三股编织与常规四股腘绳肌腱移植物在前交叉韧带重建中的临床结果比较
简介
该回顾性两中心研究对比了三股编织与常规四股腘绳肌移植物在ACL重建中的疗效，共纳入94例单束ACL断裂患者。编织组移植物直径显著更粗，手术时间无差异，中期随访IKDC和Lysholm评分更优，且编织技术本身及每增加1mm移植物直径均为良好功能结局的独立预测因子（OR分别为3.719和4.309）。提示编织技术除增粗移植物外或具有结构性优势，但受回顾性及短期随…
英文摘要
PURPOSE: To compare a triple-strand braided hamstring graft technique with the conventional quadruple-strand hamstring technique in anterior cruciate ligament reconstruction with respect to graft diameter, surgical parameters, and mid-term functional outcomes, and to determine whether the braided technique independently influences clinical success. METHODS: This two-centre retrospective review included 94 adults undergoing hamstring autograft reconstruction for isolated ACL rupture with at least one year of follow-up. Thirty-eight received the braided and 56 the conventional technique. Graft diameter, operative time, additional procedures, and functional scores (International Knee Documentation Committee [IKDC], Lysholm, visual analogue scale [VAS]) were recorded pre-operatively and at final follow-up. Multivariate logistic regression identified independent predictors of a good functional outcome (final IKDC ≥ 90), adjusting for age, sex, body mass index (BMI), injury mechanism, injury-to-surgery interval, pre-operative IKDC, and graft diameter. RESULTS: Baseline characteristics were comparable (all p > 0.05). Graft diameter was significantly greater in the braided group (p < 0.001), whereas operative time did not differ (p = 0.638). Both groups improved significantly from baseline (all p < 0.001). At final follow-up, the braided group achieved higher IKDC (p < 0.001) and Lysholm (p = 0.009) scores; the VAS difference was not significant (p = 0.126). After adjustment, the braided technique remained an independent predictor of a good functional outcome (OR 3.719, 95% CI 1.374-10.064; p = 0.010), as did each 1 mm increase in graft diameter (OR 4.309, 95% CI 1.748-10.625; p = 0.002). Model discrimination was acceptable (AUC 0.799; Nagelkerke R2 = 0.379). Age, sex, BMI, injury mechanism, and injury-to-surgery interval were not independent predictors (all p > 0.05). CONCLUSIONS: The braided technique yielded thicker grafts and superior mid-term IKDC and Lysholm scores. Its favourable effect persisted after adjustment for graft diameter, suggesting a structural advantage beyond thickness alone. Given the retrospective design and short follow-up, prospective randomised confirmation is required.