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1.
目的:探讨关节镜下应用可吸收界面螺钉固定自体4股腘绳肌腱重建前交叉韧带的临床效果.方法:对21例前交叉韧带断裂的患者,在关节镜下采用4股腘绳肌腱重建前交叉韧带,使用可吸收界面螺钉对移植物进行固定,术前、术后观察患者的症状,膝关节活动度、前抽屉试验、Lachman试验、轴移试验,按照Lysholm膝关节功能评分标准评价疗效.结果:本组未出现深静脉血栓或感染.术后随访6~18个月,膝关节屈曲平均130°,伸直0°;21例患者均无打软腿现象.前抽屉试验20例阴性,1例阳性(Ⅰ°).Lachman试验20例阴性,1例阳性.轴移试验均为阴性.Lysholm评分从术前(48.3±4.6)分提高至(84.7±4.4)分,差异有统计学意义(t=2.91,P<0.01).结论:关节镜下应用可吸收界面螺钉固定自体4股腘绳肌腱重建前交叉韧带,是治疗前交叉韧带断裂的一种方法,具有手术操作较简单、固定可靠、费用较低、愈合率高等优点.  相似文献   

2.
目的探讨交叉韧带重建术中可吸收挤压螺钉的使用方法和疗效。方法总结53例交叉韧带重建病例使用可吸收挤压螺钉的情况,在术中、术后并发症、术后康复、膝关节功能状况等方面进行回顾性分析。结果三例出现韧带切割现象。两例股骨侧螺钉拧入后导引针无法拔出。一例挤压螺钉断裂。术后Lysholm评分平均92.4±4.1。结论交叉韧带重建术中使用可吸收挤压螺钉固定的方法固定牢固,术后恢复快,利于早期康复。  相似文献   

3.
目的比较自体腘绳肌腱(HT)和人工韧带加强系统(LARS)重建前交叉韧带(ACL)的效果。方法选择61例ACL断裂患者(均为单侧断裂),其中男性37例,女性24例;年龄17~57岁,平均年龄36岁。采用自体HT重建ACL30例(HT组),采用LARS重建ACL31例(LARS组)。按Lysholm评分系统及KT-2000检查评估功能。结果全部病例均获随访,随访时间26~30个月。Lysholm评分术后2年HT组和LARS组分别为(90.80±8.87)分、(91.70±6.54)分;KT-2000测试膝关节移动距离分别为(2.58±2.18)mm、(2.39±2.09)mm。两组膝关节Lysholm评分在术后均较术前改善,差异有统计学意义(P0.05)。两组间术后Lysholm评分及膝关节稳定性KT-2000检查比较,差异无统计学意义(P0.05)。结论两种移植物均能够获得满意的临床效果,明显改善膝关节功能,LARS是一种良好的替代移植物。  相似文献   

4.
目的:探讨关节镜下 Endobutton 系统配合可吸收界面螺钉固定股薄、半腱肌腱解剖重建膝前交叉韧带的治疗效果.方法:2009年6月~2012年3月关节镜下 Endobutton 系统固定股薄、半腱肌腱单束解剖重建膝前交叉韧带21例.采用 Lysholm 关节评分评价疗效.结果:21例患者全部得到随访,随访时间3~18个月,平均9个月. Lysholm 评分从术前51分提高到术后的91分. lachman Test 和前抽屉试验术前21例均为阳性,术后19例阴性、2例弱阳性.结论:关节镜下 Endobutton 系统配合可吸收界面螺钉固定股薄、半腱肌腱解剖重建膝前交叉韧带,临床疗效确切,创伤小,手术时间短,并发症少,康复快,是一种疗效可靠的手术治疗方法.  相似文献   

5.
背景:前交叉韧带重建的方式是决定修复效果的关键因素。自体腘绳肌双束与单束重建膝关节前交叉韧带是临床上常用的修复方法。 目的:比较自体腘绳肌双束与单束重建膝关节前交叉韧带的临床疗效。 方法:回顾分析了2005-05/2009-06于中南大学湘雅二医院住院的56例急性前交叉韧带Ⅲ度损伤的患者,其中36例行单束自体腘绳肌重建术,20例行双束自体腘绳肌重建术,所有患者前交叉韧带的重建均由同一医师完成,术后随访16~42个月,评估患者的关节活动度、稳定性等指标。 结果与结论:随访期间,所有患者的关节活动度均恢复正常,无伸膝受限。两种重建术后患者的Lysholm-Tegner和IKDC膝关节综合功能评定结果、KT-1000检测结果差异均无显著性意义(P > 0.05),术后1年,取出界面螺钉时行关节镜检查,所有患者均未见明显的重建韧带松弛,说明双束与单束自体腘绳肌重建急性前交叉韧带损伤疗效相近。  相似文献   

6.
目的:系统评价关节镜下LARS人工韧带与自体腘绳肌腱重建前交叉韧带在疼痛的控制和膝关节功能恢复等方面的有效性和安全性.方法:采用计算机和手工检索PubMed,The Cochrane Library,EMBASE,中国知网(CNKI),维普数据库(VIP)和万方数据库,搜集关节镜下LARS人工韧带与自体腘绳肌腱重建前交叉韧带临床疗效比较的前瞻性临床对照研究文献,检索时限均为从建库至2016年8月.根据渥太华纽卡斯尔标准(Newcastle-Ottawa Scale,NOS)评估纳入的研究方法学质量,采用RevMan S.3软件进行meta分析.结果:共纳入8项前瞻性临床对照研究,371例前交叉韧带损伤患者.meta分析结果显示:LARS人工韧带移植组与自体肌腱移植组术后6个月Lysholm评分,MD=12.46,95%CI:12.46~15.74,差异有统计学意义(P<0.001);术后6个月滕纳尔(Tegner)评分,MD=1.72,95%CI:1.45~1.99,P<0.001,差异有统计学意义;术后12个月Lysholm评分,MD=4.31,95%CI:-0.70~9.32,差异无统计学意义(P=0.09);术后12个月Tegner评分,MD=0.52,95%CI:-0.21~1.24,差异无统计学意义(P=0.16).结论:在术后6个月时LARS人工韧带移植较自体腘绳肌腱移植进行前交叉韧带重建的效果更好;在术后12个月时,LARS人工韧带移植与自体腘绳肌腱移植进行前交叉韧带重建的疗效相当.  相似文献   

7.
背景:应用腘绳肌肌腱重建前交叉韧带过程中仍有许多的争议及未知因素需进一步探讨和研究。 目的:比较分析腘绳肌肌腱重建前交叉韧带过程中股骨端分别使用Endo-Button系统和可吸收界面螺钉两种不同固定方式的疗效。 方法:选择45例在关节镜下使用4股自体腘绳肌腱进行前交叉韧带重建患者,实验组25例股骨端使用Endo-Button钢板固定,对照组20例使用可吸收界面螺钉固定。重建后用相同的方法进行康复锻炼。 结果与结论:经过6-21个月的随访,患者膝关节屈伸活动度均达正常范围。Lachman试验中实验组Ⅰ度阳性2例,对照组Ⅰ度阳性3例;轴移试验均阴性。两组重建后膝关节Lysholm评分均较治疗前明显改善,两组间差异无显著性意义。两组随访早期均有较高的骨道扩大发生率,但组间差异无显著性意义;对照组骨道增宽程度强于实验组(P < 0.05)。说明两组早期总体临床效果相近。  相似文献   

8.
背景:人工韧带因其不需牺牲自体组织、无潜在传染性疾病、重建韧带后康复时间短等优点,自一面世始终受到到关注。目的:利用Meta分析方法对国内外应用LARS人工韧带与自体腘绳肌腱重建前交叉韧带的对照试验进行Meta分析,从而在较大样本量的前提下评价并比较两种方法重建前交叉韧带在膝关节功能恢复和康复等方面的有效性和安全性。方法:采用电子检索和手工检索进行文献初检,中国期刊全文数据库(CNKI)、中国生物医学数据库(CBM)、维普期刊网(VIP)、Pubmed(medline),收集国内外关于应用LARS人工韧带与自体腘绳肌腱重建前交叉韧带的对照研究文献,对结果进行Meta分析。其中,试验组以LARS人工韧带为材料重建前交叉韧带,对照组以自体腘绳肌腱为材料重建前交叉韧带。结果与结论:共收集国内外5个临床对照研究,Meta分析结果显示:两组病例术后6个月Lysholm评分,试验组高于对照组,差异有显著性意义。两组病例术后12个月以上Lysholm评分差异无显著性意义。两组病例术后Tegner评分差异无显著性意义。两组病例重建前交叉韧带后kt-2000/1000测量差值差异无显著性意义。分析结果表明,与自体腘绳肌重建前交叉韧带相比,LARS人工韧带短期内的Lysholm评分更高,在更长时间内的Lysholm评分,Tegner评分和kt-2000/1000测量差值上差异不明显。  相似文献   

9.
背景:由于人工韧带存在慢性疲劳,越来越多的人采用异体肌腱重建前后交叉韧带损伤。 目的:比较关节镜下自体腘绳肌和异体胫前肌单束重建前交叉韧带的疗效。 方法:收集关节镜下用自体腘绳肌和异体胫前肌单束重建前交叉韧带随访满1年的病例。自体腘绳肌重建前交叉韧带组28例;异体胫前肌重建前交叉韧带组18例。采用股骨端Endobutten、胫骨端可吸收螺钉固定。采用支具固定并进行功能训练。 结果与结论:前交叉韧带重建后6个月,异体肌腱组lysholm评分高于自体肌腱组(P < 0.05);重建后12个月两组lysholm评分差异无显著性意义。两组重建后6,12个月与重建前比较差异均有显著性意义(P < 0.05),重建后12个月与6个月比较差异有显著性意义(P < 0.05)。结果表明,自体和异体肌腱重建前交叉韧带随访1年疗效相当。  相似文献   

10.
背景:Endobutton的钢板设计和Rigidfix的横穿钉优点使之较广泛地在前交叉韧带重建中应用。 目的:比较分析自体腘绳肌腱行前交叉韧带单束重建过程中Endobutton和Rigidfix系统的效果差异。 方法:选取2007-04/2009-06运用Endobutton系统和Rigidfix-Intrafix系统行自体腘绳肌腱单束重建前交叉韧带各30例患者,重建前分别记录前抽屉试验、Lachman试验、轴移试验结果及Lysholm膝关节评分。由同一术者按两种方案分别重建前交叉韧带后,进行正规康复锻炼。重建后定期随访并由同一人记录随访指标,与重建前指标进行对比分析,评价两组患者症状的改善程度。 结果与结论:Endobutton组患者经过6~26个月的随访,Lysholm膝关节评分由重建前(56.6±5.9)分增长到重建后(91.4±4.0)分。经t检验,差异有显著性意义(P < 0.05)。Rigidfix组患者经过6~24个月的随访,Lysholm膝关节评分由重建前(59.2±6.4)分增长到重建后(93.1±4.7)分,经t检验,差异有显著性意义(P < 0.05)。Endobutton组与Rigidfix组重建后Lysholm膝关节评分差异无显著性意义(P > 0.05)。经过分析,并不能得出其中某一套系统强于另一套系统的结论。它们各自均有独特的优势,同时又不能互相取代。  相似文献   

11.
BACKGROUND: There are controversies about preserving the remnant in the anterior cruciate ligament reconstruction procedure because of its uncertain therapeutic effects. OBJECTIVE:To compare the efficacy and safety of preserving-remnant with removing-remnant for arthroscopic anterior cruciate ligament reconstruction using a meta-analysis. METHODS: A computer-based online search was conducted in PubMed, Embase, the Cochrane Library, CDSR, CBM, and CNKI databases by using the English key words of “anterior cruciate ligament AND remnant (OR stump) AND randomized controlled trial (RCT) OR quasi-RCT” and the Chinese key words of “anterior cruciate ligament reconstruction, preserving-remnant, removing-remnant” to screen the relevant articles published from 1995 to July 2015. Meta-analysis was performed using Review Manager 5.3 software. RESULTS AND CONCLUSION:A total of 13 randomized controlled trials were included. The meta-analysis results showed that there were no statistically significant differences in KT1000/2000 scores (OR=-0.28, 95%CI: -0.76-0.20, P=0.25), the good rate of synoveal coverage (OR =-0.30, 95%CI: -0.30-0.90, P=0.32), and the incidence of cyclops leions (OR=0.87, 95%CI: 0.63-2.90, P=0.44). Postoperative Lysholm scores (OR=2.45, 95%CI: 0.52-4.39, P=0.01), proprioceptive function (OR=-1.72, 95%CI: -3.32 to 0.13, P=0.03), tunnel enlargement (OR=-0.66, 95%CI: -1.08 to -0.23, P=0.002) in preserving-remnant were superior to removing-remnant for arthroscopic anterior cruciate ligament reconstruction. These results suggest that both preserving-remnant and removing-remnant for arthroscopic anterior cruciate ligament reconstruction can obtain satisfactory antero-posterior stability of the knee. Preserving-remnant exhibits superiority in post-operative scores of the knee, proprioceptive function, tunnel enlargement. Further high-quality randomized controlled trials are warranted because of some low-quality studies and the existing biases. 中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程  相似文献   

12.
BACKGROUND: Reconstruction with remnant preservation can enhance tendon-bone healing. However, the study limits on the histological level, and there is a lack of research based on the modular biological level. OBJECTIVE: To investigate whether anterior cruciate ligament reconstruction with remnant preservation can enhance tendon-bone healing. METHODS:Seventy-two New Zealand rabbits were randomly allocated to three groups (n=24 per group), followed by cruciate ligament reconstruction without remnant (group A), with remnant preservation (femoral tensioning and augmented suture) (group B) and with remnant preservation (graft passing remnant anterior cruciate ligament sheath) (group C), respectively. RESULTS AND CONCLUSION:Hematoxylin-eosin staining showed that the tendon-bone healing in the groups B and C surpassed that in the group A, and group B was better than group C. Real-time PCR revealed that the expression level of osteoprotegrin mRNA and the osteoprotegrin/receptor activator of nuclear factor-κB ligand (RANKL) ratio were greater in the groups B and C than in the group A, and highest in the group C, while the expression levels of RANKL mRNA in the groups B and C were lower than that in the group A. In conclusion, these two kinds of anterior cruciate ligament reconstruction methods with remnant preservation can enhance tendon-bone healing, which have obtained most obvious achievements in the anterior cruciate ligament reconstruction in the graft passing anterior cruciate ligament remnant sheath that may be related to the up-regulation of osteoprotegrin mRNA and down-regulation of RANKL mRNA. 中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程  相似文献   

13.
BACKGROUND: Femoral tunnel suspensory fixation device for anterior cruciate ligament reconstruction has a certain clinical comparison. However, there are a few fixture researches on the expansion of bone tunnel and graft changes.  相似文献   

14.
BACKGROUND: Evaluation of vertical jumping ability is usually only limited to height measurements. The measurements of parameters that describe kinetic factors may provide a better assessment of a patient’s jumping ability. OBJECTIVE:To determine the deficit in one-legged vertical jumping ability and to clarify the relationships between the maximum jumping height and the maximum power, force and velocity during one-legged vertical jumps after anterior cruciate ligament reconstruction. METHODS: Twenty-five healthy subjects (10 males and 15 females) and 25 anterior cruciate ligament reconstructed patients (10 males and 15 females) participated in this study. The isokinetic quadriceps femoris strength and one-legged vertical jumping ability were evaluated by the height, power, force and velocity in all subjects. RESULTS AND CONCLUSION:(1) The maximum height of the one-legged vertical jumps was only significantly correlated with the maximum force in the healthy subjects (P < 0.05). (2) However, for the reconstructed and unreconstructed legs in anterior cruciate ligament reconstructed patients, the maximum jumping height was significantly correlated with the maximum power, force and velocity during one-legged vertical jumps (P < 0.05). (3) These findings suggest the importance of a knee strategy during one-legged vertical jumps for rehabilitation after anterior cruciate ligament reconstruction. Assessment of the jumping ability after anterior cruciate ligament reconstruction may be determined by the maximum power instead of the maximum jumping height. 中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程  相似文献   

15.
Eleven skeletally immature adolescents underwent anterior cruciate ligament reconstruction using a transphyseal tibial and femoral tunnel. An autologous quadrupled hamstring tendon was used in all cases and the average follow-up was 77.7 months. Clinical results were evaluated using Lysholm knee scores and a return to pre-injury sports activities. Radiological results were evaluated using side-to-side differences of instrumented laxities and growth disturbances compared with the uninjured side on final follow-up orthoroentgenograms. The mean Lysholm score was 97.8 (range 94-100) and mean side-to-side laxity difference was 2.4 mm (range 1-4). Ten of 11 patients returned to pre-injury sports activity. No patient had a leg length discrepancy of over 1 cm or a significant abnormal angular deformity of the knee joint. Therefore, anterior cruciate ligament reconstruction using the transphyseal tunnel and hamstring autograft in skeletally immature adolescents is believed to be a reliable treatment method, which is not associated with significant leg length discrepancy or abnormal angular deformity of the knee joint.  相似文献   

16.
BACKGROUND: The standard angle between the coronal level of tibial tunnel and the joint surface is 65°-70°. The larger angle is easy to cause impacts, and inversely, the medial joint surface of the tibia plateau will be worn. OBJECTIVE: To investigate the application and effects of patellar ligament with vascular pedicle for anterior cruciate ligament reconstruction under computer assisted navigation system combined with arthroscopy. METHODS: Forty patients with anterior cruciate ligament injury were selected, and randomly allotted into two groups (n=20 per group). Patients in traditional surgery group underwent reconstruction by the operator’s experiences, and patients in combination surgery group received the patellar ligament with vascular pedicle for anterior cruciate ligament reconstruction under computer assisted navigation system combinied with arthroscopy, both based on the same location standard. Subsequently, patients underwent CT continuous CT scans, and the tibial tunnel of anterior cruciate ligament was measured to compare the reconstruction effects. RESULTS AND CONCLUSION: The tibial tunnel and femoral tunnel positions in the combination surgery group were significantly higher than those in the traditional surgery group (P < 0.05). The Lysholm scores in the combination surgery group were significantly higher than those in the traditional surgery group at 3, 6 and 12 months after surgery (P < 0.05). Compared with the traditional surgery group, the number transmission times was significantly decreased in the combination surgery group (P < 0.05). Furthermore, sagittal CT and three-dimensional CT results showed that, in the combination surgery group, the posterior wall of the tibial tunnel closely adhered to the rear cortical bone of the proximal tibia with a distance of < 2 mm; a mild rupture appeared at the posterior wall excit of the 1/3 proximal tunnel in traditional surgery group. These results suggest that anterior cruciate ligament reconstuction under computer assisted navigation system combined with arthroscopy achieves satisfactory effects on location of the femoral tunnel. The use of navigation virtual probe avoids the subjective location by surgeons; therefore, it is feasible for clinical treatment. 中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程  相似文献   

17.
BACKGROUND: Anterior cruciate ligament (ACL) reconstruction is the primary treatment method for ACL rupture. Currently, studies on ACL reconstruction involve histology and embryology, anatomical structure, biomechanics, reconstruction materials, operating technology, and rehabilitation after reconstruction. However, clinical epidemiological studies describing ACL rupture and reconstruction remain scarce. OBJECTIVE: To analyze the clinical epidemiological characteristics of ACL rupture and reconstruction to provide guidance for prevention and treatment of ACL rupture. METHODS: Data of 352 patients for age, gender, cause and mechanism of injury, treatment time, and the impact of ACL rupture on menisci and articular cartilage were gathered. Meanwhile, the events during surgery, operation methods and reconstruction materials were analyzed. RESULTS AND CONCLUSION: ACL rupture mostly occurred in young men, and happened more often to the left knee; male patients got hurt in basketball, football and accidental injuries, while female patients got hurt in the accidental injuries, badminton and skiing injuries, internal rotation with valgus stress accounted for the predominant injury mechanism. The ACL reconstruction was mostly performed within 1-3 months after ACL rupture, often accompanied by meniscal and articular cartilage damage. Lateral meniscus injury incidence was relatively stable, medial meniscus injury incidence increased significantly over the half year after ACL rupture. Most articular cartilage injury occurred to patellar cartilage. A significant increase in medial condylar cartilage damage over 1 year after ACL rupture was often observed. Anatomic single-bundle ACL reconstruction was the primary surgical approach, the resident ridge and the lateral bifurcate ridge could be used to position bone tunnel and autogenous semitendinosus and gracilis tendon were the most commonly used reconstruction materials. Our results indicate that anatomic ACL reconstruction should be performed as early as possible in restore knee joint stability and prevent secondary injury of the medial meniscus and cartilage of medial femoral condyle. 中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程  相似文献   

18.
背景:有研究认为后交叉韧带损伤在临床疗效上双束重建法并没有表现出其应有的优势,且较单束重建有一些难以克服的缺陷。双束与单束重建孰优孰劣?目前学界还没有给出一个统一的答案。 目的:应用前瞻性队列研究探讨自体肌腱单双束重建后交叉韧带的疗效和安全性。 方法:后交叉韧带损伤患者81例,按照随机数字表法分为单束重建组41例,双束重建组40例。对比两组患者韧带重建前、重建后24个月关节稳定性、Lysholm及Tegner评分,并比较两组患者住院天数、手术时间、重建后发热天数及需要穿刺的数量。 结果与结论:双束重建组患者移动度显著高于单束重建组(F=4.362,P=0.000);两组患者重建后24个月Lysholm及Tegner评分较重建前均有显著提高(P < 0.05),但重建前及重建后24个月两组之间差异无显著性意义(P > 0.05)。双束重建组患者手术用时及住院天数及重建后需要行关节腔穿刺的患者数均显著高于单束重建组(P < 0.05)。结果说明关节镜下单双束重建均是治疗后交叉韧带损伤的安全有效的方法,但是双束重建用时长、创伤大,不建议作为首选的修复方式。  相似文献   

19.
BACKGROUND: Problems can occur at the donor site where the autologous tendon graft is taken. Allogenic tissue has become an important graft option for the reconstruction of the anterior cruciate ligament.  相似文献   

20.
 背景:常规开放外科修复治疗膝关节损伤对患者造成的创伤较大,植入物固定后恢复较慢,且大多会出现膝关节功能恢复不佳的情况。目的:分析关节镜下行双股钢丝前交叉韧带前后挤夹固定修复胫骨嵴撕脱骨折的随访效果。方法:回顾性分析23例胫骨嵴撕脱骨折患者的临床资料,均实施关节镜下行双股钢丝前交叉韧带前后挤夹固定治疗。固定后随访1-6个月,观察患者的近中期治疗效果和治疗前后膝关节IKDC评分和Lysholm评分变化情况,并进行分析。结果与结论:所有患者均获得6个月随访,治疗后1个月的优良率为87%,治疗后6个月为96%。较之治疗前,治疗后23例患者的膝关节IKDC评分和Lysholm评分均显著提高(P < 0.05),提示患者的膝关节功能得到显著的改善。患者的内固定时间为35-65 min,固定中未出现血管神经和前交叉韧带损伤等并发症,固定后未出现感染等生物相容性不良的反应。 中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程  相似文献   

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