关节镜下前交叉韧带重建材料及其重建的理论研究与临床应用

背景:前交叉韧带是膝关节内的核心结构,近年来前交叉韧带损伤的发生率逐渐增高.目的:就前交叉韧带的损伤机制、手术方法、移植物选择、等长重建、重建韧带翻修等问题进行综述,为临床治疗前交叉韧带损伤提供一定的参考.方法:应用计算机检索Medline数据库(1996-01/2009-03),以Anterior cruciate ligament.implant、reconstruction、repair为检索词;应用计算机检索重庆维普数据库(1996-01/2009-03)、清华同方数据库(1996-01/2009-03),以前交叉韧带、移植物、重建、修补为检索词.结果与结论:共收集200篇关于关节镜下前交叉韧带重建的文献,排除发表时间较早、重复及类似研究,纳入18篇符合标准的文献.前交叉韧带是稳定膝关节的重要结构,运动及日常生活中多种因素可导致其损伤,治疗不当将严重影响运动能力或丧失运动能力.为恢复膝关节结构和功能,对损伤的前交叉韧带需要进行重建已成为共识.随着技术的不断进步和手术器械的研制创新,关节镜下重建术已成为当今治疗前交叉韧带损伤的主流方法.尽管治疗前交叉韧带损伤的手术方法很多,但还没有哪一种能完全复制前交叉韧带的解剖关系,手术是否能减少前交叉韧带伤后的继发损害目前还没有定论.对手术方式、移植物的选择、术后康复以及其他辅助治疗等方面仍有大量工作需要完善.

Clinical application of arthroscopic anterior cruciate ligament reconstruction materials and theoretical research of anterior cruciate ligament reconstruction

BACKGROUND: Anterior cruciate ligament (ACL) is the kernel of articular genu, for the past few years, the incidence rate of cruciate ligament injury increased gradually.OBJECTIVE: To review on the mechanism of the injury of ACL, the method of operation, the election of transplant, the reconstruction of equilong, the reconstruction of ligament and so on, and to look forward to providing some references on treating the ACL injury.METHODS: A computer-based research was conducted in Medine database (1996-01/2009-03), with the key words of "Anterior cruciate ligament, implant, reconstruction, repair". Chongqing VIP database and Qinghua Tongfang database (1996-01/2009-03) were retrieved with the same key words.RESULTS AND CONCLUSIONS: 200 literatures on arthroscopic ACL reconstruction were collected, excluding older, repeated and similar research, and the 18 standard literatures were included. ACL is a key structure to stabilize knee joint, and exercises and various factors during daily life could induce its injury. Unsuitable treatment would severely affect movement ability or movement loss. To recover structure and function of knee joint, damaged ACL should be reconstructed. With the development of technique and innovation of surgical instrument, arthroscopic reconstruction has presently been a popular method to treat ACL. There are many methods to treat ACL injury, but none of them can duplicate ACL anatomical relationship. It is still in doubt whether the operation can reduce the secondary damage. We have much more work to research on modus operandi, implant, postoperative rehabilitation and other adjunctive therapies.