اﻳﺮان ﻣﻔﺎﺻﻞ و اﺳﺘﺨﻮان ﺟﺮاﺣﻲ ﻣﺠﻠﻪ ارﺗﻮ ﺟﺮاﺣﺎن اﻧﺠﻤﻦ اﻳﺮان ﭘﺪي ﺷﻤﺎره ﺷﺸﻢ، دوره4 ) ﻣﺴﻠﺴﻞ ﺷﻤﺎره24 ( ، ﺗﺎﺑﺴﺘﺎن1387 ﺻﻔﺤﻪ، ﻫﺎي171 - 164 ﺑﺎزﺳﺎزي رﺑﺎط ﻣﺘﻘﺎﻃﻊ ﺟﻠﻮﻳﻲ ﻫﻤﺴﺘﺮﻳﻨﮓ ﮔﺮاﻓﺖ ﺑﺎ ﺑﺎ روش دوﺑﻞ ﻛﺮدن ﺛﺎﺑﺖ دﻛﺘﺮ ﻣﺪدي ﻓﻴﺮوز ) 1 ( دﻛﺘﺮ، ﻋﺒﺎﺳﻴﺎن ﻣﺤﻤﺪرﺿﺎ ) 2 ( دﻛﺘﺮ، رﺣﻴﻤﻲ ﻓﻮاد ) 3 ( دﻛﺘﺮ، ﻻﻫﻴﺠﻲ زاده ﻋﺒﺪاﻟﻪ ﻓﺮﻳﻮر ) 4 ( دﻛﺘﺮ، ﻫﺮﻧﺪي اﻋﻠﻤﻲ آرﻣﻴﻦ ) 5 ( دﻛﺘﺮ ﻓﺮزام ﻓﺮﻫﻤﻨﺪ ) 6 ( ﻳﺰدان ﻃﺎﻫﺮه، ﻳﺎر ) 7 ( ، ﻣﺪدي ﻓﻴﺮوزه ) 8 ( ، ﺻ رﺿﺎ ﺎدﻗﻴﺎن ) 9 ( Biologic Double Tibial Fixation in ACL Reconstruction by Medial Hamstring Graft Firooz Madadi, MD; Mohammad Reza Abbassian, MD; Fooad Rahimi, MD; Farivar Abdollahzadeh Lahiji, MD; Armin Aalami Harandi, MD; Firozeh Madadi » Shahid Beheshti University of Medical Sciences « Other Colleagues: Farzam Farahmand; Tahereh Yazdanyar, Reza Sadeghian ﺧﻼﺻﻪ ﭘﻴﺶ زﻣﻴﻨﻪ: آﺳﻴﺐ رﺑﺎط ﻣﺘﻘﺎﻃﻊ ﺟﻠﻮﻳﻲ ﺷﺎﻳﻊ از ﻳﻜﻲ ﺗﺮﻳﻦ ﻣﻲ زاﻧﻮ ﻣﻔﺼﻞ ﺻﺪﻣﺎت ﺑﺎﺷﺪ. روش ﮔﺮﭼﻪ ﺑﺮاي ﻣﺘﻌﺪدي ﻫﺎي ﻛﺮدن ﺛﺎﺑﺖ ﺑﺎزﺳﺎزي رﺑﺎط ﺗﻲ در ﺷﺪه و ﺷﺪه ﻣﻌﺮﻓﻲ ﺑﻴﺎ ﻟﻲ ﻛﺮدن ﺛﺎﺑﺖ ﺑﺎزﺳﺎزي در ﻣﻨﺎﺳﺐ و ﻣﻘﺒﻮل روش ﻳﻚ ﻫﻤﺴﺘﺮﻳﻨﮓ ﮔﺮاﻓﺖ ﻫﻴﺒﺮﻳﺪ ﻣﻲ ﺟﻠﻮﻳﻲ ﻣﺘﻘﺎﻃﻊ رﺑﺎط ﺑﺎﺷﺪ. ﻣﻄﺎﻟﻌﻪ اﻳﻦ ﻣﻨﻈﻮر ﺑﻪ ﺑﻴﻮﻣﻜﺎﻧﻴﻚ ﺧﺼﻮﺻﻴﺎت ﻣﻘﺎﻳﺴﺔ ﺗﺜﺒﻴﺖ ﺗﻲ ﺟﺰء ﻣﺨﺘﻠﻒ روش دو از اﺳﺘﻔﺎده ﺑﺎ ﻫﻤﺴﺘﺮﻳﻨﮓ ﮔﺮاﻓﺖ ﺑﻴﺎل ﺷﺪ اﻧﺠﺎم ﻛﺮدن ﺛﺎﺑﺖ. روش و ﻣﻮاد ﻫﺎ: ﻛﺎرآزﻣﺎﻳ ﻣﻄﺎﻟﻌﻪ ﻳﻚ در ﺗﺼﺎدﻓﻲ ﺑﺎﻟﻴﻨﻲ ﻲ، 22 ﺑﻴﻤﺎر ﺑﺎ اﻳﺰوﻟ ﭘﺎرﮔﻲ ﺟﻠﻮﻳﻲ ﻣﺘﻘﺎﻃﻊ رﺑﺎط ﻪ روش ﺑﻪ ﻛﻪ دوﺑﻞ ﻛﺮدن ﺛﺎﺑﺖ ﺗﻲ ﺑﺨﺶ ﺑﻴﺎ ﮔﺮﻓﺘﻪ ﻗﺮار اوﻟﻴﺔ ﺑﺎزﺳﺎزي ﺗﺤﺖ ﺑﻮدﻧﺪ، ﺑﺎ24 ﺑﻴﻤﺎر ﻛﻪ روش ﺑﻪ ﻣﻨﻔﺮد ﻛﺮدن ﺛﺎﺑﺖ ﺗﻲ ﻗﺴﻤﺖ در ﺑﻴﺎ ﺟﺬب ﻗﺎﺑﻞ اﻳﻨﺘﺮﻓﺮاﻧﺲ ﭘﻴﭻ ﺑﺎ ﺑﻮدﻧﺪ، ﺷﺪه ﺛﺎﺑﺖ ﺷﺪﻧﺪ ﻣﻘﺎﻳﺴﻪ. ﺟﺰ ﮔﺮاﻓﺖ ﺑﺮاي ﻓﻤﻮرال، ء از اﻧﺪوﺑﺎﺗﻮن ﺷﺪ اﺳﺘﻔﺎده. اﻳﻦ در روش ﻣﺎ، ﺟﺪﻳﺪ ﺑﺎﻗﻲ ﻣﺎﻧﺪه از ﺑﻌﺪ ﻫﻤﺴﺘﺮﻳﻨﮓ ﮔﺮاﻓﺖ ﻛﺮدن ﺛﺎﺑﺖ ﻛﺎﻧﺎل در ﺗﻲ ﺑﻴﺎ ا ﭘﻴﭻ ﺑﺎ ﻳ ﺟﺬب ﻗﺎﺑﻞ ﻨﺘﺮﻓﺮاﻧﺲ ﺗﻮﻧﻞ از ﺗﻲ در اﺳﺘﺨﻮاﻧﻲ ﺑﻴﺎ و ﺷﺪ داده ﻋﺒﻮر اداﻣ ﻪ ﮔﺮ ا اﺗﻲ ﻧﺦ ﺑﺎ ﻓﺖ ﺑﺎﻧﺪ ﺑﺨﻴﻪ ﺷﺪ. ﺑﺮاي ﺷﺎﻫﺪ ﮔﺮوه در ﺛﺎﺑﺖ ﻛﺮدن در ﮔﺮاﻓﺖ ﺗﻲ ﻛﺎﻧﺎل از ﻓﻘﻂ ﺑﻴﺎل ا ﭘﻴﭻ ﻳ ﺟﺬب ﻗﺎﺑﻞ ﻨﺘﺮﻓﺮاﻧﺲ ﺷﺪ اﺳﺘﻔﺎده. دو ﺑﻴﻤﺎران ﺳﭙﺲ ﮔﺮوه ﺳﺎﻟﻪ ﻳﻚ ﭘﻴﮕﻴﺮي ﻳﻚ در از اﺳﺘﻔﺎده ﺑﺎ درﺟﻪ ﻣﻘﻴﺎس ﺑﻨﺪي» ﺳﻴﻦ ﺳﻴﻨﺎﺗﻲ« (Cincinnati knee scale) و دﺳﺘﮕﺎه» KT-2000 « ﻣﻘﺎﻳﺴﻪ و ارزﻳﺎﺑﻲ ﺷﺪﻧﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻧﺸﺎﻧﻪ اﻣﺘﻴﺎز ﻣﻴﺎﻧﺔ ﻫﺎ) symptoms ( ﮔ در ﻣﻮرد ﺮوه8 ﺷﺎﻫﺪ ﮔﺮوه در و9 ﺑﻮد. اﺑﺰار از اﺳﺘﻔﺎده ﺑﺎ» KT-2000 « ﻣﻮرد، ﮔﺮوه در11 و ﻋﺎﻟﻲ ﻧﺘﻴﺠﺔ ﺑﻴﻤﺎر11 ﺧﻮب ﺑﻴﻤﺎر و ؛ ﺷﺎﻫﺪ ﮔﺮوه4 و ﻋﺎﻟﻲ ﻧﺘﻴﺠﺔ ﺑﻴﻤﺎر20 داﺷﺘﻨﺪ ﺧﻮب ﻧﺘﻴﺠﺔ ﺑﻴﻤﺎر) 01 / 0 = p .( ﻧﺘﻴﺠﻪ ﮔﻴﺮي: ﻫﺎﻣﺴﺘﺮﻳﻨﮓ، ﮔﺮاﻓﺖ از اﺳﺘﻔﺎده ﺑﺎ ﺟﻠﻮﻳﻲ ﻣﺘﻘﺎﻃﻊ رﺑﺎط ﺑﺎزﺳﺎزي در ﺗﻲ ﻗﺴﻤﺖ ﻛﺮدن ﺛﺎﺑﺖ ﺑﺎ ﻣﻘﺎﻳﺴﻪ در دوﺑﻞ ﺻﻮرت ﺑﻪ ﮔﺮاﻓﺖ ﺑﻴﺎي ﺗﻲ ﺟﺰء ﻛﺮدن ﺛﺎﺑﺖ ﻧﺎراﺣﺖ ﻋﻼﻳﻢ ﻧﻈﺮ از ﭘﻴﭻ، ﺑﺎ ﺑﻴﺎ ﺳﻴﺴﺘﻢ ﺑﺎ ارزﻳﺎﺑﻲ ﺑﺮاﺳﺎس ﻫﻤﭽﻨﻴﻦ و ﻛﻨﻨﺪه» KT-2000 « ﻣﻲ ﻧﺸﺎن ﺑﻬﺘﺮي ﻧﺘﺎﻳﺞ دﻫﺪ. واژه ﻫﺎي ﻛﻠﻴﺪي: ﮔﺮاﻓﺖ زاﻧﻮ، ﻣﻔﺼﻞ ﺟﻠﻮﻳﻲ، ﻣﺘﻘﺎﻃﻊ رﺑﺎط ﻫﺎ Abstract Background: Several different methods for fixation of grafts in anterior cruciate ligament (ACL) reconstruction have been used. The purpose of present study is to compare two techniques of tibial fixation in hamstring quadruple graft reconstruction. Methods: In a randomized clinical trial study, 46 cases of isolated tears were reconstructed using hamstring grafts. In 24 cases the tibial fixation sites were fixed with interference screw, and in 22 patients the remnant end of graft at tibia was passed through a bony tunnel and fixed with suture to the bone. The cases were all assessed with a mean follow-up of one year with “Cincinnati knee ligament rating scale” and “KT-2000” examination. Results: The score in 22 “target group” cases was 8, and in 24 “control group” was 9. In “KT-2000” examination, 11 patients of double fixation were excellent and 11 good. In control group 4 cases had excellent and 20 good results (p=0.01). Conclusions: Double tibial fixation for ACL reconstruction with Hamstring tendon graft has a better outcome on “Symptom” evaluation and “KT-2000” instrument compared to single tibial-site fixation. Keywords: Anterior cruciate ligament; Knee joint; Grafts ﻣﻘﺎﻟﻪ درﻳﺎﻓﺖ: 5 ﭼﺎپ از ﻗﺒﻞ ﻣﺎه ﺑﺎزﻧﮕﺮي و اﺻﻼح ﻣﺮاﺣﻞ: 2 ﺑﺎر ﭘﺬ ﻣﻘﺎﻟﻪ ﻳﺮش: 1,5 ﻣﺎه ﭼﺎپ از ﻗﺒﻞ ) 1 ( و) 4 ( : ﺑﻬﺸﺘﻲ ﺷﻬﻴﺪ ﭘﺰﺷﻜﻲ ﻋﻠﻮم داﻧﺸﮕﺎه ارﺗﻮﭘﺪ، ) 2 ( و) 3 ( و) 5 : ( ارﺗﻮﭘﺪ دﺳﺘﻴﺎر ي ﺑﻬﺸﺘﻲ ﺷﻬﻴﺪ ﭘﺰﺷﻜﻲ ﻋﻠﻮم داﻧﺸﮕﺎه، ) 6 :( ﻣﻜﺎﻧﻴﻚ، ﻣﻬﻨﺪس ﺷﺮﻳﻒ ﺻﻨﻌﺘﻲ داﻧﺸﮕﺎه ) 7 ( ﻓﻴﺰﻳﻮﺗﺮاﭘﻴﺴﺖ، داﻧﺸﮕﺎه، ﭘﺰﺷﻜﻲ ﻋﻠﻮم ﺗﻬﺮان ) 8 ( : ﺑﻬﺸﺘﻲ ﺷﻬﻴﺪ ﭘﺰﺷﻜﻲ ﻋﻠﻮم داﻧﺸﮕﺎه ﭘﺰﺷﻜﻲ، داﻧﺸﺠﻮي ) 9 :( ﭘﺰﺷﻜﻲ، داﻧﺸﺠﻮي ﮔﺮاﻧﺎدا ﭘﺰﺷﻜﻲ ﻋﻠﻮم داﻧﺸﮕﺎه ﺗﺤﻘﻴﻖ اﻧﺠﺎم ﻣﺤﻞ: اﺧﺘﺮ ﺑﻴﻤﺎرﺳﺘﺎن ﺗﻬﺮان، ﻧﺸﺎﻧﻲ راﺑﻂ ﻧﻮﻳﺴﻨﺪه: ﺷﺮﻳﻌﺘﻲ، خ ﺗﻬﺮان، اﺧﺘﺮ ﺑﻴﻤﺎرﺳﺘﺎن آذر، خ روﻣﻲ، ﭘﻞ ﻛﺘﺮ د ﻣﺪدي ﻓﻴﺮوزfmedadi@yahoo.com E-mail: Downloaded from ijos.ir at 6:39 +0330 on Saturday November 27th 2021