背景:前交叉韧带是维持膝关节稳定结构极其重要的静力结构.许多学者发现,前交叉韧带损伤重建后效果不佳的原因之一是对前交叉韧带的正常解剖结构以及生物学特性的认识不足.目的:比较关节镜下前交叉韧带损伤后同种异体肌腱双束单隧道重建及单束单隧道重建的疗效差异.方法:①解剖学研究:取6个新鲜人尸的正常膝关节,每个标本均拍摄正侧位X射线,CT以及MRI,证实标本无膝关节软骨破坏、膝周肿瘤以及前交叉韧带断裂等问题.沿前交叉韧带胫骨端骨面取下前交叉韧带,苏木精-伊红染色,观察各个截段韧带的纤维分布;②临床研究:对40例前交叉韧带重建病例进行研究,其中股骨端双束单隧道重建21例,股骨端单束单隧道重建19例.术前和随访时,所有患者都需要接受Lyrsholm、Tegner评分和 IKDC2000,对比术后膝关节功能恢复情况.结果与结论:①解剖学显示,苏木精-伊红染色未发现胫骨端存在双束的分界;②临床研究:40例患者(40个膝关节)均获得12个月以上随访,关节活动度均正常,股骨端双束单隧道重建和股骨端单束单隧道重建术后 Lysholm 评分、Larson 评分和 IKDC 评分均显著高于术前;两组比较,股骨端双束单隧道重建 Larson评分显著高于股骨端单束单隧道重建;③结果表明,前交叉韧带双束单隧道重建更加符合前交叉韧带胫骨端的解剖特点,可以比单束单隧道重建更好地重建膝关节的稳定性,术中操作简便,在胫骨端可较好恢复解剖重建,近期疗效佳,远期效果有待进一步观察.%BACKGROUND: The anterior cruciate ligament (ACL) is an extremely important static structure that stabilizes the structure of the knee joint. Many scholars have found that an insufficient understanding of normal anatomical structure and biological characteristics of the ACL results in poor outcomes in the ACL reconstruction. OBJECTIVE: To compare the clinical effects of single-bundle and double-bundle single-tunnel techniques in ACL reconstruction with allogeneic tendon. METHODS: (1) Anatomy research: Six fresh knee joints were used for the experiments, and X-ray, CT and MRI were taken for each sample to confirm no osteoclasia, tumor and collapse of ACL. Then the ACL was stripped from the tibial bone and used to run hematoxylin-eosin staining and observe the fiber distribution of each piece of the ACL. (2) Clinical research: A total of 40 cases of ACL arthroscopic reconstruction were involved in this study, including 19 single-bundle ones and 21 double-bundle ones. The International Knee Documentation Committee 2000 subjective knee form (IKDC2000), Tegner and Lysholm evaluations were performed in all the patients. Paired t-test was used to analyze the IKDC, Tegner and Lysholm scores before operation and at follow-up time. RESULTS AND CONCLUSION: Anatomy research: From the view of anatomy, there was no evidence to support the double beams of the ACL at the tibial end by hematoxylin-eosin staining. Clinical research: Forty patients (40 knee joints) were successfully followed for over 12 months, and their joint range of motion was normal. The IKDC, Tegner and Lysholm scores were all improved in both two groups after the surgery, while the Larson scores were significantly higher in the double-bundle group than the single-bundle group. To conclude, the single-tunnel double-bundle ACL reconstruction is better to restore the knee stability than the single-bundle ACL reconstruction. This is an easy operation that has the merits of operating conveniently, restoring the normal anatomy of the tibial end, and exhibiting excellent short-term therapeutic effects. However, its long-term effects are uncertain.
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