(LARS) artificial ligaments.Methods From July 2008 to May 2013, 58 cases of PCL reconstruction in the Affiliated Hospital of Xuzhou Medical College were studied. LARS artificial ligamentsor autogenous hamstring tendons were chosen as grafts for PCL reconstruction, including 30 LARS artificial ligaments (LARS group) and 28 autogenous hamstring tendons (ST/G group). Intrafix interference screw at both the femoral side and tibial side were used in LARS group. In ST/G group the endobutton was used at the femoral side, and intrafix interference screw and staple fixation were used at the tibal side. Lysholm score, tegner score and IKDC score were used to evaluated each patient in pre-operation, 3 months post-operation, 6 months post-operation, 9 months post-operation and 12 months post-operation, respectively.Results All patients were completed operation and followed-up for 12-18 months, average 14.5 months. The times of walking with crutch, walking without crutch and recovering mild exercise after operation[(12.4±4.3)h、(40.3±5.7)h、(3.4±0.6)h, respectively] in LARS group were less than those in ST/G group[(23.5±6.6)h、(60.4±7.6)h、(7.2±1.3)h, respectively]. There were statistically significant differences between the two groups (t′=7.532、t=11.445、 t′=14.127, all P values<0.05). Lysholm scores and IKDC scores in LARS group were higher than those in ST/G group at 3 months post-operation, 6 months post-operation and 9 months post-operation. Tegner scores in LARS group were higher than those in ST/G group at 3 months post-operation and 6 months post-operation., There were statistically significant differences between the two groups (all P values<0.05). The scores of the three knee functions in cases using the LARS artificial ligaments were higher than those in cases using autogenous hamstring tendon 12 months post-operation (all P values＞0.05).Coclusions The early clinical outcome in the patients using the LARS artificial ligaments is better than that in the patients using ST/G.

Key words： Posterior cruciate ligament Artificial ligament Autogenous four-strand hamstring tendons reconstruction

收稿日期: 2013-11-20

通讯作者: 郭开今,xzgkj@sina.com

引用本文:

沈振宇, 周冰, 赵凤朝, 陈向阳, 卢文海, 史思峰, 郭开今. 关节镜下LARS人工韧带与自体腘绳肌腱重建膝关节后交叉韧带早期疗效比较[J]. 中华解剖与临床杂志, 2014, 19(6): 487-491.
Shen Zhenyu, Zhou Bing, Zhao Fengchao, Chen Xiangyang, Lu Wenhai, Shi Sifeng, Guo Kaijin.. Comparison of early clinical outcome of posterior cruciate ligament reconstruction using the ligament advanced reinforcement system artificial ligament and the autologous hamstring tendon with arthroscopic. Chinese Journal of Anatomy and Clinics, 2014, 19(6): 487-491.

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http://www.cjac.com.cn/CN/10.3760/cma.j.issn.2095-7041.2014.06.012 或 http://www.cjac.com.cn/CN/Y2014/V19/I6/487

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