采用人工韧带或自体腘绳肌腱重建前十字韧带术后重返运动的差异：一项配对设计研究

Differences in Returning to Play after Anterior Cruciate Ligament Reconstruction with Artificial Ligament and with Autologous Hamstring Tendon: A Paired Design Study

DOI：10.12064/ssr.20200508

中文关键词:前十字韧带自体肌腱人工韧带重返运动

英文关键词:anterior cruciate ligament autologous tendon artificial ligament return to play

基金项目:国家自然科学基金（No. 81572108）；上海市扬帆计划（19YF1414600）。

作者	单位
陈天午	复旦大学附属华山医院运动医学科，上海 200040；复旦大学运动医学研究所，上海 200032 。
李云霞	复旦大学附属华山医院运动医学科，上海 200040；复旦大学运动医学研究所，上海 200032 。
陈疾忤	复旦大学附属华山医院运动医学科，上海 200040；复旦大学运动医学研究所，上海 200032 。
华英汇	复旦大学附属华山医院运动医学科，上海 200040；复旦大学运动医学研究所，上海 200032 。
陈世益	复旦大学附属华山医院运动医学科，上海 200040；复旦大学运动医学研究所，上海 200032 。

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中文摘要:

目的：比较前十字韧带重建术（ACLR）后重返运动率和重返运动时机在分别采用自体移植物和人工韧带（LARS）患者间的差异。方法：纳入2004年1月—2010年12月于复旦大学附属华山医院运动医学科接受ACLR手术的病例后，收集术后重返不同强度运动的情况和相应的重返运动时机信息，以及患者伤前、术前、术后第1年、第2年、第3年、第5年、第7年、第10年的运动水平。统计学分析两组间重返运动率和重返运动时机的差异。结果：LARS组中，24例术后重返运动，重返率为96%；重返竞技体育18例，重返率为72%；重返娱乐活动6例，重返率为24%。自体HT组中，45例术后重返运动，重返率为90%；重返竞技体育21例，重返率为42%；重返娱乐活动24例，重返率为48%。两组患者在重返竞技运动率（P=0.016）上具有显著统计学差异。LARS组中，重返轻体育活动时间为术后（2.0±1.0）月；重返涉及膝关节扭转、急停变向运动时间为术后（3.5±1.4）月；重返竞技运动时间为术后（5.2±1.7）月。自体HT组中，重返轻体育活动时间为术后（3.9±1.4）月；重返涉及膝关节扭转、急停变向运动时间为术后（5.9±1.3）月；重返竞技运动时间为术后（11.1±2.4）月。两组患者在重返运动时机（轻体育运动，P＜0.001；涉及膝关节扭转、急停变向运动，P＜0.001；重返比赛，P＜0.001）均存在显著统计学差异。LARS组患者术后第1年、第2年Tegner运动评分均显著高于自体HT组。结论：术后远期随访结果显示采用LARS重建前十字韧带（ACL）的患者不仅重返不同水平运动时机显著早于采用自体HT患者，且在重返竞技运动率上拥有显著优势。

英文摘要:

Objective: To compare the difference in the rate and timing of returning to play after anterior cruciate ligament reconstruction (ACLR) between patients with autograft and artificial ligament. Methods: The patients who underwent ACLR in the Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University from January 2004 to December 2010 were included in the study. The information on their return to sports of different intensity, the timing of return, as well as their sports performance before injury, before surgery, and in the first, second, third, fifth, seventh and tenth year after surgery were collected. Statistical analysis was used to explore the difference between the two groups in the rate of return to sport and the timing to return. Results: In the LARS group, 24 patients have returned to sport after surgery, with a return rate of 96%. 18 patients have returned to competition, the rate being 72%. Six patients have returned to recreational activities, the rate 24%. In the autogenous HT group, 45 patients have returned to sport after surgery, the return rate 90%. 21 patients have returned to competitive sports, the rate 42%. 24 patients have returned to recreational activities, the return rate 48%. There was a statistically significant difference in the rate of returning to competitive sport between the two groups (P=0.016). As for the LARS group, patients returned to light physical activity (2.0±1.0) months after the surgery, returned to sports involving knee torsion and sudden stop (3.5±1.4) months after the surgery, and returned to competitive sports (5.2±1.7) months after the surgery. For the autologous HT group, patients returned to light physical activity (3.9±1.4) months after the surgery, returned to sports involving knee torsion and sudden stop (5.9±1.3) months after the surgery, and returned to competitive sports (11.1±2.4) months after the surgery. The two groups had significant difference in the timing of returning to play (light physical activity, P<0.001; sports involving knee torsion and sudden stop, P<0.001; returning to competition, P<0.001). The LARS group had a significantly higher Tegner activity score than the autologous HT group in the first and second years after the surgery. Conclusion: The results of the long-term follow-up after the surgery showed that patients who used LARS to reconstruct the anterior cruciate ligament (ACL) not only have returned to different levels of sports significantly earlier than those who used autologous HT, but also had an obvious advantage in returning to competitive sports.

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