[自体腘绳肌腱移植重建前交叉韧带术后肌腱再生的磁共振成像研究]

[MRI study on tendon regeneration after anterior cruciate ligament reconstruction with hamstring tendon autografts].

作者信息

Liu Hu, Chen Baicheng, Sun Ran, Yan Changbao, Zhu Chaohua, Xie Lei, Wang Zhihui

机构信息

Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang Hebei 050051, PR China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Sep;25(9):1090-3.

PMID:21991817

Abstract

OBJECTIVE

To evaluate the tendon regeneration after anterior cruciate ligament (ACL) reconstruction with semitendinosus tendon and gracilis tendon autografts by MRI.

METHODS

Between September 2007 and September 2009, 52 patients undergoing ACL reconstructions with semitendinosus tendon and gracilis tendon autografts were enrolled. There were 29 males and 23 females with an average age of 31.6 years (range, 19-42 years). The left knees were involved in 34 cases and the right knees in 18 cases. The injury was caused by traffic accident in 11 cases, by sports in 38 cases, by heavy pound injury in 2 cases, and by other in 1 case. The time between injury and operation was 6 days to 31 months (median, 11.4 months). Joint pain occurred in 19 cases, joint instability in 28 cases, and joint swelling in 5 cases. The physical examination on admission showed thigh amyotrophy in 7 cases (thigh circumference side-to-side difference > 1 cm) and limitation of joint motion in 2 cases. The results of floating patella test, Lachman test, pivot shift test, and anterior drawer test were positive in 5, 51, 49, and 52 cases, respectively. The range of motion of knee was (127.77 +/- 5.73) degrees, International Knee Documentation Committee (IKDC) score was 49.50 +/- 4.08, and Lysholm score was 52.40 +/- 3.45. Of the patients, 23 were accompanied with medial meniscus tear, 6 with lateral meniscus tear, 2 with plica synovialis, and 1 with loose body.

RESULTS

All incisions healed by first intention. All the patients were followed up 12-18 months (mean, 14.9 months). At 12 months postoperatively, the results of Lachman test and pivot shift test were positive in 1 case, respectively; the results of anterior drawer test were negative in 52 cases. The range of motion of knee was (131.91 +/- 1.81)degrees, Lysholm score was 94.98 +/- 2.77, IKDC score was 93.65 +/- 2.42; and there were significant differences when compared with the preoperative ones (P < 0.05). At 12 months postoperatively, at 90 degrees resisted flexion of the knee, a very distinct fibrous band could be identified on the posteromedial aspect of the knee in 39 cases. MRI showed that both semitendinosus tendon and gracilis tendon regeneration in 10 cases, only semitendinosus tendon regeneration in 29 cases, only gracilis tendon regeneration in 2 cases, and no tendon regeneration in 11 cases. The regeneration rate of the semitendinosus tendon was 75.0% (39/52); the regeneration rate of the gracilis tendon was 23.1% (12/52); and the regeneration rate of the semitendinosus tendon and gracilis tendon was 78.8% (41/52).

CONCLUSION

MRI results suggest that some of the semitendinosus tendon and gracilis tendon could regenerate after harvested for ACL reconstruction.

摘要

目的

通过磁共振成像（MRI）评估前交叉韧带（ACL）重建术中使用半腱肌肌腱和股薄肌肌腱自体移植后的肌腱再生情况。

方法

选取2007年9月至2009年9月期间52例行ACL重建术并使用半腱肌肌腱和股薄肌肌腱自体移植的患者。其中男性29例，女性23例，平均年龄31.6岁（范围19 - 42岁）。左膝34例，右膝18例。损伤原因：交通事故11例，运动损伤38例，重物砸伤2例，其他1例。受伤至手术时间为6天至31个月（中位数11.4个月）。19例有关节疼痛，28例有关节不稳，5例有关节肿胀。入院体格检查发现7例大腿肌萎缩（双侧大腿周径差>1 cm），2例关节活动受限。浮髌试验、Lachman试验、轴移试验及前抽屉试验阳性分别为5例、51例、49例和52例。膝关节活动范围为（127.77±5.73）度，国际膝关节文献委员会（IKDC）评分49.50±4.08，Lysholm评分52.40±3.45。23例伴有内侧半月板撕裂，6例伴有外侧半月板撕裂，2例伴有滑膜皱襞，1例有游离体。

结果

所有切口均一期愈合。所有患者随访12 - 18个月（平均14.9个月）。术后12个月时，Lachman试验和轴移试验阳性各1例；前抽屉试验52例均为阴性。膝关节活动范围为（131.91±1.81）度，Lysholm评分94.98±2.77，IKDC评分93.65±2.42；与术前相比差异有统计学意义（P < 0.05）。术后12个月，在膝关节90度抗阻屈曲时，39例在膝关节后内侧可辨认出一条非常明显的纤维带。MRI显示10例半腱肌肌腱和股薄肌肌腱均再生，29例仅半腱肌肌腱再生，2例仅股薄肌肌腱再生，11例无肌腱再生。半腱肌肌腱再生率为75.0%（39/52）；股薄肌肌腱再生率为23.1%（12/52）；半腱肌肌腱和股薄肌肌腱均再生率为78.8%（41/52）。