TransFix system®を用いた膝屈筋腱による膝前十字靱帯再建術―早期荷重による臨床的・社会的利害得失

Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Graft with the TransFix System® : Effect of Immediate Weight-Bearing on Clinical Outcome and Social Impact

　抄録：膝屈筋腱を移植腱とし，TransFix system^®によって固定する前十字靱帯（ACL）再建術では，固定間距離が短く，優れた初期固定力を有している．今回，本術式を用いた術後リハビリテーションを従来法（全荷重4週）と早期全荷重とで比較し，その利害得失について検討した．症例はACL再建術を受けた連続する41例（男20・女21，平均27歳）で，後療法によって前向きに2群に分類した（従来群21膝・早期群20膝）．その結果，臨床的には，術後の膝安定性や筋力の回復，膝関節水症の有無では両群間に有意な差はみられなかった．一方，社会的には，早期群では術後入院期間が平均11日と約5日短縮し，社会復帰までの期間も平均28日と約2週短縮していた．また，入院費用も有意に減少した．本術式による早期荷重プログラムは，安全かつ早期に社会復帰を可能とし，社会的損失を減少させることが可能である．

　The TransFix^® system provides superior strength for the initial graft fixation in anterior cruciate ligament reconstruction. The immediate-weight-bearing program after anterior cruciate ligament reconstruction with hamstring tendon graft was compared with the standard protocol (full weight-bearing at 4 weeks) in terms of clinical outcome and social impact. Forty consecutive cases, 41 knees, 21 in females and 20 in males, average age 27 years old, were divided prospectively into the two groups：a standard group of 21 knees and an immediate-weight-bearing group of 20 knees. There was no difference between the groups in terms of knee stability, muscle strength, or incidence of hydroarthrosis following the operation. However, the length of hospital stay and the recovery period to preoperative occupational activity were significantly shorter in the immediate-weight-bearing group, and hospital costs were lower. The immediate-weight-bearing program following anterior cruciate ligament reconstruction with a secure fixation device is safe and reduces social loss.