涤纶复合毡型人工韧带的实验研究

目的观察涤纶复合毡型人工韧带在动物体内的生物相容性和生物力学特性。方法用涤纶复合毡型人工韧带替代羊的胫后肌腱,分别于术后3、6、9、12个月收集标本做力学测定,并做光学显微镜观察;将涤纶复合毡型人工韧带植入鼠的四肢肌肉组织内,于术后2、4、8、12周处死,取出的标本做光学显微镜和透射电镜观察。结果替代羊胫后肌腱的涤纶复合毡型人工韧带,早期被纤维组织呈“岛屿”状分隔。随着植入时间延长,韧带周围出现胶原带,与伸入毡型韧带中间的胶原化纤维组织连接成片状,其抗拉强度不随时间的延长而发生衰减,经统计学分析,不同样本间的力学强度差异无显著意义。植入鼠肌肉组织内的毡型韧带早期见肉芽组织由四周向韧带中央呈包绕性生长,“盲区”较大。随着时间的延长,“盲区”逐渐缩小直至消失,被肉芽组织替代,胶原纤维明显增多,形成不同程度胶原化的纤维组织。结论涤纶复合毡型人工韧带富于网状孔隙结构,有利于组织的生长和愈合,具有良好的生物相容性和力学性能,能用于修复和重建人体受损的韧带组织。     

涤纶毡片重建环状韧带治疗桡骨小头脱位

目的观察涤纶毡片植入动物体内后的组织学变化和用于重建人体环状韧带治疗桡骨小头脱位的临床疗效方法60只雄性SD大鼠,随机分为3组,每组20只,于皮下组织、肌肉组织、脂肪组织内植入涤纶毡片。于1、2、4、8、12周收集上述组织标本,作光镜、电镜观察。临床治疗单纯桡骨小头脱位7例,Monteggia骨折10例,并随访疗效。结果早期毡片周围出现较多的炎性细胞浸润,中央为“盲区”。4周左右,“盲区”被排列致密的胶原纤维所替代,12周左右植入的毡片均出现胶原化。患者均获得随访,时间6~62个月,平均37.25个月。其中13例肘关节伸屈和旋转功能在手术后3~4周完全恢复,4例陈旧性Monteggia骨折伸屈功能恢复较早(1个月),但前臂旋转功能恢复较慢(2~3个月)。结论涤纶毡片的网状结构及较好的生物相容性,有利于诱导纤维组织长入形成新的韧带,用于重建人体环状韧带疗效可靠。     

涤纶毡片在肩锁关节脱位中的应用

作者1993～1997年,对23例Ⅲ°肩锁关节脱位采用切开复位,心脏修补材料涤纶毡片重建喙锁韧带,疗效满意。1　临床资料本组23例Ⅲ°肩锁关节脱位,男19例,女4例。年龄22～56岁,平均31岁。左侧13例,右侧10例。合并脑外伤,蛛网膜下腔出血3例。均为肩部闭合性损伤,肩关节外展,上?..     

新型合成材料人工韧带的研制和动物实验研究

本实验用人工韧带以涤纶为主要成分的合成材料、开放性编织成网孔状内，外双套管结构，对１２只狗的１６个膝关节行前交叉韧带替代术。阶梯状骨髓道生物学固定是其手术特征。术后分期取材检查。１８周形态学显示新韧带已初具正常前交叉韧带形态，近骨隧道口韧带表面有微血管网形成。     

人工韧带与骨界面结合的实验研究

[目的]利用韧带先进加强系统(ligament advanced reinforcement system, LARS)重建实验动物的前交叉韧带(anterior cruciate ligament, ACL),研究LARS人工韧带与骨界面结合的情况.[方法]取雄性成熟波尔山羊24只,随机分成3组.利用临床ACL重建系统建立动物实验模型.分别于术后4、8、12周取材做大体观察、组织学、影像学和生物力学检查.所得实验数据进行统计分析.[结果](1)术后4周组织学显示韧带-骨界面充满大量的疏松结缔组织,可见到炎细胞浸润表现;术后8周韧带-骨界面之间有新骨形成.部分标本出现Sharpey纤维结构;术后12周韧带-骨界面见大量的Sharpey纤维结构及大量的成纤维细胞.未见钙化软骨;(2)对第3组实验动物术后4、8、12周进行影像学检查,然后利用eflime图像处理软件所得数据进行统计学分析.结果显示有显著性统计学差异(P<0.01);(3)生物力学测试发现,在不同时间点均将韧带从骨隧道中拉出,韧带无一断裂.结果显示没有统计学差异(P>0.05).[结论]LARS人工韧带重建ACL后,其两端骨隧道中韧带-骨界面可通过Sharpey纤维结构,形成间接连接,促进韧带-骨的结合,增强韧带-骨愈合的强度.     

人工气管移植的实验研究及临床应用

长段气管切除后的气管重建迄今仍是一个难题，虽然，气管一支气管重建的病例不少，但切除长度均有限。为此对４９只犬进行了人工气管移植术，对动物定期进行解剖，观察，并对自行研制的涤纶－硅环人工气管作进一步研究，１９８６年首次对１例气管癌病人行人工气管移植术获得成功，综合结果表明：ＩＶ型人工气管可用于临床，是一比较理想的气管替代材料。     

Chronic acromioclavicular separation: the medium term results of coracoclavicular ligament reconstruction using braided polyester prosthetic ligament

In this series, we treated chronic acromioclavicular disruption with an artificial coraco-clavicular ligament made from braided polyester (The Nottingham Surgilig). The ligament has a loop at each end and is passed around the coracoid process, threaded through itself, then passed around the posterior aspect of the clavicle and finally anchored to it with a bone screw. Eleven men with an average age of 39 underwent this procedure. Three patients had previously been operated on using the Weaver-Dunn procedure which had failed. All eleven patients have been reassessed clinically and radiographically at an average of 55 months. Using the Imatani evaluation score, 10 patients achieved a good/excellent result with the mean Constant score being 92. One patient had fracture of the base of the coracoid after heavy lifting in the early postoperative period which resulted in a poor outcome. Two patients needed an additional operation. In one the lateral end of the clavicle was excised together with removal of the fixation screw, and in the other a subacromial decompression was carried out. The Nottingham Surgilig is a useful alternative for the treatment of chronic acromioclavicular separation, especially in revision reconstruction when the coracoacromial ligament is no longer available.     

LARS韧带重建前交叉韧带的近期疗效

目的探讨LARS韧带重建前交叉韧带(anterior cruciate ligament,ACL)的手术方法和近期疗效。方法回顾分析2008年11月-2010年4月于关节镜下采用LARS韧带重建并获完整随访的80例ACL损伤患者临床资料。男51例,女29例;年龄17～43岁,平均29.2岁。致伤原因:运动伤63例,交通事故伤14例,重物砸伤3例。左膝43例,右膝37例。病程10 d～11个月。前抽屉试验、Lachman试验和轴移试验均为阳性。术前Lysholm、Irgang、Larson评分分别为(55.4±5.7)、(48.3±6.2)、(54.8±7.4)分,国际膝关节评分委员会(IKDC)评分均低于正常值。MRI检查显示ACL损伤。术中保留ACL残余纤维束。结果术后切口均Ⅰ期愈合,无感染、下肢深静脉血栓形成等术后早期并发症发生。80例均获随访,随访时间7～24个月,平均16.8个月。术后3例股骨侧螺钉外露,2例胫骨侧螺钉松动,1例伸膝受限,均对症处理。随访期间均无LARS韧带断裂、关节纤维化等并发症发生。末次随访时前抽屉试验阳性2例,Lachman试验阳性3例,轴移试验阳性3例。术后6周及末次随访时Lysholm、Irgang、Larson评分与术前比较,差异均有统计学意义(P<0.05)。术后6周及末次随访时IKDC评分正常率分别为43.75%(35/80)及97.50%(78/80)。结论 LARS韧带黏弹性较差,术中需要在偏伸直位固定避免屈曲受限,屈曲位允许移植物有轻微松弛,掌握其特殊手术技巧后重建ACL能获得较好的近期疗效。     

关节镜下LARS重建后交叉韧带的近期疗效

目的探讨在关节镜下应用LARS重建后交叉韧带（PCL）的近期疗效。方法7例陈旧性PCL损伤患者在伤后2～13个月使用LARS人工韧带（PPLY110）作双束双隧道PCL重建。结果7例均获随访,时间5～25个月,膝关节稳定性良好,膝活动度较术前改善,无伸直受限,后抽屉试验、反轴移试验均为阴性,Lyshlom评分由术前（47.71±5.99）分提高到术后（82.29±2.50）分。未发生并发症。结论关节镜下LARS重建PCL操作简便、创伤小,术后能早期功能锻炼,近期疗效满意,是目前临床应用效果理想的人工韧带。     

关节镜下LARS人工韧带及4股半腱肌肌腱重建前交叉韧带

目的评价LARS人工韧带和自体4股半腱肌肌腱关节镜下重建膝前交叉韧带（ACL）的临床疗效。方法对28例膝ACL断裂患者行关节镜下ACL重建术,根据重建材料的来源分为LARS人工韧带组（13例）和自体4股半腱肌肌腱组（15例）。采用ACL解剖等长重建技术建立胫骨、股骨骨道。并对两组的关节稳定性和Lysholm膝关节功能评分进行对比研究。结果术后膝关节稳定性LARS人工韧带组优于4股半腱肌肌腱组（P〈0.05）。移植后两组Lyshrolm膝关节功能评分较移植前提高（P〈0.05）。术后6个月LARS人工韧带组Lysholm评分（90.4分±5.3分）高于4股半腱肌肌腱组（81.2分±4.7分）（P〈0.05）。结论在关节镜下重建ACL术中,LARS人工韧带可作为自体材料的良好替代物。     

LARS人工韧带关节镜下重建膝前交叉韧带

目的 探讨关节镜下LARS人工韧带治疗膝关节前交叉韧带（ACL）完全性损伤的疗效。方法对12例ACL完全损伤患者实施关节镜下LARS人工韧带重建术。结果12例均获随访,时间3～11个月,膝关节前直向不稳症状均消失,前抽屉试验阴性,关节功能良好,未并发急性滑膜炎。患膝伸屈度0°～120°。根据Lysholm膝关节评分法,膝关节评分由术前（45．45±1．18）分提高到术后（84．77±2．26）分。结论LARS人工韧带组织相容性好,是理想的韧带移植材料。关节镜下LARS人工韧带重建ACL完全性损伤疗效好,创伤小,并发症少,患膝稳定性早期即可完全恢复,术后关节功能能达到正常运动要求。     

Silk enhances the ligamentization of the polyethylene terephthalate artificial ligament in a canine anterior cruciate ligament reconstruction model

Anterior cruciate ligament (ACL) reconstruction is the leading treatment for ACL rupture. Ligament Advanced Reinforcement System (LARS), which is made of polyethylene terephthalate (PET), is the most frequently used artificial ligament for ACL reconstruction. However, PET is hydrophobic, so it is difficult to induce the ingrowth of the autologous tissue. The aim of this study is to explore the effects of silk hybrid on the ligamentization of the PET artificial ligament in a canine ACL reconstruction model. Silk/PET hybrid suspensory ligament was fabricated with silk in the weft yarn and PET in the warp yarn, while PET suspensory ligament was fabricated with PET in both the weft and warp yarns. After fabrication, the micromorphology of the ligaments was observed and mechanical testing was performed. Though the failure loads of the degummed silk/PET hybrid suspensory ligaments were significantly lower than those of the PET suspensory ligaments (P < 0.001), both of them were enough for ACL reconstructions of beagle dogs. In the animal study, 14 beagle dogs were divided into PET suspensory ligament group and silk/PET hybrid suspensory ligament group randomly, with 7 dogs in each. The dogs underwent ACL reconstructions in their right knees. At postoperative 6 months, the dogs were sacrificed, and the specimens were evaluated with gross observation, histology, immunohistochemistry, and mechanical testing. The histological and immunohistochemical results showed that the native ACL of the beagle dog held abundant fibroblasts and collagen. The PET‐regenerated ligament was loose, and there was a small amount of autologous tissue and collagen. Compared to the PET‐regenerated ligament, the silk/PET hybrid‐regenerated ligament had a compact structure, and there was more regenerated autologous tissue and collagen. In conclusion, compared to the PET ligament, the silk/PET hybrid ligament kept greater ability to induce the ingrowth of the autologous tissue, indicating that the silk hybrid had enhanced the ligamentization of the PET artificial ligament.     

关节镜下人工韧带重建前交叉韧带的临床初步体会

目的探讨关节镜下应用LARS人工韧带重建前交叉韧带的可行性及近期疗效. 方法用法国产LARS人工韧带对16例前交叉韧带(anterior cruciate ligament,ACL)损伤行关节镜下ACL重建术.等距点钻胫骨、股骨骨道,将肌腱拉入骨道,韧带游离部分位于关节腔内,拉紧后2枚螺钉固定韧带,合并损伤同期处理. 结果手术时间51～86 min,平均64 min.术后无滑膜炎、韧带断裂、活动明显受限等并发症.16例均随访1.5～6个月,平均3.8月.按照IKDC评分标准:术前C级6例,D级10例;术后A级6例,B级9例, C级1例(χ2=6.264,P<0.05).Lysholm膝关节功能评分术前36～76分,(63.7±7.3)分;术后86～97分,(94.8±9.6)分(t=10.356,P<0.05). 结论关节镜下LARS人工韧带重建ACL,操作简便,可使膝关节获得即时稳定性,早期康复锻炼,最大限度的防止关节功能受限,近期疗效满意.     

关节镜下LARS人工韧带重建后交叉韧带

目的探讨关节镜下LARS人工韧带重建后交叉韧带（PCL）可行性及近期疗效。方法用LARS人工韧带对6例PCL损伤患者行关节镜下PCL重建术。采用PCL重建技术钻胫骨、股骨骨道,将LARS韧带拉入骨道,韧带游离部分位于关节腔内,拉紧后2枚界面螺钉固定韧带。结果手术时间50-80（65±9.92）min。术后无滑膜炎、韧带断裂、活动明显受限等并发症。6例随访6-12（8±2.28）个月。根据Lysholm膝关节功能评分,术前评分：20-37（23.67±10.84）分;术后评分：84-93（88.00±3.46）分（t=16.69,P〈0.01）。结论关节镜下LARS人工韧带重建PCL术中操作简便,效果可靠。