自体与同种异体骨-髌腱-骨移植重建前交叉韧带早期MRI的对比观察

目的比校自体与同种异体骨-髌腱-骨(B-PT-B)移植之间存在的差异。方法按病例入选标准选出重建ACL患者50例,其中A组20例采用自体B-PT-B移植,B组30例采用同种异体B-PT-B移植,术后1周与术后1.5,3,6,9,12,15,18个月进行膝关节斜矢状位与斜冠状位及胫骨骨隧道斜轴状MRI扫描检查,观测移植物和胫骨骨隧道的演变过程。结果MRI动态观察,自体B-PT-B在体内重塑形的过程需12个月,而同种异体B-PT-B需15-18个月。移植骨瓣与骨隧道之间产生骨性愈合的时间自体组在术后3-6个月,同种异体组在术后6-12个月。术后两组各时限均有胫骨骨隧道扩大现象出现,其主要发生部位在胫骨骨隧道内口附近;其骨隧道扩大程度两组各时限均无统计学差异(均P>0.05);与术后3,6,9个月比较,两组胫骨骨隧道扩大程度均以术后6周最为显著(均P<0.05)。结论同种异体B-PT-B在人体内重塑的速率较自体B-PT-B慢,自体与同种异体B-PT-B移植重建ACL术后胫骨骨隧道扩大的程度基本相当。     

自体与同种异体骨-髌腱-骨移植重建前交叉韧带早期临床疗效的对比观察

目的 比较自体与同种异体骨-髌腱-骨（B-PT-B）移植之间存在的差异。方法 按病例入选标准选出重建前交叉韧带（ACL）患者50例，其中A组20例采用自体B-PT-B移植，B组30例采用同种异体B-PT-B移植。分别于术前、术后按膝关节IKDC2000主观评分标准和Lysholm评分标准进行主观问卷调查；术后按膝关节IKDC2000客观评定标准进行评定。结果 ①术前和术后3，6，12，18个月A组和B组在IKDC2000主观评分和Lysholm评分无统计学差异（均P〉0．05）；IKDC2000亚项主观评分术前和术后12、18个月IKDC2000主观评分亚项中膝关节疼痛程度和发作频率的主观评分，A组与B组比较均无统计学差异（均P〉0．05）；而术后3，6个月其A组膝关节疼痛程度和发作频率的主观评分分值均低于B组（均P〈0．05）。②IKDC000客观评定术后12，18个月关节活动度、关节稳定性、X线评价及IKDC2000膝关节检查综合评定A组与B组间无统计学差异（均P〉0．05）；但A组有关节间室弹响者多于B组（均P〈0．05）。A组术后12个月有供区体征者3例，术后18个月有供区体征者2例。结论 同种异体B-PT-B重建ACL术后早期可获得与自体B-PT-B重建ACL术后相近的临床效果。     

早期康复锻炼对ACL重建术后胫骨隧道的影响

目的探讨早期不同康复训练方案对膝关节前交叉韧带(ACL)重建术后胫骨骨道增宽的影响。方法将34例用同种异体骨-髌腱-骨(B-PT-B)重建ACL的患者分为2组,A组16例。男8例,女8例;平均年龄(32.7±15.6)岁。手术采用同种异体B-PT-B重建ACL进行ACL单束重建,术后采用普通的康复方案进行功能康复;B组18例,男8例,女10例;平均年龄(33.1±14.8)岁。手术采用同种异体B-PT-B重建ACL进行ACL单束重建,同时接受半月板缝合修复手术,术后采用保守的康复训练方案进行康复治疗。2组患者均在术后12个月采用CorelDRAW8.0软件对测量X线片上胫骨骨隧道关节面内口的直径;同时采用lysholm评分评价ACL重建术后临床疗效。结果34例同种异体B-PT-B重建ACL患者中有29%(10例)出现胫骨骨隧道的增宽;与术后采用普通的康复方案的A组相比,术后采用保守的康复训练方案进行康复治疗的B组患者骨隧道的增宽程度明显减小。术后12个月A和B组的临床lysholm疗效评分分别为(92.5±4.5)和(94.5±5.5),两组之间的临床疗效差异无显著性,P>0.05。结论早期不同的康复训练方案...     

关节镜下自体与同种异体骨-髌腱-骨重建膝前交叉韧带的临床探讨

目的探讨关节镜下自体与同种异体骨-髌腱-骨（B-PT—B）移植重建膝前交叉韧带（ACL）的临床疗效。方法对术前MRI检查有前交叉韧带断裂且术中关节镜检证实为前交叉韧带断裂者25例,按病人要求,分别选择采用关节镜下自体（自体组）和同种异体（同种异体组）骨-髌腱-骨移植重建膝前交叉韧带进行治疗,观察并记录两组治疗前后的症状、体征变化及术后Lysholm膝关节功能评分。术后随访6～24个月,平均16．7个月。结果两组术后均未发生严重的并发症,关节失稳明显改善,客观指标正常。手术时间自体组为（80±10）min,同种异体组为（60±10）min。术后发热时间自体组为（2±1）d,同种异体组为（3±1）d。膝关节功能按Lysholm评分标准,自体组为（86．7±4．3）min,同种异体组为（85．8±4．4）min。按Lukiano评分标准,自体组优良率为92．5％,同种异体组为90．09％。两组病例膝关节活动范围均正常。结论采用关节镜下自体B—PT-B移植手术时间较同种异体B—PT-B移植时间长,而术后吸收热时间较短（P〈0．01）,但白体与异体B—PT—B移植住院时间、Lysholm评分和重建ACL临床疗效差异均无统计学意义（P〉0．05）。同种异体移植重建无明显排斥反应,避免了自体B-PT—B重建时的自体组织损伤。同种异体B—PT—B是ACL重建的良好选择之一。     

保留前交叉韧带组织对异体骨-髌腱-骨移植物表面再血管化的影响

目的 利用关节镜再观察研究保留的前交叉韧带(ACL)残余组织对重建ACL的异体骨-髌腱-骨(B-PT-B)移植物再血管化的影响.方法 选择异体B-PT-B移植物重建ACL患者28例,依据ACL残存纤维束量采用两两配对分为两组,A组清理残存ACL纤维,B组保留残存纤维.术后6个月行关节镜检查,探查中松开止血带后连续拍摄移植物数码照片直至10 min,利用Photoshop软件分析移植物表面红色色度值,计算三级红色色度值区域面积随时间变化情况并制作曲线以了解表面血供.结果 A组有14例患者接受再次关节镜探查,B组13例,Photoshop色度法发现B组移植物表面红色色度在松开止血带后各时段均优于A组,B组曲线出现两次明显血供增加的峰值.结论 异体B-PT-B移植物重建治疗ACL部分损伤,术中保留残余纤维束,术后6个月异体移植物再血管化明显优于未保留残存纤维束的病例;异体移植物表面在术后6个月可有不同程度的微血管生成.     

保留或非保留 ACL 残迹对自体腘肌腱重建 ACL 术后胫骨骨道影响的对比研究

目的：探讨保留或非保留 ACL 胫骨残迹对 ACL 重建术后胫骨骨道的影响以及与临床疗效的关系。方法65例孤立性 ACL 损伤病例行关节镜下自体半腱肌、股薄肌肌腱重建 ACL,其中 A 组27例,保留 ACL 胫骨残迹,B 组38例,采用非保留残迹进行 ACL 重建。术后进行 MRI 检查,测量胫骨矢状位骨道最宽处直径,以术后1周对应部位骨道直径为衡量基准,对骨道扩大率进行统计学分析。采用 Lysholm 评分评估各组临床疗效。结果 A组25例,B 组35例得以随访,其中 A 组平均随访12.4个月,B 组平均随访12.1个月。两组病例术后胫骨骨道均有不同程度增宽,以 B 组骨道扩大程度相对较高。结果表明胫骨骨道随时间延长逐步扩大,在术后6周即有明显的扩大,自术后3个月,骨隧道变化程度相对较小,并趋于稳定;两组资料胫骨骨隧道扩大程度在各个时间段上均无统计学意义。所有病例稳定性良好,术后 Lysholm 评分在随访过程中逐步提高,两组病例在各个时间段对比无统计学意义（P ＆gt;0.05）。结论是否保留 ACL 残迹对骨道扩大、术后疗效无相关性,但保留 ACL 残迹可以促进腱-骨愈合,降低骨道扩大的发生程度。     

二步冷冻保存同种异体骨-ACL-骨移植后排斥反应的影响

目的 :探讨新鲜异体和二步冷冻保存同种异体骨 前交叉韧带 (ACL) 骨移植后排斥反应的差异。方法 :将 6 0只新西兰兔和 6 0只日本大耳兔分别随机分成自体骨 ACL 骨移植组、新鲜异体骨 ACL 骨移植组和二步冷冻保存同种异体骨 ACL 骨移植组 ,分别于术前及术后 1周、2周、3周、4周各采血 2ml测定血清中白细胞介素 2 (IL 2 )水平 ,术后 4周、12周切取移植关节 ,作苏木精 -伊红染色。结果 :光镜下检查显示 ,自体移植组和二步冷冻保存移植组均未见明显炎性细胞浸润 ,胶原排列规则 ,分化成熟。新鲜异体移植组有大量淋巴细胞浸润 ,其IL 2水平明显高于自体移植组和二步冷冻保存同种异体移植组且高于术前水平 (P <0 .0 1)。结论 :二步冷冻减轻了同种异体骨 ACL 骨移植后排斥反应 ,移植后其组织学改变同自体移植相似     

交锁髓内钉联合自体骨、异体骨及抗生素混合移植治疗胫骨干开放性骨缺损

目的 评价交锁髓内钉联合自体骨、异体骨及抗生素混合物移植治疗胫骨开放性骨缺损的疗效。方法 采用交锁髓内钉联合自体骨、异体骨及抗生素混合物移植治疗胫骨干开放性骨缺损16例，所有患者在清创后采用交锁髓内钉固定胫骨骨干，恢复小腿长度和轴线，骨缺损处利用自体骨、同种异体骨及抗生素混合移植物充填，伤口一期缝合，术后第2天即开始功能锻炼，并随访观察6～18个月。结果 所有患者均达到骨愈合，关节功能按照Johner—Wruhs评分标准：优10例，良6例。无感染及下肢缩短畸形等并发症发生。结论 对于胫骨干开放性骨缺损，采用交锁髓内钉联合自体骨、同种异体骨及抗生素混合物移植治疗疗效较好。     

自体与同种异体肌腱重建前交叉韧带临床对比分析

目的:观察自体骨-髌腱-骨与同种异体移植物关节镜下重建膝关节前交叉韧带(ACL)的疗效与差异。方法:将52例ACL损伤患者分为两组:自体骨-髌腱-骨组23例,同种异体肌腱移植组29例。回顾性分析比较两组患者术前、术后一般情况,膝关节Lachman试验、中立位前抽屉试验(ADT)、Lysholm评分及IKDC评分。随访时间为6～12个月,平均8个月。结果:所有患者均获得随访,术后切口均愈合良好。自体组无明显免疫排斥反应发生,异体组有6例患者出现排斥反应,经甲强龙治疗后愈合良好。两组手术前后各项指标差异有显著性差异;术后膝关节稳定性、Lysholm评分及IKDC评分两组之间未见明显差异。结论:关节镜下自体及同种异体肌腱重建ACL都有较好的疗效,同种异体肌腱重建组无取材区并发症及手术创伤小的优点。     

同种异体冻干骨加自体骨移植治疗骨缺损

目的报道采用同种异体冻干骨和自体骨混合一起移植治疗骨质缺损的治疗结果.方法自1995年～2000年对20例大块骨质缺损因自体骨源不足而采用同种异体冻干骨和自体骨按一定比例混合一起进行植骨修复.年龄9岁～65岁,平均32.3岁.骨缺损范围30cm3～90cm3.随访1年～5年,平均1年7个月.结果术后平均5.5个月移植骨和宿主骨骨性愈合.3月～6个月功能恢复正常,无不良反应.结论对治疗大块骨质缺损,应用同种异体冻干骨和自体骨按一定比例混合一起进行植骨治疗是一种有效的方法,可得到类似于自体骨移植的治疗效果.     

COA：Characteristics of Bone Tunnel Changes after Anterior Cruciate Ligament Reconstruction Using LARS Artificial Ligament

[Abstract] Purpose: The purpose of this study was to observe the characteristics of bone tunnel changes and possible causative factors following anterior cruciate ligament (ACL) reconstruction using LARS artificial ligament. Methods: Forty-three (43) patients underwent ACL reconstruction using LARS artificial ligament and were followed up for 3 years. X-ray and CT examinations were performed at 1, 3, 6, 12, 24 and 36 months after surgery, respectively, to measure the width of tibial and femoral tunnels. Knee function was evaluated according to the Lysholm scoring system. The anterior and posterior stability of the knee was measured using the KT-1000arthrometer. Results: According the Peyrache grading method, grade 1 femoral bone tunnel enlargement was observed in three cases six months after surgery. No grade 2 or grade 3 bone tunnel enlargement was found. The bone tunnel enlargement in three cases was close to the articular surface with an average tunnel enlargement of (2.5 ± 0.3) mm. Forty (40) cases were evaluated as grade 0. The average tibial and femoral tunnel enlargements at the last follow-up were 0.8 ± 0.3 mm and 1.1 ± 0.3 mm, respectively. There was no statistically significant difference in bone tunnel width changes at different time points (P>0.05). X-ray and CT measurements were consistent. Conclusions: There was no marked bone tunnel enlargement immediately following ACL reconstruction using LARS artificial ligament. Such enlargement may, however, result from varying grafting factors involving the LARS artificial ligament or from different fixation methods.     

Comparison of Clinical Outcome of Autograft and Allograft Reconstruction for Anterior Cruciate Ligament Tears

Background:

Hamstring (HS) autograft and bone-patellar tendon-bone allograft are the most common choice for reconstruction of anterior cruciate ligament (ACL). There was a little report about the clinical outcome and difference of arthroscopic ACL reconstruction using allograft and autograft. This study aimed to compare the clinical outcome of autograft and allograft reconstruction for ACL tears.

Methods:

A total of 106 patients who underwent surgery because of ACL tear were included in this study. The patients were randomly divided into two groups, including 53 patients in each group. The patients in group I underwent standard ACL reconstruction with HS tendon autografts, while others in group II underwent reconstruction with bone-patellar tendon-bone allograft. All the patients were followed up and analyzed; the mean follow-up was 81 months (range: 28–86 months). Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC), Lysholm scores, physical instability tests, and patient satisfaction questionnaires. The complication rates of both groups were compared. Tibial and femoral tunnel widening were assessed using lateral and anteroposterior radiographs.

Results:

At the end of follow-up, no significant differences were found between the groups in terms of IKDC, Lysholm scores, physical instability tests, patient satisfaction questionnaires, and incidences of arthrofibrosis. Tibial and femoral tunnel widening was less in the HS tendon autografts. This difference was more significant on the tibial side.

Conclusions:

In the repair of ACL tears, allograft reconstruction is as effective as the autograft reconstruction, but the allograft can lead to more tunnel widening evidently in the tibial tunnel, particularly.     

Characteristics of bone tunnel changes after anterior cruciate ligament reconstruction using Ligament Advanced Reinforcement System artificial ligament

Background  There are different materials used for anterior cruciate ligament (ACL) reconstruction. It has been reported that both autologous grafts and allografts used in ACL reconstruction can cause bone tunnel enlargement. This study aimed to observe the characteristics of bone tunnel changes and possible causative factors following ACL reconstruction using Ligament Advanced Reinforcement System (LARS) artificial ligament.

Methods  Forty-three patients underwent ACL reconstruction using LARS artificial ligament and were followed up for 3 years. X-ray and CT examinations were performed at 1, 3, 6, 12, 24, and 36 months after surgery, to measure the width of tibial and femoral tunnels. Knee function was evaluated according to the Lysholm scoring system. The anterior and posterior stability of the knee was measured using the KT-1000 arthrometer.

Results  According to the Peyrache grading method, grade 1 femoral bone tunnel enlargement was observed in three cases six months after surgery. No grade 2 or grade 3 bone tunnel enlargement was found. The bone tunnel enlargement in the three cases was close to the articular surface with an average tunnel enlargement of (2.5±0.3) mm. Forty cases were evaluated as grade 0. The average tibial and femoral tunnel enlargements at the last follow-up were (0.8±0.3) and (1.1±0.3) mm, respectively. There was no statistically significant difference in bone tunnel width changes at different time points (P >0.05). X-ray and CT measurements were consistent.

Conclusions  There was no marked bone tunnel enlargement immediately following ACL reconstruction using LARS artificial ligament. Such enlargement may, however, result from varying grafting factors involving the LARS artificial ligament or from different fixation methods.

     

骨膜包裹(膕)绳肌腱重建前交叉韧带促进腱骨愈合的临床观察

目的 观察采用自体骨膜包裹(膕)绳肌腱移植物重建前交叉韧带的临床疗效.方法 110例(110膝)前交叉韧带损伤的患者分为2组:实验组采用自体骨膜包裹(膕)绳肌腱重建前叉韧带(52膝),对照组采用单纯(膕)绳肌腱重建前交叉韧带(58膝).术后1年采用IKDC评分、Tegner评分和HSS评分评价临床效果;采用KT-1000,Lachman试验和轴移试验评估关节稳定性;采用膝关节MR测量骨隧道宽度.统计学处理采用t检验和χ~2检验.结果 实验组HSS评分与对照组比较差异无统计学意义(t=0.714,P>0.05);KT-1000测量实验组胫骨前移值小于对照组(t=6.427,P<0.05);术后1年MR观察实验组股骨隧道扩大率小于对照组(χ~2=4.17,P<0.05),实验组胫骨隧道扩大率小于对照组(χ~2=3.90,P<0.05).结论 自体骨膜包裹(膕)绳肌腱移植物重建前交叉韧带的方法短期临床效果确定,并能够增强重建韧带的稳定性,降低骨隧道扩大的发生率.     

关节镜下3种方法重建前交叉韧带的对比研究

目的:探讨关节镜下应用自体腘绳肌腱(HT)或异体胫前肌腱(ATT)配合两种不同固定方法重建前交叉韧带(ACL)的手术方法与疗效.方法:2007年9月～2010年6月收治60例单侧膝关节单纯ACL损伤患者,根据ACL重建时移植物与固定方法的不同,分成3组.A组12例,采用自体HT、双桩固定;B组23例,采用自体HT、Endobutton、可吸收界面螺钉固定;C组25例,采用异体ATT、Endobutton、可吸收界面螺钉固定.术后平均随访13.6个月,根据Lysholm膝关节评分和KT- 2000关节测量仪测定稳定性评价临床疗效.结果:Lysholm评分、KT2000测试,3组手术前后各项指标差异均有统计学意义(P＜0.01),但3组间术后各项指标差异均无统计学意义(P＞0.05).结论:关节镜下采用四股自体HT或异体ATT配合两种不同固定方法重建膝ACL,早期0.5～1.5年随访效果,疗效满意,不良反应发生率低.其中采用自体HT、双桩固定重建ACL的方法,具有取材方便、并发症少、疗效确切、医疗费用低等优点,值得临床推广应用.     

关节镜下锁扣带袢钛板TightRope固定自体腘绳肌腱的单束解剖重建前交叉韧带

目的:对关节镜下自体腘绳肌腱单束解剖重建前交叉韧带(ACL)的患者,对比分析股骨骨道分别采用锁扣带袢钛板TightRope、可吸收界面螺钉2种不同固定方式的临床疗效。方法:2016年1月-2017年12月,关节镜下采用自体腘绳肌腱单束解剖重建ACL患者63例,其中股骨骨道采用TightRope固定32例(TightRope组)、可吸收界面螺钉固定31例(界面螺钉组),胫骨骨道均使用可吸收界面螺钉加门型钉固定。重建后用相同的方法进行康复锻炼。定期随访,评估各项指标进行对比,评价Tightrope与可吸收界面螺钉股骨端内固定在ACL重建中的临床效果。结果:所有患者随访9-21个月,平均13.4个月。2组重建术后膝关节最大屈曲度组间差异无显著性意义。2组末次随访彩像检查均有较高的骨道扩大发生率,但组间差异无显著性意义。与重建前比较,末次随访时TightRope组和界面螺钉组的Lysholm评分、前抽屉试验阳性率、Lachman征阳性率、轴移试验阳性率均明显改善(P<0.05),但组间差异无显著性意义(P>0.05)。结论:关节镜下应用TightRope固定自体腘绳肌腱单束解剖重建ACL可获得满意的临床疗效,与可吸收界面螺钉固定疗效相当,但其操作更简便。     

Failed anterior cruciate ligament reconstruction: analysis of factors leading to instability after primary surgery

Background Revision anterior cruciate ligament (ACL) surgery can be expected to become more common as the number of primary reconstruction keeps increasing.This study aims to investigate the factors ca...     

Relationship between tunnel widening and different rehabilitation procedures after anterior cruciate ligament reconstruction with quadrupled hamstring tendons

Background It has been demonstrated that bone tunnel widening could appear after knee anterior cruciate ligament (ACL) reconstruction, especially for those patients whose ruptured ACL were reconstructed with semitendinosus and gracilis tendons. Many factors can influence the extent of tunnel widening. Few studies have investigated the relationship between bone tunnel widening and rehabilitation procedures. This research was carried out to find the rehabilitation procedures’ influence on the tibial bone tunnel widening after ACL reconstruction. Methods Sixty-five cases, whose ACL reconstructions were done using quadrupled semitendinosus and gracilis tendons, were divided into two groups. Group A had 33 cases, 19 men, 14 women, averaged (31.2±12.4) years old, only ACL reconstruction was done using Paessler’s technique, and aggressive rehabilitation procedure was used for function recovery post operation. Group B had 32 cases, 20 men, 12 women, averaged (30.3±10.3) years old. Except for ACL reconstruction, every patient in group B accepted meniscus repair using re-fixation methods or cartilage repair using microfracture technique, conservative rehabilitation procedure was used post operation. Six months post operation, standard posterior-anterior radiographic plates were taken for each case, CorelDRAW 8.0 software was used to digitize all X-ray plates and measure the upper, middle and lower parts of the tibial tunnel. Magnification effect of X-ray plates was taken out after measurement. Results Six months after ACL reconstruction the tibial tunnel widening of the upper, middle and lower parts on both the posterior-anterior and lateral X-ray plates in Group A with aggressive rehabilitation procedure was much more serious than in Group B with conservative rehabilitation. KT-1000 knee stability measurement and clinical manifestation showed no difference between the two groups. Conclusions Rehabilitation procedure after ACL reconstruction is one of the reasons for tunnel widening. It not only can directly influence the function recovery of ACL reconstructed knee, but also perhaps indirectly influence the function recovery and long-term clinical result of the operated knee by influencing the tunnel widening.