关节镜下带跟骨异体跟腱单束单隧道重建前交叉韧带

目的 通过与关节镜下单纯采用同种异体肌腱重建前交叉韧带 （anterior cruciate ligament，ACL） 比较，探讨带跟骨异体跟腱重建 ACL 促进腱-骨愈合的作用。方法 选择 2008 年１月至 2009 年 12 月收治并符合纳入标准的 41 例 ACL 损伤患者，随机分为两组，其中 21 例采用带跟骨异体跟腱重建 ACL （试验组）， 20 例采用单纯同种异体肌腱重建 ACL （对照组）。两组患者年龄、性别、损伤原因、病程及术前功能评分等一般资料差异均无统计学意义 （P＞0.05），具有可比性。两组均采用单束单隧道技术重建 ACL。结果 术后２周两组所有患者切口均Ｉ期愈合。两组患者均获随访，试验组随访时间 24～28 个月，平均 26 个月；对照组 24～30 个月，平均 28 个月。术后２年，试验组 Lachman 试验阴性率 71.4％ （15 例），前抽屉试验阴性率 76.2％ （16 例）；对照组２个试验的阴性率分别为 70.0% （14 例） 和 75.0% （15 例）。术后２年，试验组 Lysholm 评分、国际膝关节文献委员会 （IKDC） 评分与对照组比较，差异均无统计学意义 （P＞0.05）。CT 检查示，术后２年两组骨隧道直径均较术后１个月有不同程度增加，但试验组 （4/21，19.0%） 的骨隧道扩大率明显小于对照组 （8/20，40.0%） （P＜0.05）。膝关节松弛度检测显示：试验组关节前向松弛度为 （1.82±0.90） mm，明显小于对照组的 （2.29±0.77） mm。结论 与采用单纯同种异体肌腱重建 ACL 相比，采用带跟骨异体跟腱重建 ACL 可在一定程度上降低骨隧道扩大率，促进腱-骨愈合，近期疗效较好。

The single-bundle and single-tunnel reconstruction of anterior cruciate ligament using achilles tendon allograft with attached calcaneus under arthroscopy

Objective To investigate the effectiveness of anterior cruciate ligament （ACL） reconstruction using achilles tendon allograft with attached calcaneus in promoting the tendon-bone healing through comparing with that of ACL reconstruction using simple tendon allograft under arthroscopy. Methods From January 2008 to December 2009, 41 patients with ACL injuries in accordance with the inclusion criteria were treated. They were randomly divided into 2 groups according to different treatment methods. In the trial group, ACL reconstruction using achilles tendon allograft with attached calcaneus was performed on 21 patients. In the control group, ACL reconstruction using simple tendon allograft was performed on 20 patients. There were no significant differences in such general data as the age, gender, cause of injury, disease duration, preoperative functional score and so on between the 2 groups （P〉0.05）, which were comparable. The single-bundle and single-tunnel ACL reconstruction was performed in both groups. Results All the incisions in both groups were healed by the first intention 2 weeks postoperatively. The patients were followed up for an average period of 26 months （range; 24-28 months） in the trial group, and 28 months （range; 24-30 months） in the control group. 2 years after the operation, 15 cases （71.4%） were negative in the Lachman test, and 16 cases （76.2%） were negative in the anterior drawer test in the trail group. In contrast, 14 cases （70.0%） and 15 cases （75.0%） were negative respectively in the control group. There were no significant differences in the Lysholm score and International Knee Documentation Committee （IKDC） score between the 2 groups 2 years after the operation （P〉0.05）. The CT exam showed the bone tunnel diameter was enlarged in different degrees in both groups 2 years after the operation, when compared with that 1 month postoperatively. However, the rate of bone tunnel enlargement in the trial group （4/21, 19.0%） was obviously less than that in the control group （8/20, 40.0%） （P〈0.05）. The knee joint laxity examination showed the displacement in the trial group （1.82±0.90） mm was obviously less than that in the control group （2.29±0.77） mm. Conclusions The ACL reconstruction using achilles tendon allograft with attached calcaneus can decrease the rate of bone tunnel enlargement to some degree and promote the tendon-bone healing, with better short-term clinical outcomes, when compared with the ACL reconstruction using simple tendon allograft.