双束前交叉韧带重建：四股与八股腘绳肌腱移植物对比
Double-bundle anterior cruciate ligament reconstruction: four versus eight strands of hamstring tendon graft.
作者信息
Zhao Jinzhong, He Yaohua, Wang Jianhua
机构信息
Department of Arthroscopic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
出版信息
Arthroscopy. 2007 Jul;23(7):766-70. doi: 10.1016/j.arthro.2007.01.022.
PURPOSE
The purpose of this study was to compare the clinical results of a double-bundle anterior cruciate ligament (ACL) reconstruction with 4 strands versus 8 strands of hamstring tendon graft.
METHODS
Seventy-six patients with chronic ACL rupture were randomly separated into two groups for double-bundle ACL reconstruction. In the 4-strand hamstring graft (4SHG) group, the semitendinosus tendon was used to make two 2-stranded hamstring tendon grafts, whereas in the 8-strand hamstring graft (8SHG) group, the semitendinosus tendon was used to make one 4SHG and the gracilis tendon was used to make the other 4SHG. The 4SHG group comprised 33 patients and the 8SHG group comprised 35 patients, with a minimum follow-up of 2 years. International Knee Documentation Committee (IKDC) and Lysholm scales were used to evaluate the clinical results.
RESULTS
In the 4SHG group the side-to-side difference was less than 3 mm in 26 patients (78.8%), 3 to 5 mm in 4 patients (12.1%), and 6 to 10 mm in 3 patients (9.0%), with a mean value of 2.8 +/- 0.5 mm; the pivot-shift test was negative in 29 patients (89.9%) and positive in 4 (12.1%). In the 8SHG group the side-to-side difference was less than 3 mm in 32 patients (91.4%), 3 to 5 mm in 2 patients (5.7%), and 6 mm in 1 patient (2.9%) (P = .004), with a mean value of 1.3 +/- 0.4 mm (P = .0003); the pivot-shift test was negative in 34 patients (97.1%) and positive in 1 (2.9%). According to the IKDC scale, 29 patients (87.9%) in the 4SHG group and 33 patients (94.3%) in the 8SHG group had a grade of normal or nearly normal. In the 4SHG and 8SHG groups the mean IKDC subjective knee evaluation results were 86.4 +/- 4.2 and 96.3 +/- 2.8 (P = .0007), respectively, and the mean Lysholm scores were 89.6 +/- 3.7 and 96.5 +/- 2.9 (P = .0006), respectively.
CONCLUSIONS
On the basis of KT-1000 examination (MEDmetric, San Diego, CA) and clinical measures, double-bundle ACL reconstruction with 8SHG yields significantly better results than double-bundle ACL reconstruction with 4SHG, with a mean side-to-side difference in anterior knee laxity of 1.3 +/- 0.4 mm versus 2.8 +/- 0.5 mm (P = .0003), IKDC subjective result of 96.3 +/- 2.8 versus 86.4 +/- 4.2 (P = .0007), and Lysholm score of 96.5 +/- 2.9 versus 89.6 +/- 3.7 (P = .0006).
LEVEL OF EVIDENCE
Level II, lesser-quality randomized controlled trial.
目的
本研究旨在比较采用4股与8股绳肌腱移植进行双束前交叉韧带（ACL）重建的临床效果。
方法
76例慢性ACL断裂患者被随机分为两组进行双束ACL重建。在4股绳肌腱移植（4SHG）组，使用半腱肌腱制作两条2股绳肌腱移植体；而在8股绳肌腱移植（8SHG）组，使用半腱肌腱制作一个4SHG，使用股薄肌腱制作另一个4SHG。4SHG组有33例患者，8SHG组有35例患者，最小随访时间为2年。采用国际膝关节文献委员会（IKDC）和Lysholm评分量表评估临床效果。
结果
在4SHG组，26例患者（78.8%）的两侧差异小于3 mm，4例患者（12.1%）的两侧差异为3至5 mm，3例患者（9.0%）的两侧差异为6至10 mm，平均值为2.8±0.5 mm；29例患者（89.9%）的轴移试验为阴性，4例患者（12.1%）为阳性。在8SHG组，32例患者（91.4%）的两侧差异小于3 mm，2例患者（5.7%）的两侧差异为3至5 mm，1例患者（2.9%）的两侧差异为6 mm（P = 0.004），平均值为1.3±0.4 mm（P = 0.0003）；34例患者（97.1%）的轴移试验为阴性，1例患者（2.9%）为阳性。根据IKDC评分量表，4SHG组29例患者（87.9%）和8SHG组33例患者（94.3%）的评级为正常或接近正常。在4SHG组和8SHG组，IKDC主观膝关节评估结果的平均值分别为86.4±4.2和96.3±2.8（P = 0.0007），Lysholm评分分别为89.6±3.7和96.5±2.9（P = 0.0006）。
结论
基于KT - 1000检查（MEDmetric，圣地亚哥，加利福尼亚州）和临床测量，采用8SHG进行双束ACL重建的效果明显优于采用4SHG进行双束ACL重建，膝关节前侧松弛度的两侧平均差异分别为1.3±0.4 mm和2.8±0.5 mm（P = 0.0003），IKDC主观结果分别为96.3±2.8和86.4±4.2（P = 0.0007），Lysholm评分分别为96.5±2.9和89.6±3.7（P = 0.0006）。
证据水平
二级，质量较低的随机对照试验。
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