Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures
Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures
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DOI：
10.1302/0301-620x.91b10.21886
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发表时间：
2009-10-01
影响因子：
--
通讯作者：
Alhran, H.
中科院分区：
文献类型：
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作者：
Ibrahim, S. A. R.;Hamido, F.;Alhran, H.
共有218例单侧前交叉韧带缺损患者被随机分配到四组之一。在A组中，进行了解剖学双束前交叉韧带重建; B组采用Endobutton单束进行股骨固定; C组采用RigidFix交叉针单束进行股骨固定; D组采用生物可吸收TransFix II螺钉单束进行股骨固定。对于胫骨固定，所有组均使用生物可吸收Intrafix界面螺钉，所有患者的移植物均由半腱肌和股薄肌肌腱制成。共有18例患者失访。其余200例接受了临床评价，包括前抽屉评估、Lachman试验和平移试验以及KT-1000关节测量仪测量。他们还完成了国际膝关节文献委员会，Lysholm膝关节和Tegner活动评分。在平均29个月（25至38）的随访中，四组之间的受伤时间和活动范围以及Lysholm膝关节评分没有显著差异。然而，双束法显示出显著更好的结果，用于t-移位检验（p = 0.002）。KT 1000测量结果显示，双束组重建膝关节与患者正常膝关节之间的平均差异为1.4 mm，单束组为2.4 mm;具有统计学显著性。Lachman和前抽屉试验也显示双束法的上级结果。国际膝关节文献委员会评分显示两组之间无显著差异（p < 0.001）。临床评价显示双束组比单束组松弛度更小。然而，无论采用哪种技术，与术前状态相比，所有膝关节均通过前交叉韧带重建得到改善。
A total of 218 patients with unilateral anterior cruciate ligament deficiency were randomly assigned to one of four groups. In group A an anatomical double bundle anterior cruciate ligament reconstruction was performed; group B were treated by a single bundle using an Endobutton for femoral fixation; in group C by a single bundle using RigidFix cross pins for femoral fixation; and in group D by a single bundle using a bioabsorbable TransFix II screw for femoral fixation. For tibial fixation a bioabsorbable Intrafix interference screw was used for all the groups and the graft was fashioned from the semitendinosus and gracilis tendons in all patients. In all, 18 patients were lost to follow-up. The remaining 200 were subjected to a clinical evaluation, with assessment of the anterior drawer, Lachman's and the pivot-shift tests, and KT-1000 arthrometer measurement. They also completed the International Knee Documentation Committee, Lysholm knee and Tegner activity scores.At a mean of 29 months (25 to 38) follow-up there were no significant differences concerning time between injury and range of movement and Lysholm knee scores among the four groups. However, the double bundle method showed significantly better results for the pivot-shift test (p = 0.002). The KT 1000 measurements showed a mean difference between the reconstructed knee and the patients' normal knee of 1.4 mm in the double bundle group and 2.4 mm in the single bundle group; which was statistically significant. The Lachman and anterior drawer tests also showed superior results for the double bundle method. The International Knee Documentation Committee scale showed no significant difference among the groups (p < 0.001).On clinical evaluation the double bundle group showed less laxity than the single bundle groups. However, regardless of the technique, all knees were improved by anterior cruciate ligament reconstruction compared with their pre-operative status.