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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 136 -140. doi: 10.3877/cma.j.issn.1674-134X.2023.01.020

临床经验

关节镜下腓骨长肌腱单束重建前交叉韧带
刘日1, 高丽姝2, 魏海强1,†(), 谢坤南1, 于俊1, 戴士峰1   
  1. 1. 063000　唐山市第二医院关节外科
    2. 063000　唐山市人民医院内分泌科
  • 收稿日期:2021-03-27 出版日期:2023-02-01
  • 通信作者: 魏海强
  • 基金资助:
    河北医学科学研究重点课题计划(20201458); 河北医学科学研究重点课题计划(20211157)

Anterior cruciate ligament reconstruction with peroneus longus tendon under arthroscope

Ri Liu1, Lishu Gao2, Haiqiang Wei1,†(), Kunnan Xie1, Jun Yu1, Shifeng Dai1   

  1. 1. Department of Joint Surgery, The Second Hospital of Tangshan, Tangshan 063000, China
    2. Department of Endocrinology, Tangshan People′s Hospital, Tangshan 063000, China
  • Received:2021-03-27 Published:2023-02-01
  • Corresponding author: Haiqiang Wei
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刘日, 高丽姝, 魏海强, 谢坤南, 于俊, 戴士峰. 关节镜下腓骨长肌腱单束重建前交叉韧带[J/OL]. 中华关节外科杂志(电子版), 2023, 17(01): 136-140.

Ri Liu, Lishu Gao, Haiqiang Wei, Kunnan Xie, Jun Yu, Shifeng Dai. Anterior cruciate ligament reconstruction with peroneus longus tendon under arthroscope[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(01): 136-140.

目的

探讨关节镜下应用自体腓骨长肌腱(PLT)重建膝关节前交叉韧带(ACL)的临床疗效，并对供体区相关并发症进行分析。

方法

前瞻性分析唐山市第二医院关节外科2017年3月至2017年11月收治的45例前交叉韧带断裂患者的一般资料，将所有患者分成两组，其中腘绳肌腱组(23例)行关节镜下自体腘绳肌腱单束重建前交叉韧带，腓骨长肌腱组(22例)行关节镜下自体腓骨长肌腱单束重建前交叉韧带。所有患者术前Lachman试验、前抽屉试验阳性，MRI显示前交叉韧带断裂。记录手术前后患侧胫骨较健侧前移差值(SSD)及大腿周径变化；采用IKDC(国际膝关节文献委员会)评分、足踝残疾指数(FADI)评价膝、踝关节功能；术后行MRI检查评估肌腱走形。定量资料的比较采用t检验。

结果

45例患者术后均获随访，平均(17.3±1.4)个月，无关节粘连、韧带再断裂、严重下肢深静脉血栓等并发症。术中移植物编织后直径及长度腓骨长肌腱组大于腘绳肌腱组，差异有统计学意义(t＝－2.544、－10.523，均为P<0.05)。至术后1年时，两组患者膝关节IKDC评分及活动度较术前有显著改善(腘绳肌腱组t＝－61.610，腓骨长肌腱组t＝－55.740，均为P<0.05)，但两组间差异无统计学意义(均为P>0.05)；两组患者踝关节FADI评分差异无统计学意义(P>0.05)；腓骨长肌腱组大腿周径双侧差值小于腘绳肌腱组(t＝12.420，P<0.05)；MRI提示两组患者移植物走形良好，无髁尖窝撞击。

结论

关节镜下自体腓骨长肌腱重建前交叉韧带临床疗效确切，大腿肌肉萎缩程度较轻，且对踝关节功能无明显影响，值得临床推广。

关键词: 关节镜, 前交叉韧带重建, 韧带
Objective

To investigate the clinical efficacy of arthroscopic reconstruction of anterior cruciate ligament (ACL) with peroneus longus tendon (PLT) and study the donor-related complications.

Methods

A retrospective study was conducted on 45 patients who had anterior cruciate ligament rupture and treated in the Department of Joint Surgery of the Second Hospital of Tangshan between March and November 2017. The patients were divided into a PLT group (n=23) and an HT group (n=22). The patients in PLT group received the reconstruction of anterior cruciate ligament under arthroscope with autograft peroneus longus tendon, and the patients in HT group received arthroscopic reconstruction of anterior cruciate ligament with hamstring tendon single bundle. Preoperative Lachman test and front drawer test were positive on all patients together with rupture of anterior cruciate ligament showing on MRI. Side-to-side difference (SSD) and thigh circumference were taken before and after surgery. Knee and ankle functions were assessed by International Knee Documentation Committee(IKDC) score and foot and ankle disability index(FADI). Postoperative MRI scans were taken for assessment of tendon running.

Results

All patients were included in postoperative follow-up for (17.3±1.4) months in average. No postoperative complication such as joint adhesion, ligament re-rupture or severe deep venous thrombosis of lower limb occurred. The diameter of PLT after graft weaving was found greater than that of HT, with statistically significant difference (t=-2.54, -10.523, both P<0.05). At 12 months after surgery, IKDC scores and activity of knee joint in two groups were remarkably improved in comparison with those before surgery (HT group t=-61.610 and PLT group t=-55.740, both P<0.05), and without statistically significant difference between the two groups (all P>0.05). There was no statistically significant difference in ankle FADI scores between the two groups (P>0.05). The bilateral difference of thigh circumference in the PLT group was smaller than that in the HT group (t=12.420, P<0.05). MRI indicated that the grafts were running well and without condylar fossa impingement in both groups.

Conclusion

Arthroscopic reconstruction of ACL with PLT autograft has good clinical effect, featuring less muscle atrophy of thigh and unaffected ankle function, which is worthy of clinical application.

Key words: Arthroscope, Anterior cruciate ligament reconstruction, Ligaments
表1 两组患者围手术期一般资料
Table 1 Comparison of perioperative general data between the two groups
组别Group 例数Case number 性别(男/女)Gender(male/female) 患肢侧别Affected sides(左/右) 致伤原因Injury causes(交通/坠落/运动/砸伤) 年龄Ages[岁，(±s)] 受伤时间Injury time[d，(±s)] 术中肌腱长度Leght of tendon[cm，(±s)] 术中肌腱直径Diameter of tendon[cm，(±s)]
腘绳肌腱组HT group 23 12/11 11/12 10/2/10/1 32.0±1.8 13.5±2.3 21.6±1.9 6.8±2.4
腓骨长肌腱组PLT group 22 10/12 11/11 8/2/12/0 31.0±2.8 14.0±1.7 28.6±2.4 8.3±1.6
统计值   χ2＝0.203 χ2＝0.021 χ2＝1.181 t＝1.412 t＝－0.847 t＝－10.523 t＝－2.544
P值   >0.05 >0.05 >0.05 >0.05 >0.05 <0.001 0.014
表2 两组患者IKDC评分和FADI评分、大腿周径差和SSD差值比较(±s)
Table 2 Comparison of preoperative and postoperative IKDC and FADI scores, thigh circumference difference and SSD between the two groups
组别Group 例数Case number IKDC(分) t值 P值 FADI(分) t值 P值
术前Preoperation 术后1年Postoperative one year 术前Preoperation 术后1年Postoperative one year
腘绳肌腱组HT group 23 56.2±2.7 90.3±2.2 －61.610 <0.001 95.1±2.3 94.6±2.8 0.897 >0.05
腓骨长肌腱组PLT group 22 55.7±3.0 90.1±2.5 －55.740 <0.001 94.3±3.5 95.2±2.7 －1.245 >0.05
t值   0.798 0.228     1.187 －0.972    
P值   >0.05 >0.05     >0.05 >0.05    
组别Group 例数Case number SSD值(mm) t值 P值 大腿周径差(mm)thigh diameter differences t值 P值
术前Preoperation 术后1年Postoperative one year 术前Preoperation 术后1年Postoperative one year
腘绳肌腱组HT group 23 4.0±2.0 2.5±1.4 2.364 0.023 4.23±2.07 11.39±3.62 －8.097 <0.001
腓骨长肌腱组PLT group 22 4.1±2.6 2.4±1.8 2.581 0.013 4.34±0.65 4.13±0.47 1.246 >0.05
t值   －0.214 0.311     －1.566 12.420    
P值   >0.05 >0.05     >0.05 <0.001    
[1]
Emond CE, Woelber EB, Kurd SK, et al. A comparison of the results of anterior cruciate ligament reconstruction using bioabsorbable versus metal interference screws: a meta-analysis[J]. J Bone Joint Surg Am, 2011, 93(6): 572－580.
[2]
Freedman KB, D′Amato MJ, Nedeff DD, et al. Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts[J]. Am J Sports Med, 2003, 31(1): 2－11.
[3]
Chen W, Li H, Chen Y, et al. Bone-patellar tendon-bone autografts versus hamstring autografts using the same suspensory fixations in ACL reconstruction: a systematic review and meta-analysis[J/OL]. Orthop J Sports Med, 2019, 7(11): 2325967119885314. DOI: 10.1177/2325967119885314.
[4]
Getgood AMJ, Bryant DM, Litchfield R, et al. Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2-year outcomes from the STABILITY study randomized clinical trial[J]. Am J Sports Med, 2020, 48(2): 285－297.
[5]
Birchmeier T, Lisee C, Kane K, et al. Quadriceps muscle size following ACL injury and reconstruction: a systematic review[J]. J Orthop Res, 2020, 38(3): 598－608.
[6]
Dhammi IK, Rehan-Ul-Haq, Kumar S. Graft choices for anterior cruciate ligament reconstruction[J]. IJOO, 2015, 49(2): 127－128.
[7]
Nazem K, Barzegar M, Hosseini A, et al. Can we use peroneus longus in addition to hamstring tendons for anterior cruciate ligament reconstruction？[J/OL]. Adv Biomed Res, 2014, 3: 115. DOI: 10.4103/2277-9175.132696.
[8]
Brown CH Jr, Steiner ME, Carson EW. The use of hamstring tendons for anterior cruciate ligament reconstruction. Technique and results[J]. Clin Sports Med, 1993, 12(4): 723－756.
[9]
Zhao J, Huangfu X. The biomechanical and clinical application of using the anterior half of the peroneus longus tendon as an autograft source[J]. Am J Sports Med, 2012, 40(3): 662－671.
[10]
吴伟东，郑荣宗，应锦河. 关节镜下重建修复膝关节多韧带损伤[J]. 中国骨与关节损伤杂志，2012, 27(1): 82－83.
[11]
Kerimoǧlu S, Aynaci O, Saraçoǧlu M, et al. Anterior cruciate ligament reconstruction with the peroneus longus tendon[J]. Acta Orthop Traumatol Turc, 2008, 42(1): 38－43.
[12]
Mustamsir E, Phatama KY. Tensile strength comparison between peroneus longus and hamstring tendons: Abiomechanical study[J]. Int J Surg Open, 2017, 9: 41－44.
[13]
Conte EJ, Hyatt AE, Gatt CJ, et al. Hamstring autograft size can be predicted and is a potential risk factor for anterior cruciate ligament reconstruction failure[J]. Arthrosc J Arthrosc Relat Surg, 2014, 30(7): 882－890.
[14]
Khajotia BL, Chauhan S, Sethia R, et al. Functional outcome of arthroscopic reconstruction of anterior cruciate ligament tear using peroneus longus tendon autograft[J/OL]. Int J Res Orthop, 2018, 4(6): 898. DOI: 10.18203/issn.2455-4510.intjresorthop20184382.
[15]
杜天舒，张春礼. 自体腓骨长肌腱移植重建前交叉韧带发展现状[J/CD]. 中华关节外科杂志(电子版), 2015, 9(3): 412－415.
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