中国组织工程研究

中国组织工程研究 ›› 2013, Vol. 17 ›› Issue (18): 3341-3348.doi: 10.3969/j.issn.2095-4344.2013.18.016

• 细胞与组织移植 cell and tissue transplantation • 上一篇    下一篇

关节镜下前交叉韧带单束与“人”字形重建远期疗效的比较

王立晖，李卫平，宋  斌，杨  睿，陈  仲   

  1. 中山大学孙逸仙纪念医院运动医学科，广东省广州市  510120
  • 收稿日期:2013-03-04 修回日期:2013-03-25 出版日期:2013-04-30 发布日期:2013-04-30
  • 通讯作者: 李卫平，主任医师，中山大学孙逸仙纪念医院运动医学科，广东省广州市 510120 lwp63@163.com
  • 作者简介:王立晖★，男，1987年生，广东省潮州市人，汉族，中山大学在读硕士，主要从事骨外科及运动医学临床研究。 wangody@126.com
  • 基金资助:

    广东省科技计划社会发展项目(2011B031800 017)。

Long-term effect of the single-bundle versus reverse “Y”-plasty reconstruction method for the anterior cruciate ligament reconstruction

Wang Li-hui, Li Wei-ping, Song Bin, Yang Rui, Chen Zhong   

  1. Department of Sport Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou  510120, Guangdong Province, China
  • Received:2013-03-04 Revised:2013-03-25 Online:2013-04-30 Published:2013-04-30
  • Contact: Li Wei-ping, Chief physician, Department of Sport Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China lwp63@163.com
  • About author:Wang Li-hui★, Studying for master’s degree, Department of Sport Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China wangody@126.com
  • Supported by:

    Social Development Project of Guangdong Provincial Science and Technology Program, No. 2011B031800017

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摘要：

背景：对于膝关节前交叉韧带损伤目前临床多采用单束或双束重建的方法，而采用“人”字形重建的方法临床上使用较少。
目的：比较单束和“人”字形方法重建膝关节前交叉韧带的远期临床疗效。
方法：回顾性分析2005年11月至2007年12月于中山大学孙逸仙纪念医院运动医学科行关节镜下前交叉韧带重建的59例前交叉韧带断裂患者的临床资料，所有患者均采用自体腘绳肌腱作为移植材料，股骨端和胫骨端均采用可吸收挤压螺钉固定。其中31例采用单束重建，28例采用“人”字形重建。
结果与结论：随访5-7年，随访期间59例患者均无韧带再断裂、明显关节肿痛及活动受限。末次随访时两组患膝Lysholm评分、Larson评分、国际膝关节文献委员会膝关节评分均明显高于重建前(P < 0.05)；且重建前和末次随访时两组患膝Lysholm评分、Larson评分、国际膝关节文献委员会膝关节评估表评分比较差异均无显著性意义(P > 0.05)。末次随访时单束重建组6例前抽屉试验弱阳性，5例Lachman征弱阳性，9例轴移试验弱阳性，7例X射线检查见胫骨隧道扩大；“人”字形重建组7例前抽屉试验弱阳性，4例Lachman征弱阳性，2例轴移试验弱阳性，6例X射线检查见胫骨隧道扩大。两组比较仅轴移试验阳性率间差异有显著性意义(P < 0.05)。表明关节镜下单束与“人”字形重建前交叉韧带均能获得满意的远期临床疗效，二者在改善患者膝关节稳定性及活动功能方面无差异，但“人”字形重建后患者的膝关节旋转稳定性更好。

关键词: 器官移植, 组织移植, 关节镜, 膝关节, 前交叉韧带, 长期疗效, 单束重建, “人”字形重建, 省级基金

Abstract:

BACKGROUND: The single-bundle or double-bundle reconstruction methods are commonly used to reconstruct the anterior cruciate ligament at present, while reverse “Y”-plasty reconstruction method is rarely used in clinic.
OBJECTIVE: To compare the long-term clinical curative effect of single-bundle and reverse “Y”-plasty reconstruction method for anterior cruciate ligament reconstruction.
METHODS: From November 2005 to December 2007, the clinical data of 59 patients with anterior cruciate ligament injury who received anterior cruciate ligament reconstruction under arthroscopic were retrospectively analyzed. All patients received the autogenous hamstring tendon as the graft material; the femoral end and the tibial end were fixed with absorbable interference screw. Among them, 31 patients adopted single bundle reconstruction method, and 28 patients adopted reverse “Y”-plasty reconstruction method.
RESULTS AND CONCLUSION: Totally, 59 patients were followed-up for 5 to 7 years. No patient had ligament rerupture, joint pain and limited mobility during follow-up period. The Lysholm score, Larson score and international knee documentation committee knee score in the final follow-up period were significantly higher than those before reconstruction (P < 0.05); there were no significant differences in the Lysholm score, Larson score and international knee documentation committee knee score between follow-up period and preoperation (P > 0.05). In single-bundle group, anterior drawer test results of six cases were mild-positive, Lachman test results of five cases were mild-positive, pivot shift test of nine cases were mild-positive, and seven cases had bone tunnel expansion during X-ray examination. In reverse “Y”-plasty group, anterior drawer test results of seven cases were mild-positive, Lachman test results of four cases were mild-positive, pivot shift test results of two cases were mild-positive, and six cases had bone tunnel expansion during X-ray examination. There was significant difference in the positive rate of pivot shift test between two groups (P < 0.05). The results indicate that both single-bundle and reverse “Y”-plasty reconstruction method can obtain the satisfactory long-term curative effect in anterior cruciate ligament reconstruction, and there are no significant differences in the stability and activity of the knee joint between two methods, but the reverse “Y”-plasty reconstruction method can obtain better rotary stability of knee joint after reconstruction.

Key words: organ transplantation, tissue transplantation, arthroscopy, knee joint, anterior cruciate ligament, long-term effect, single-bundle reconstruction, reverse “Y”-plasty reconstruction, provincial grants-supported paper

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