Sun Ran, Chen Bai-cheng, Zhang Xiao-yang, Wang Fei, Shao De-cheng, Wang Xiao-feng, Chen Jing-qing
Department of Orthopedic Surgery, Third Hosipital of Heibei Medical University, Shijiazhuang 050051, China.
Zhonghua Yi Xue Za Zhi. 2010 Jan 19;90(3):182-6.
To develop a surgical technique using a periosteal flap wrapped autologous hamstring tendons in ACL reconstruction and to examine its short-term outcome.
A total of 110 patients (110 knees) were included. The experimental group (n = 52) received ACL reconstruction with hamstring tendons wrapped in periosteum. In the other 58 patients, ACL was reconstructed with autologous hamstring tendons. The mean post-operative follow-up was 19 (12 - 25) months. All patients were assessed at 12 months post-operation. The parameters of efficacy evaluation included IKDC score, Tegner score, modified HSS score, KT-1000 arthrometer reading and a radiographic assessment using anteroposterior and lateral radiographs. The incidence of femoral and tibial bone tunnel enlargement between two groups was compared with chi(2) test.
Clinical outcomes in experimental group (periosteum-wrapped grafts) were dependent on the wrap-up of periosteum, bone tunnel, graft fixation and postoperative rehabilitation. The good or excellent outcomes were reported in approximately 90% of the experimental group. And 44 patients showed normal or nearly normal knee function according to IKDC criteria. KT-1000 tests showed an average maximal manual side-to-side difference of 1.7 +/- 1.1 mm. Forty patients showed the outcomes of KT-1000, Lachman's knee ligament test and pivot-shift testing. The evaluation of the level of activity using the Tegner score revealed that 40 patients regained their pre-injury activity level. And 44 patients showed full knee extension and 42 patients showed full knee flexion after surgery. The average HSS score showed no significant difference between experimental group (90.6 +/- 0.57 points) and control group (89.9 +/- 0.8 points) (t = 0.714, P > 0.05). The KT-1000 measurement (133N) was larger in control group (2.3 +/- 1.0 mm) than in experimental group (1.7 +/- 1.1 mm). There was significant difference in laxity between two groups (t = 6.427, P < 0.05). At 12 months post-operation, tunnel enlargement could be observed in both groups. The average enlargement of femoral tunnel was less in experimental group (17.3%) than control group (34.5%) (chi(2) = 4.17, P < 0.05). And the enlargement of tibial tunnel was less in experimental group (19.2%) than control group (36.2%) (chi(2) = 3.90, P < 0.05).
The surgical technique using a periosteal flap wrapped with autologous hamstring tendons in ACL reconstruction has definite clinical efficacies. It can enhance the stability of knee and prevent the enlargement of bone tunnel.
开发一种在 ACL 重建中使用骨膜瓣包裹自体腘绳肌腱的手术技术，并研究其短期疗效。
共纳入 110 例患者（110 膝）。实验组（n = 52）采用骨膜包裹的腘绳肌腱进行 ACL 重建。另外 58 例患者采用自体腘绳肌腱重建 ACL。术后平均随访 19（12 - 25）个月。所有患者在术后 12 个月进行评估。疗效评估参数包括 IKDC 评分、Tegner 评分、改良 HSS 评分、KT - 1000 关节测量仪读数以及使用前后位和侧位 X 光片进行的影像学评估。两组间股骨和胫骨骨隧道扩大的发生率采用卡方检验进行比较。
实验组（骨膜包裹移植物）的临床结果取决于骨膜的包裹、骨隧道、移植物固定和术后康复。实验组约 90%报告了良好或优秀的结果。根据 IKDC 标准，44 例患者显示膝关节功能正常或接近正常。KT - 1000 测试显示平均最大手动侧方差异为 1.7 +/- 1.1 毫米。40 例患者进行了 KT - 1000、Lachman 膝关节韧带试验和轴移试验。使用 Tegner 评分评估活动水平显示，40 例患者恢复到受伤前的活动水平。术后 44 例患者膝关节完全伸直，42 例患者膝关节完全屈曲。实验组平均 HSS 评分为 90.6 +/- 0.57 分，对照组为 89.9 +/- 0.8 分，两组间差异无统计学意义（t = 0.714，P > 0.05）。对照组（133N）的 KT - 1000 测量值（2.3 +/- 1.0 毫米）大于实验组（1.7 +/- 1.1 毫米）。两组间松弛度差异有统计学意义（t = 6.427，P < 0.05）。术后 12 个月，两组均可见隧道扩大。实验组股骨隧道平均扩大率（17.3%）低于对照组（34.5%）（卡方 = 4.17，P < 0.05）。实验组胫骨隧道扩大率（19.2%）低于对照组（36.2%）（卡方 = 3.90，P < 0.05）。
在 ACL 重建中使用骨膜瓣包裹自体腘绳肌腱的手术技术具有确切的临床疗效。它可以增强膝关节的稳定性并防止骨隧道扩大。
