摘要目的 评价采用异体肌腱重建膝关节前十字韧带(anterior cruciate ligament,ACL)的临床疗效及通过二次关节镜探查评估移植物的转归.方法 2012年1月至2016年3月对ACL断裂应用异体肌腱重建术后12个月以上的患者行二次关节镜探查66例(66膝),男51例,女15例;ACL重建手术时年龄18～55岁,平均(30.6±10.4)岁.二次关节镜探查前采用Lysholm评分、国际膝关节文献委员会(International Knee Documentation Committee,IKDC)膝关节评估表及膝关节活动度评价膝关节功能恢复情况;采用前抽屉试验、Lachman试验及KT-1000侧侧差值评价膝关节前向稳定性.二次关节镜探查时观察移植物连续性、移植物滑膜覆盖情况、韧带张力以及关节内是否有异常结构;比较ACL张力良好与张力松弛者的膝关节稳定性.结果 ACL重建术至二次关节镜探查的时间为12～36个月,平均(18.3±5.8)个月,其中12～18个月31例、18～36个月35例.所有患者均未发生感染、严重排异反应及其他严重并发症.末次随访时除1例患者出现约10°伸直受限外,其余患者膝关节活动度基本正常;术后12个月Lysholm评分由术前(54.95±9.01)分提高至(86.14±5.86)分,IKDC评分由术前(54.79±9.12)分提高至(85.11±5.77)分,差异有统计学意义;前抽屉试验及Lachman试验由术前全部阳性改善至术后阳性8例、阴性58例;KT-1000侧侧差值由术前(6.70±1.24) mm降低至(1.52±1.02) mm,差异有统计学意义.二次关节镜探查示移植物完全吸收2例(连续性不佳)、移植物磨损4例、关节腔内Cyclops样结节2例.于术后18个月以后行二次关节镜探查患者的移植物滑膜覆盖优良率优于术后18个月以内探查者,差异有统计学意义;术后18个月以后行二次关节镜探查的患者中27例韧带张力良好、8例松弛,术后18个月以内行二次关节镜探查的患者中25例张力良好、6例松弛,差异无统计学意义.ACL张力良好组KT-1000侧侧差值为(1.14±0.35) mm,松弛组为(2.95±1.38) mm,两组差异有统计学意义.结论 采用深冻异体肌腱重建ACL能够获得较好的膝关节稳定性,但移植物血管化、滑膜化进程缓慢.

abstractsObjective To evaluate the clinical outcomes and report the second-look arthroscopic findings of reconstructed anterior cruciate ligament (ACL) using deep-frozen allograft.Methods Sixty-six patients undergoing ACL reconstruction using deep-frozen allograft in our institute with at least twelve months follow-up from January 2012 to March 2016 were included and received second-look arthroscopy.The patients consisted of 51 males and 15 females with an average age of 30.6 years (range,18 to 55 years) at the time of ACL reconstruction.Knee functions were evaluated by Lysholm score and International Knee Documentation Committee (IKDC) score.Knee stability was evaluated by drawer test,Lachman test and KT-1000 arthrometer.Second-look arthroscopic evaluation was performed in all patients,focused on continuity of the reconstructed ACL,the synovial coverage and subjective tension of the graft,and the prevalence of cyclops-like lesion and other changes after reconstruction procedures.Resuits All patients were followed up for average 18.3 months (range,12 to 36 months).Thirty-one patients underwent second-look arthroscopy from 12 to 18 months,and the other 35 patients underwent second-look arthroscopy from 18 to 36 months after ACL reconstruction.No infection,rejection reaction and other serious complication were reported after operation.The knee range of motion was normal in all cases,except that 10° extension limitation in one case.The Lysholm score significantly improved from preoperative 54.95±9.01 to 12 months postoperatively 86.14±5.86,and the IKDC improved from 54.79±9.12 to 85.11±5.77.Lachman test was positive in 8 cases,but negative in 58 cases postoperatively.KT-1000 arthrometer measurement showed that the side-toside difference significantly improved from preoperative 6.70± 1.24 mm to postoperative 1.52± 1.02 mm.Complete discontinuity occurred in 2 cases of the reconstructed grafts,graft tear in 4 cases.Cyclops-like mass was identified in 2 cases.The overall synovial coverage was slightly better in the patients who were followed up more than 18 months than those less than 18 months.However,there was no significant difference among the groups in the field of graft tension.The patients with taut grafts showed statistically better KT-1000 values (1.14±0.35 mm) than those with lax grafts (2.95±1.38 mm).Conclusion Frozen allograft could be a reasonable choice for ACL reconstruction.However,the graft integration and remodeling could tend to be slow.