关节镜辅助下膝关节前、后交叉韧带联合损伤的治疗

目的 探讨关节镜辅助下联合使用自体和同种异体肌腱修复膝关节前后交叉韧带损伤的方法和疗效观察.方法 关节镜辅助下采用自体腘绳肌腱修复前交叉韧带,同种异体肌腱修复后交叉韧带,术后用Lysholm功能评分和KT2000测量进行膝关节功能评定.结果 29例患者获得随访,平均随访28个月.术前Lysholm功能评分平均(58.2±4.3)分,终末随访时平均(91.4±4.1)分,差异有显著性(P<0.05).术后终末随访时KT2000关节稳定性定量测量结果显示,患膝较健膝略松弛,但统计学上差异无显著性.结论 关节镜辅助下联合使用自体和同种异体肌腱修复膝关节前后交叉韧带损伤是治疗膝关节多韧带损伤,重建膝关节稳定性的一有效方法.     

关节镜下自体肌腱及同种异体肌腱重建膝关节前后交叉韧带

背景:自体肌腱移植重建膝关节前后交叉韧带已广泛应用,但是供区容易出现并发症,同种异体肌腱移植越来越多应用于重建膝关节前后交叉韧带,是一种重要的替代材料.目的:比较关节镜下自体肌腱及同种异体肌腱移植重建膝关节前后交叉韧带的临床疗效差异.方法:40 例前后交叉韧带损伤患者分为2组:自体肌腱组为自体半腱肌及股薄肌重建膝关节前后交叉韧带,异体肌腱组为应用由山西骨组织库提供的同种异体肌腱重建膝关节前后交叉韧带.结果与结论:全部病例均获得6个月以上随访,最长随访时间36个月.重建前后两组大腿周径患健侧差值、Lachman 试验、中立位前抽屉试验(ADT)和国际膝关节评分委员会(IKDC)、Lysholm 及Tegner 评分差异均有显著性意义(P < 0.01),两组间术后各项指标差异均无显著性意义(P > 0.05).结果表明,自体肌腱与单纯深低温冷冻同种异体肌腱移植在重建膝关节前后交叉韧带疗效无明显差异.     

关节镜下自体肌腱及同种异体肌腱重建膝关节前后交叉韧带

背景：自体肌腱移植重建膝关节前后交叉韧带已广泛应用,但是供区容易出现并发症,同种异体肌腱移植越来越多应用于重建膝关节前后交叉韧带,是一种重要的替代材料。目的：比较关节镜下自体肌腱及同种异体肌腱移植重建膝关节前后交叉韧带的临床疗效差异。方法：40例前后交叉韧带损伤患者分为2组：自体肌腱组为自体半腱肌及股薄肌重建膝关节前后交叉韧带,异体肌腱组为应用由山西骨组织库提供的同种异体肌腱重建膝关节前后交叉韧带。结果与结论：全部病例均获得6个月以上随访,最长随访时间36个月。重建前后两组大腿周径患健侧差值、Lachman试验、中立位前抽屉试验（ADT）和国际膝关节评分委员会（IKDC）、Lysholm及Tegner评分差异均有显著性意义（P〈0.01）,两组间术后各项指标差异均无显著性意义（P〉0.05）。结果表明,自体肌腱与单纯深低温冷冻同种异体肌腱移植在重建膝关节前后交叉韧带疗效无明显差异。     

同种异体肌腱前交叉韧带重建术17例效果观察及康复护理

目的:探讨关节镜下深低温冷冻同种异体肌腱重建膝前交叉韧带(ACL)术后康复护理方法。方法:选择17例关节镜下同种异体肌腱重建ACL患者为观察组,17例同期关节镜下自体肌腱重建ACL患者为对照组,均给予一对一式健康教育、康复训练指导和护理干预。结果:34例患者随访6～14个月(平均10个月),术后6个月膝关节Lysholm评分:异体肌腱移植组评分86.3±4.53分,同期自体肌腱移植组评分87.2±3.69分,两组比较无显著性差异(P>0.05)。结论:同种异体肌腱重建膝前交叉韧带术,经积极健康教育和科学的康复训练指导与护理干预,可取得满意效果。     

关节镜下自体肌腱与同种异体肌腱重建前交叉韧带临床疗效对比分析

目的:对比分析膝关节前交叉韧带损伤患者,分别应用关节镜下自体肌腱及同种异体肌腱治疗的效果。方法选取符合标准的95例膝关节前交叉韧带损伤患者,采用随机数字表法分组,对照组47例采用自体肌腱进行重建,观察组48例给予深冻同种异体肌腱进行重建,对比2组患者手术时间、术后发热时间、住院时间及膝关节功能改善效果。结果观察组手术时间低于对照组,术后发热持续时间高于对照组(P0.05);2组患者术后Lysholm评分、Tegner评分、国际膝关节评分(InternationalKneeDocumentationCommittee,IKDC)及住院时间相当(P0.05)。结论关节镜下同种异体肌腱与自体肌腱韧带重建术,均能够有效促进膝关节前交叉韧带损伤患者术后膝关节稳定性、运动能力及综合功能的恢复,自体肌腱韧带重建术术后无排斥反应,同种异体肌腱韧带重建术对患者的损伤小,临床应用时需依据患者的实际情况选择合适的手术方式。     

Rigidfix系统固定重建前交叉韧带的疗效比较

目的 探讨关节镜下应用Rigidfix系统及挤压螺钉固定重建前交叉韧带(ACL)的临床效果及自体与同种异体肌腱重建的疗效比较.方法 2005年7月～2008年5月对该院共42例关节镜下确诊的ACL断裂的患者行双骨道单束自体肌腱或同种异体肌腱韧带重建治疗,应用Rigidfix系统及挤压螺钉对重建韧带进行固定,术后完成相关随访,随访主要包括关节活动度,膝关节查体,MRI影象等,功能评定采用Lysholm评分系统.结果 所有患者随访1.5～4.0年,平均2.8年.其中1例出现术后感染的患者膝关节屈曲受限外,余患者末次随访所有膝关节伸-3°～0°,屈110°～130°,2例患者前抽屉试验、Lachman试验为阳性,Lysholm评分由术前(34.6±4.36)分提高至术后(89.4±5.42)分.采用自体肌腱重建患者Lysholm评分由术前(32.4±6.95)分提高至术后(91.3±5.51)分,同种异体肌腱重建患者由术前(35.6±4.49)分提高至术后(90.2±6.32)分,两组患者功能比较差异无显著性(P＞0.05).结论 关节镜下应用Rigidfix系统及挤压螺钉固定自体及同种异体肌腱重建前交叉韧带均可获得较为满意的临床疗效.     

关节镜下单、双束同种异体肌腱重建前交叉韧带的疗效比较

目的比较前交叉韧带重建中应用关节镜下单束、双束同种异体肌腱的疗效。方法选择本院2013年1月~2014年12月收治的前交叉韧带损伤患者103例,依照治疗方式,分为对照组(n=53)、观察组(n=50),术后随访24个月,分别于术前、术后24个月评价临床疗效(应用IKDC评分)、膝关节韧带损伤条件特异性(利用Lysholm评分系统),观察Lachman试验及轴移试验结果。结果术前,两组患者IKDC评分、Lysholm评分、Lachman试验结果、轴移试验结果差异无统计学意义(P>0.05);术后,对照组IKDC评分、Lysholm评分、Lachman试验结果正常率、轴移试验结果正常率均低于观察组,差异具有统计学意义(P<0.05)。结论重建前交叉韧带时,关节镜下双束同种异体肌腱重建方法的疗效优于关节镜下单束重建,可更为有效的促进患者膝关节运动功能恢复。     

膝关节多韧带损伤一期重建后5年随访

背景:前后交叉韧带损伤合并Ⅲ度内侧副韧带损伤严重影响膝关节的稳定性,重建后短期疗效确切,但中期疗效尚不明确.目的:评估多韧带损伤重建后的中期疗效.方法:选择40例前后交叉韧带损伤合并Ⅲ度内侧副韧带损伤的患者,男30例,女10例,年龄19-48岁,前后交叉韧带损伤于关节镜下行同种异体肌腱重建,内侧副韧带损伤行带线铆钉修补.重建前后行Lachman试验、IKDC分级、Lysholm评分及KT-1000对患者进行主观和客观评分,以评估重建疗效.结果与结论:40例患者均获随访,随访时间60个月.重建后患者膝关节疼痛、肿胀、屈伸活动受限等症状明显改善, Lachman试验、Lysholm膝关节功能评分、IKDC分级评分及KT-1000较重建前明显提高(P<0.05),提示应用同种异体肌腱重建前后交叉韧带、带线铆钉修补内侧副韧带,能有效恢复膝关节的稳定性,短中期疗效确切.     

关节镜下腘绳肌腱及生物界面螺钉重建交叉韧带27例

背景:关节镜下采用腘绳肌腱及生物界面螺钉重建交叉韧带的临床实验已经在国内广泛开展,但是对于腘绳肌腱细小的南方人应用此种修复方式的临床研究较少.目的:首次分析关节镜下腘绳肌腱及界面螺钉重建海南地区人群交叉韧带的效果.方法:回顾性分析海南地区27例交叉韧带重建的病例临床资料,其中24例前交叉韧带断裂,2例后交叉韧带断裂,1例前、后交叉韧带同时断裂.采用腘绳肌腱及生物界面螺钉进行重建,其中自体腘绳肌23例,同种异体腘绳肌4例.术后定期复查膝关节功能并指导功能锻炼,应用Lysholm评分和国际膝关节评分委员会(IKDC)韧带评分系统进行功能评定.结果与结论:22例患者获随访8.7(3～24)个月,1例隐神经损伤,1例移植后3个月膝关节化脓性感染,行移植物取出待二期行翻修;除感染1例外,所有患膝移植后活动均正常,不稳感消失,同种异体腱组患膝皮温较高,但体温不超过38℃;术后Lysholm评分较术前明显增加(P<0.01),其中19例术后IKDC评分正常或接近正常,说明自体或同种异体腘绳肌腱是修复前交叉韧带或后交叉韧带的良好移植物,腘绳肌腱及界面螺钉重建交叉韧带效果满意.     

自体与同种异体肌腱重建膝关节前交叉韧带的比较

背景：关节镜辅助下重建前交叉韧带的移植物主要有自体移植物、同种异体移植物和人工韧带3种,关于移植物的选择,存在较多争议。目的：评估自体健侧腘绳肌腱和同种异体肌腱两种移植物在膝关节前交叉韧带重建中的效果。方法：纳入2007-01/2009-01在承德医学院附属医院骨科就诊的经关节镜检查证实为前交叉韧带损伤的患者70例（70膝）,分别采用自体健侧腘绳肌腱和同种异体肌腱重建前交叉韧带,记录膝关节Lysholm功能评分、KT-1000测量值及不良反应。结果与结论：患者随访18~24个月,均未发生血管神经损伤,无感染、植入物断裂等并发症;同种异体肌腱移植患者有2例膝关节引流管口持续渗出,经换药半月后愈合,其余切口均一期愈合。末次随访时,自体健侧腘绳肌腱和同种异体肌腱重建患者的Lysholm评分均显著提高,双侧膝关节前向松弛度差值显著减少,且两种方法比较差异无显著性意义（P〉0.05）。说明应用自体健侧腘绳肌腱与同种异体肌腱重建膝关节前交叉韧带疗效相当,效果满意。     

膝关节交叉韧带囊肿的MRI诊断

目的探讨MRI对交叉韧带囊肿的诊断价值。方法回顾性分析12例资料完整的交叉韧带囊肿MRI表现并与关节镜手术对照。结果12例中发生于前交叉韧带内3例;后交叉韧带内1例;紧贴后交叉韧带后方1例;前后交叉韧带之间7例。MRI诊断交叉韧带囊肿与关节镜手术符合率100％。结论MRI能清晰显示交叉韧带囊肿的部位、形态、大小以及与周围结构的关系,是唯一能够确立诊断、指导治疗的有效手段。     

Advanced MR imaging of the cruciate ligaments

The anterior and posterior cruciate ligaments are crucial stabilizers of the knee. These ligaments are named by the location of their tibial attachments. Each ligament is composed of separate functional bundles that differ in size but are equally important in function. MR imaging is accurate and sensitive, making it the imaging technique of choice for evaluating these ligaments. Acute and chronic injuries involving the cruciate ligaments have typical appearances and associated findings. MR imaging interpretation must take into account atypical injuries and imaging pitfalls. Knowledge of normal ligament reconstruction techniques allows differentiation of the normal postoperative appearance from reconstruction failure and complications. Ligament reconstruction techniques, complications, and appearances are reviewed in this article.     

关节镜下前交叉韧带重建术30例全程护理

目的:探讨关节镜下前交叉韧带重建术的全程护理方法及效果。方法:对30例采用双枚股骨横穿钉(RIGIDfix)固定股骨端和带鞘锥形膨胀挤压螺钉(Intrafix)固定胫骨端关节镜下前交叉韧带重建术的患者实施全程护理,进行系统的康复功能锻炼指导,并对其效果进行客观评价。结果:本组30例患者均获得随访,术后膝关节活动范围均超过120°,无伸膝受限,Lysholm评分明显提高(P<0.01)。结论:实施全程护理,进行系统的康复功能锻炼指导,对恢复膝关节活动度、患肢负重、平衡能力及重建患膝本体感觉具有十分重要的意义。     

同种异体跟腱移植一期重建修复前后交叉韧带损伤3例

为了探讨采用异体跟腱一期重建前后交叉韧带的临床效果,武警总医院关节四肢科对2007-06/2008-04其收治的3例前后交叉韧带同时断裂的男性患者,分别在关节镜下接受异体跟腱一期重建膝关节前后交叉韧带.3例患者随访间均超过6个月,术后12周内恢复行走,前后抽屉试验及内外翻应力试验均为阴性,膝关节屈伸活动范围在100°以上,没有明显并发症.术后Lysholm膝关节功能评分分别为87分,83分和85分.提示一期重建前后交叉韧带时,采用异体跟腱具有手术操作容易、创伤小、短期效果理想.缺点足其长期效果还需要更多病例和更长时间的随诊来证实.     

膝关节交叉韧带重建与生物材料的选择:在跆拳道运动中的特点

背景:膝关节交叉韧带的重建与人工韧带的选择有密切的关系.目的:通过检索相关文献,综述跆拳道运动员膝关节交叉韧带损伤的原因、膝关节交叉韧带重建和人工生物材料的选择问题,探讨人工韧带的重建、功能恢复及其临床效果的关系.方法:应用网络http://www.highwire.org/, http://www.chkd.cnki.net/index.htm/, 检索1999-01/2009-10的相关文献,检索词"Sport Training Dept, anterior cruciate ligament, ACL", 限定文章语言种类为English;并用检索词"跆拳道,膝关节前交叉韧带",限定文章语言种类为中文,检索相关的博士硕士论文,以及相关的中英文会议论文集.另外手工查找膝关节前交叉韧带有关的资料和书籍.排除实验设计不合理的文章及观点模糊的综述.结果与结论:①膝关节损伤是跆拳道运动常见的伤病,膝关节交叉韧带的重建,人工韧带的选择很关键.采用何种材料主要考虑一定形态、大小的移植物的强度、移植物的愈合过程、供区的损坏程度以及移植后能否建立与正常韧带组织相似的附着点.②人工合成材料重建交叉韧带的应用成败主要取决于其组成材料.材料的生物性、机械性是否能与正常韧带生物相容性和生物力学匹配制约着手术的成败.采用理想的生物材料修复韧带,可避免因自体取材的附加损伤.③人工合成材料重建交叉韧带的特点:可避免取材部位的并发症;关节镜下手术操作简便,手术时间短,创伤小;术中即刻获得足够抗拉强度;术后能够早期活动,恢复快;并发症少.临床上近期效果满意,远期效果还需进一步观察证实.     

On the coupling between anterior and posterior cruciate ligaments,and knee joint response under anterior femoral drawer in flexion: a finite element study

OBJECTIVE: To investigate the extent of coupling between the anterior and posterior cruciate ligaments as well as the role of the posterior cruciate ligament in the knee joint response under anterior femoral force at different flexion angles. DESIGN: A developed finite element model of the tibiofemoral joint is used to perform non-linear elastostatic analyses. BACKGROUND: The structural properties of the posterior cruciate ligament subsequent to an injury (either left untreated or replaced by a graft) would likely change, an event that alters the function of not only the ligament itself but also the other intact cruciate ligament and the entire joint. METHODS: The model consists of two bony structures and their articular cartilage layers, menisci and four principal ligaments. Under 100 N anterior femoral load at different flexion angles from 0 degrees to 90 degrees, kinematics, forces in ligaments and contact forces in the fully unconstrained joint were computed in intact cases and following alterations in joint ligaments. RESULTS: Collateral ligaments were the primary structures to resist the force at full extension under 100 N anterior femoral load with a moderate contribution from the posterior cruciate ligament. With joint flexion up to 90 degrees, however, force in the posterior cruciate ligament substantially increased whereas that in collateral ligaments diminished. CONCLUSIONS: A remarkable coupling was found between the posterior cruciate ligament and the anterior cruciate ligament in flexion; a structural alteration in one of them significantly influenced the mechanical role of both ligaments and not just the one affected. A tauter or stiffer ligament increased the force in both ligaments while an excessive laxity or rupture in one diminished forces in both. RELEVANCE: Alterations in ligament stiffness or initial tautness during reconstruction surgery or following injuries markedly influence the normal role of both cruciate ligaments. Consideration of cruciate ligaments coupled together rather than in isolation should be the rule in the management of ligament injuries towards a successful long-term outcome.     

关节镜下膝关节前后交叉韧带重建:自体移植与异体移植的中远期疗效对比

背景:关节镜下一期联合重建关节镜下前、后交叉韧带的文献报道不多,尤其是中长期随访研究。目的:关节镜下一期自体肌腱与同种异体肌腱重建前、后交叉韧带的中远期疗效比较。方法:自2002-06/2007-06对45例前后交叉韧带同时断裂患者行一期重建,20例选用自体移植物,25例选用异体移植物,以可吸收挤压钉固定行前后交叉韧带单束重建,同时处理合并伤。结果与结论:33例获随访,随访时间3~8年,关节活动无明显受限。3例前抽屉试验弱阳性,5例后抽屉试验弱阳性;LACHMAN征弱阳性6例,轴移试验弱阳性3例。自体肌腱和同种异体肌腱重建3年后患膝Lysholm评分、Larson评分均明显高于重建前(P<0.05)。自体肌腱与同种异体肌腱患膝Lysholm评分、Larson评分比较差异均无显著性意义(P>0.05)。8例出现骨隧道扩大,5例为前交叉韧带胫骨段,3例为后交叉韧带胫骨段。5例出现关节积液,经关节腔穿刺冲洗后缓解,随访期间无韧带再断裂。结果表明关节镜下一期自体肌腱与同种异体肌腱重建前后交叉韧带均可获满意的关节活动度及关节稳定性,中远期疗效好。     

自体与同种异体肌腱重建膝关节前交叉韧带的比较

背景:关节镜辅助下重建前交叉韧带的移植物主要有自体移植物、同种异体移植物和人工韧带3种,关于移植物的选择,存在较多争议。目的:评估自体健侧腘绳肌腱和同种异体肌腱两种移植物在膝关节前交叉韧带重建中的效果。方法:纳入2007-01/2009-01在承德医学院附属医院骨科就诊的经关节镜检查证实为前交叉韧带损伤的患者70例(70膝),分别采用自体健侧腘绳肌腱和同种异体肌腱重建前交叉韧带,记录膝关节Lysholm功能评分、KT-1000测量值及不良反应。结果与结论:患者随访18~24个月,均未发生血管神经损伤,无感染、植入物断裂等并发症;同种异体肌腱移植患者有2例膝关节引流管口持续渗出,经换药半月后愈合,其余切口均一期愈合。末次随访时,自体健侧腘绳肌腱和同种异体肌腱重建患者的Lysholm评分均显著提高,双侧膝关节前向松弛度差值显著减少,且两种方法比较差异无显著性意义(P>0.05)。说明应用自体健侧腘绳肌腱与同种异体肌腱重建膝关节前交叉韧带疗效相当,效果满意。     

Preliminary comparison of the rupture of human and rabbit anterior cruciate ligaments

Objective. This study was aimed at examining ruptures of the human anterior cruciate ligaments by scanning electron microscopy and video imaging and comparing the appearance of the rupture surfaces with those from rabbit anterior cruciate ligaments.

Design. The specimens were tested to failure as femur-anterior cruciate ligament–tibia complexes using an Instron 8511 materials testing machine.

Background. Rupture of the anterior cruciate ligament is a major clinical problem, leading to instability of the knee joint. Due to the frequency and potential severity of the injuries, a need still exists for information on the biomechanical properties of ligaments under loading conditions, which occur at the time of trauma.

Methods. Four human femur-anterior cruciate ligament–tibia complexes were loaded to failure at a displacement rate of 0.008 m/s. Video recordings of the tests were used to study the progress of the ruptures and to compare the modes of failure of the ligaments. Scanning electron microscopy was employed to study the appearance of collagen fibres at the rupture surfaces.

Results. The modes of failure of the rabbit anterior cruciate ligament and appearance of the rupture surfaces were similar to those of the human anterior cruciate ligaments.

Conclusion. The rabbit anterior cruciate ligament provides a model for investigating failure of the human ligament during trauma.Relevance

The results will be of significance since most studies on ligaments are carried out on animal models with the intention of applying the deductions from the results to human ligaments. Examining the appearance of collagen fibres at these surfaces may help us to understand more about what actually happens during and after ligament rupture.     

Influence of a mono-centric knee brace on the tension of the collateral ligaments in knee joints after sectioning of the anterior cruciate ligament--an in vitro study

OBJECTIVE: To analyze the influence of knee bracing on the tension of the medial and lateral collateral ligaments in anterior cruciate ligament deficiency. DESIGN: The tension of the collateral ligaments in anterior cruciate ligament deficient knees was measured with and without knee bracing using an in vitro model. BACKGROUND: Anterior cruciate ligament deficiency increases the tension in both collateral ligaments at the knee joint. Therefore knee braces should reduce that tension increase. However, that effect has never been proven quantitatively. METHODS: After anterior cruciate ligament-transection, the forces of the medial (anterior/posterior part) and lateral collateral ligament were measured in ten fresh human cadaver knees at 0 degrees, 20 degrees, 40 degrees, 60 degrees, 80 degrees and 100 degrees of flexion, with and without application of a mono-centric knee brace. To quantify the ligament forces, strain gauges were fixed at the bony origins of the ligaments. RESULTS: Bracing led to a significant decrease of ligament forces (20-100 degrees: P < 0.0001) in the anterior part of the medial collateral ligament in all joint positions. In the posterior aspect, this effect was observed only at 40 degrees (P < 0.0001) and 80 degrees (P = 0.001) of flexion. In the lateral collateral ligament, bracing caused a strain reduction from 60 degrees to 100 degrees of flexion (P < 0.0001). Therefore a flexion angle dependent effect of knee bracing on the strain was seen in the posterior aspect of the medial and in the lateral collateral ligament in anterior cruciate ligament deficient knee joints. CONCLUSIONS: Application of a mono-centric knee brace leads to a significant position dependent reduction of collateral ligament tension after anterior cruciate ligament-rupture.