Ristić Vladimir, Ninković Srdan, Harhaji Vladimir, Stanković Milan, Savić Dragan, Milankov Miroslav
Odeljenje ortopedske hirurgije i traumatologije, Opsta bolnica Subotica.
Med Pregl. 2010 Nov-Dec;63(11-12):845-50. doi: 10.2298/mpns1012845r.
Modern literature concerning reconstructions of Anterior Cruciate Ligament is mostly focused on the choice of graft (hamstring or bone-tendon-bone), its placing, tensioning and fixation. The bone-hamstring-bone graft consists of compressed cancellous bone on its ends and it has been developed to achieve a more rigid fixation of the graft. The aim of this study was to compare the postoperative results in surgically treated patients two years after the reconstruction of anterior cruciate ligament.
The study included 55 patients divided into two groups according to the implanted graft: bone-tendon-bone and bone-hamstring-bone graft. The results were assessed by Tegner and Lysholm scoring systems, arthrometric measurements, functional tests and International Knee Documentation Committee standard.
The average postoperative results did not show a statistically significant difference (p < 0.05) between the two groups (94 in the bone-tendon-bone group versus 93 in the bone-hamstring-bone group) according to Lysholm scoring system, nor in the arthrometric measurements obtained by Lachman test (2.0:2.1). According to the International Knee Documentation Committee standard, the bone-hamstring-bone group had more excellent results, but also three unsatisfactory ones; so, the bone-tendon-bone group was found to have uniform and better results (100% of excellent and good results vs. 91% in the bone-hamstring-bone group). Better results were also recorded by Tegner scoring system in the bone-tendon-bone group (8.6 vs. 7.1) due to the fact that there were more active athletes and greater preoperative level of activities in this group (3.1 vs. 7.1 in the bone-hamstring group).
The choice of graft is a less important factor in the reconstruction of anterior cruciate ligament than its placing, tensioning and fixation, because a significant difference between groups was recorded only by the International Knee Documentation Committee standard.
现代关于前交叉韧带重建的文献大多集中在移植物的选择(腘绳肌或骨-肌腱-骨)、其放置、张紧和固定上。骨-腘绳肌-骨移植物两端为压缩松质骨,其设计目的是实现移植物更牢固的固定。本研究的目的是比较前交叉韧带重建术后两年手术治疗患者的术后结果。
本研究纳入55例患者,根据植入的移植物分为两组:骨-肌腱-骨和骨-腘绳肌-骨移植物。结果通过Tegner和Lysholm评分系统、关节测量、功能测试以及国际膝关节文献委员会标准进行评估。
根据Lysholm评分系统,两组的平均术后结果在统计学上无显著差异(p < 0.05)(骨-肌腱-骨组为94分,骨-腘绳肌-骨组为93分),通过Lachman试验获得的关节测量结果也无显著差异(2.0:2.1)。根据国际膝关节文献委员会标准,骨-腘绳肌-骨组有更多优秀结果,但也有三个不满意结果;因此,发现骨-肌腱-骨组的结果更均匀且更好(优秀和良好结果的比例为100%,而骨-腘绳肌-骨组为91%)。由于骨-肌腱-骨组有更多活跃运动员且术前活动水平更高(骨-腘绳肌组为3.1,骨-肌腱-骨组为7.1),Tegner评分系统在该组也记录到更好的结果(8.6对7.1)。
在重建前交叉韧带时,移植物的选择不如其放置、张紧和固定重要因素,因为仅根据国际膝关节文献委员会标准记录到组间有显著差异。