双束和单束重建前交叉韧带对膝关节稳定性和膝关节退变的前瞻性随机对照研究

doi:10.3969/j.issn.10073205.2018.01.010

河北医科大学学报

双束和单束重建前交叉韧带对膝关节稳定性和膝关节退变的前瞻性随机对照研究

冀中能源峰峰集团有限公司总医院邯郸院区骨三科，河北邯郸 056000

出版日期:2018-01-25 发布日期:2018-01-05
作者简介:张合(1977-)，男，河北唐山人，冀中能源峰峰集团有限公司总医院邯郸院区主治医师，医学硕士，从事骨关节疾病诊治研究。
基金资助:
邯郸市科学技术研究与发展计划（1623208105ZC）

Double bundle versus single bundle of anterior cruciate ligament reconstruction for knee stability and knee joint osteoarthritis：a prospective randomized controlled trial#br#

Department of Orthopaedics Ⅲ， the Handan Branch of Jizhong Engry Fengfeng Group Hospital， Hebei Province, Handan 056000, China

Online:2018-01-25 Published:2018-01-05

摘要/Abstract

摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗观察双束同种异体肌腱重建前交叉韧带(anterior cruciate ligament,ACL)对比双束自体肌腱和单束自体肌腱重建前交叉韧带的临床效果。
〖HTH〗方法〖HTSS〗〖KG*2〗将249例需行前交叉韧带重建的患者随机分成3组：使用同种异体肌腱双束重建前交叉韧带患者86例（doublebundle reconstruction with allograft，DBAL)；使用自体肌腱双束重建前交叉韧带患者83例（doublebundle reconstruction with autograft，DBAU）；使用自体肌腱单束重建前交叉韧带患者80例（singlebundle reconstruction with allograft，SBAU）。术后记录3、12、36个月KT1000值、轴移试验、国际膝关节文献委员会膝关节评估表（the International Knee Documentation Committee Knee Uation Form，IKDC）评分和Lysholm评分。术后36个月行X线检查评估膝骨性关节炎以及前内侧束、单束重建后骨道扩大情况。
〖HTH〗结果〖HTSS〗〖KG*2〗术后KT1000值，3组均呈现不断升高的趋势，在组间、时点间、组间·时间点差异均有统计学意义（P＜005）。术后Lysholm评分和IKDC评分，3组均呈现不断升高的趋势，在时点间差异有统计学意义（P＜005），在组间、组间·时间点差异均无统计学意义（P＞005）。术后轴移试验3、12、36个月随访，3组差异均有统计学意义，且SB组阳性例数均多于DB组（P＜005）。术后3组36个月骨关节炎X线分级、股骨骨道扩大、胫骨骨道扩大差异均有统计学意义（P＜005）。
〖HTH〗结论〖HTSS〗〖KG*2〗双束异体肌腱和双束自体肌腱重建前交叉韧带均可以获得良好前向稳定性和旋转稳定性，膝关节退变和骨道扩大例数均明显少于单束重建。

关键词: 前交叉韧带重建, 膝关节, 前瞻性研究

Abstract: ［Abstract］ Objective〖HTSS〗〓To compare the clinical outcomes of anterior cruciate ligament(ACL) reconstruction with doublebundle allogenic tendon, doublebundle autogenous tendon and singlebundle autogenous tendon.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 249 patients with ACL injury were randomly divided into three groups: 86 patients underwent doublebundle reconstruction with allograft(DBAL), 83 patients underwent doublebundle reconstruction with autograft(DBAU) and 80 patients underwent singlebundle reconstruction with allograft(SBAU). Postoperative evaluation tools were composed of KT1000 value, pivotshift test, the International Knee Documentation Committee Knee Uation Form(IKDC) score, Lysholm score. Patients were followed up at 3, 12 and 36 months postoperatively. An Xray examination was performed to evaluate the development of knee osteoarthritis and the expansion of the anteromedial tunnel from DB reconstruction and the single tunnel from SB reconstruction at 36 months postoperatively.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The postoperative KT1000 value showed a increasing trend in 3 groups, and there were significant differences between different groups，time points and group·time points(P＜005). The postoperative Lysholm score and IKDC score also showed an increasing trend in the 3 groups, and the difference was statistically significant at time points(P＜0.05), but there was no significant difference between groups and between group·time points(P＞005). Pivot test for 3 groups revealed that the SB group had statistically more patients with positive symptoms than both DB groups(P＜005). There were statistically significant differences in Xray classification, femoral and tibial tunnel expansion in the 3 groups at 36 months postoperatively(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Double bundle anterior cruciate ligament reconstruction with either allogeneic tendon or autologous tendon can achieve good anterior stability and rotation stability, and the osteoarthritis development and the tunnel expansion are significantly lower than the single bundle reconstruction.

Key words: anterior cruciate ligament reconstruction, knee joint, prospective studies

张〓合，赵洪波，曹成明，李江涛，高小康，韩守江*. 双束和单束重建前交叉韧带对膝关节稳定性和膝关节退变的前瞻性随机对照研究[J]. 河北医科大学学报, doi: 10.3969/j.issn.10073205.2018.01.010.

ZHANG He, ZHAO Hongbo, CAO Chengming, LI Jiangtao, Gao Xiaokang, HAN Shoujiang*. Double bundle versus single bundle of anterior cruciate ligament reconstruction for knee stability and knee joint osteoarthritis：a prospective randomized controlled trial#br#[J]. Journal of Hebei Medical University, doi: 10.3969/j.issn.10073205.2018.01.010.

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双束和单束重建前交叉韧带对膝关节稳定性和膝关节退变的前瞻性随机对照研究

Double bundle versus single bundle of anterior cruciate ligament reconstruction for knee stability and knee joint osteoarthritis：a prospective randomized controlled trial#br#

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