关节镜下保留残端重建前交叉韧带与不保留残端重建的Meta分析

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     

关节镜下保留残端与非保残重建前交叉韧带的疗效比较

目的　比较关节镜下保留及非保留残端重建前交叉韧带 (anterior cruciate ligament, ACL) 的疗效。 方法　选择我院2014.03~2015.05收治的64例有韧带残端残留的ACL断裂患者64例为研究对象,采用关节镜下四股自体腘绳肌腱单束重建技术,随机分为两组,即保留残端组和非保留残端组,每组32例,非保残组给予切除残端行常规关节镜手术重建ACL,保残组在保留残端的基础上行关节镜下ACL重建术。记录比较两组术前、术后关节稳定性及功能评分进行对比,术后1年测本体感觉,部分患者二次手术时探查重建韧带。 结果　64 例均获随访,随访时间 12~27个月。术后1年Lysholm评分,非保残组平均91.9分,保残平均93.2分;IKDC 评分功能在A、B级非保残组29例,保残组30例;抽屉试验阴性非保残组29例保残组31例,Lachman 试验阴性两组均为30例,比较差异均无统计学意义( P＞0.05);两组的本体感觉重复试验无差异,患者自述关节稳定性及位置觉以观察组稍优,术后共有9例患者二次行关节镜手术,对照组4例,观察组5例,镜下见对照滑膜覆盖率及韧带表面光滑度较观察组稍差,因例数太少,未行统计学分析。 结论　关节镜下保留残端与非保留残端单束重建术重建 ACL ,均能获得满意的临床效果,但关节镜下保留残端患者有更好的自我感觉,可能和保留残端有利于移植物的再血管化及本体感受器的恢复有关,需要更多的数据来进行统计学分析。     

早期关节活动对前交叉韧带重建后腱骨愈合的影响

背景：异体移植物可作为前交叉韧带重建翻修以及膝关节复合损伤修复的选择。 目的：通过建立异体韧带移植重建前交叉韧带的动物模型,观察早期活动对异体植入物止点腱骨愈合的组织形态以及关节活动功能恢复的影响。 方法：健康成年新西兰兔9只,随机取3只兔双侧跟腱作为供体,取6只兔切断一侧膝关节前交叉韧带,固定重建前交叉韧带。动物随机数字表法均分运动组和制动组,6周后观察关节活动功能、腱骨愈合大体观察以及组织学观察。 结果与结论：术侧肢体活动情况基本正常,所有动物前交叉韧带上下止点愈合情况均良好。前交叉韧带周围滑膜均可见明显增生。活动组可见较多Sharpey纤维,腱骨间接连接形成,而制动组未见明显Sharpey纤维。说明术后6周异体重建物止点已有腱骨愈合,早期活动对重建物的腱骨愈合并无明显不良影响,可能还更有利。     

关节镜下保留残端与不保留残端重建前交叉韧带:前瞻性、随机、对照研究的Meta分析

目的:关节镜下重建前交叉韧带已经成为当前前交叉韧带损伤的首选治疗方法,但对于是否保留前交叉韧带胫骨残端重建存在较大争议.文章系统评价关节镜下保留残端与不保留残端重建前交叉韧带的临床效果.方法:通过计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data、CNKI和...     

关节镜下前交叉韧带残端评估及保残重建的临床效果

目的 探讨关节镜下前交叉韧带（ACL）残端评估及保残重建的临床效果。方法 选取于我院行关节镜下人工韧带加强系统（LARS）移植重建ACL的患者111例,按照手术方式的不同分为Crain组（59例）及对照组（52例）。Crain组在改良Crain分型理论指导下保留残端并在鞘内重建ACL,对照组在ACL重建时清除残端。比较2组患者术前及术后24 h、72 h疼痛视觉模拟量表（VAS）评分。分别于术前及术后3个月、6个月、9个月和12个月采用Lysholm评分评估患者的膝关节功能。采用Lachman试验、轴移试验评估手术前后膝关节的稳定性。记录2组患者随访期间并发症发生情况。结果 Crain组患者术后24 h、72 h VAS评分均低于对照组（P<0.05）。2组患者术前及术后9个月、12个月Lysholm评分比较差异无统计学意义（P>0.05）,Crain组患者术后3个月、6个月Lysholm评分高于对照组（P<0.05）。2组患者手术前后Lachman试验及轴移试验阴性结果比较差异具有统计学意义（P<0.05）,2组患者术后Lachman试验及轴移试验阴性结果比较...     

保留残端对前交叉韧带重建术后恢复的临床意义

目的　对78例患者保留前交叉韧带残端的膝关节前交叉韧带重建术后膝关节功能及稳定性的评价,探讨保留前交叉韧带残端对患者术后韧带功能恢复中的临床作用。 方法　2009年1月～2013年1月,取保留前交叉韧带残端的膝关节前交叉韧带重建术患者78例,其中男性51例,女性27例,平均年龄29.2岁,受伤至手术平均时间为3个月,随访时间均大于12个月,全部病例均采用同种异体腘绳肌腱重建前交叉韧带。78例患者均存在前交叉韧带完全断裂,包括30例体部断裂,44例股骨起点断裂,ACL胫骨止点断裂4例,尽量保留残端。术后对患者膝关节的稳定性及膝关节功能进行随访,通过相关检查来判断临床效果。 结果　取末次随访数据进行分析,末次随访时间12～35个月,平均25个月。有76例患者前抽屉试验、Lachman试验、轴移试验均为阴性;对比术前,膝关节前后稳定性、Lysholm评分、Tegner评分及IKDC综合评分均有所改善,差异具有统计学意义（P<0.05）。 结论　保留残端对ACL重建术有良好的临床疗效。     

前交叉韧带重建术后腱-骨愈合的生物学研究进展

目的 总结前交叉韧带(ACL)重建术后促进腱-骨愈合的生物学因素以及生物学技术的研究进展。方法 在PubMed、Web of Science、中国知网、万方数据等数据库以“前交叉韧带”“腱-骨愈合”“生物学技术”“生长因子”为关键词,检索2000年1月—2017年12月国内外有关ACL重建术后促进腱-骨愈合生物学方面的相关文献资料,并进行汇总分析。结果 共检索到文献1 081篇,按纳入标准和排除标准最终纳入44篇文献,其中中文文献4篇和英文文献40篇。ACL重建术后通过调整重建止点周围的生物学和生物力学环境可以促进腱-骨愈合。大量的研究证实生长因子、干细胞、自体骨膜、富血小板血浆、基质金属蛋白酶组织抑制因子等方法均对腱-骨界面的愈合有促进作用,目前已应用于临床的有自体骨膜、富血小板血浆、他汀类药物、低强度脉冲超声波以及中医药等,且临床效果较确切,操作简单。结论 使用生物治疗技术可以促进腱-骨愈合,若将基础研究结果广泛应用于临床,还需进行大量的临床研究才可确定其疗效。     

关节滑液对兔前交叉韧带重建后腱骨愈合生物力学和组织学的影响*

背景：目前前交叉韧带重建后关节滑液对移植物强度以及腱骨愈合的影响尚无定论。 目的：观察兔前交叉韧带重建后腱骨愈合过程中,关节滑液对移植肌腱生物力学及组织学的影响。 方法：取新西兰大白兔下肢半腱肌腱,以同侧肢体半腱肌腱重建前交叉韧带模拟关节滑液影响模型,并同时取对侧肢体半腱肌行股骨髁上“U”形肌腱埋植避免关节滑液的影响。重建4周,取股骨-韧带-胫骨复合体,行生物力学测定和组织学观察。 结果与结论：重建后4周,生物力学测定时发现“U”字形埋植肌腱断裂时平均载荷明显大于前交叉韧带重建后处于关节内的肌腱(P < 0.01)。组织学观察发现,骨隧道内坏死的腱组织已被纤维组织、新生骨组织替代,腱骨交界面形成Sharpey纤维连接和纤维软骨,优于关节内肌腱;“U”字形埋植肌腱腱骨交界面成骨细胞数目明显多于前交叉韧带重建肌腱(P < 0.01)。结果证实“U”字形埋植肌腱的生物力学及腱骨愈合均优于处于关节内肌腱,提示关节滑液对前交叉韧带重建后韧带的强度以及腱骨愈合有不利影响。     

间歇性负压干预前交叉韧带重建后的腱-骨愈合

背景：间歇性负压被证实可以促进软组织修复及骨愈合,但其对交叉韧带重建后腱-骨愈合的影响尚未见报道。 目的：观察间歇性负压对兔前交叉韧带重建后腱-骨愈合及肌腱移植物生物力学的影响。 方法：取24只新西兰大白兔制备自体半腱肌前交叉韧带重建模型,随机取一侧后腿作为负压侧,负压侧关节通过引流管接微型负压吸引器,并维持低强度、间歇性负压;对侧后腿作为对照,接普通引流管。5 d后两侧同时拔除吸引管。造模后6周,取关节液检测白细胞介素1β的表达水平;取股骨-韧带-胫骨复合体行肌腱移植物拉力测定和腱-骨界面组织学观察。 结果与结论：1只兔关节感染,最终23只兔进入结果分析。拉力测定结果显示,负压组完全断裂所需拉力显著大于对照组(P < 0.05)。组织学观察结果发现,负压组成骨细胞数目显著多于对照组,差异有显著性意义(P < 0.01)。关节液检测结果提示负压组关节滑液中白细胞介素1β含量低于对照组,差异有显著性意义(P < 0.01)。提示间歇性负压可能在前交叉韧带重建后腱-骨愈合、肌腱移植物的塑性过程中扮演着积极作用。     

硫酸钙促进ACL重建后腱-骨愈合的实验研究*

目的研究外科级硫酸钙促进腱-骨愈合的效应。方法实验采用比格犬33只建立动物模型,分别在实验侧采用注射型硫酸钙。在双侧后肢切取趾长屈肌腱进行前交叉韧带（ACL）重建。重建模拟临床方式：肌腱两端采用悬吊式固定,肌腱只充填骨隧道靠近关节腔的一部分。在实验侧,重建术后隧道内间隙充填硫酸钙;对侧不作类似处理,作为对照。术后2、4、6、8、10、12周,各取3只犬行组织学检查,了解腱-骨界面的组织学变化;术后2、4、6周各取5只作生物力学检查,测试腱-骨愈合强度;通过对比了解实验侧硫酸钙对腱-骨愈合的效应。结果实验侧组织学观察术后4周在腱-骨界面形成许多骨岛,出现不规排列的sharpey’s纤维;8周时腱-骨间sharpey’s纤维集结成束;12周时腱-骨间肌腱与骨出现密集的纤维连接。对照组4周腱骨间隙存在间隙;8周时腱-骨间隙才出现稀疏的sharpey’s纤维;12周时腱-骨界面出现的密集分布sharpey’s纤维。生物力学测试对比,实验侧和对照侧在术后6周内,有明显差异（0.05）。结论硫酸钙可以早期促进腱-骨界面的愈合。     

可吸收挤压螺钉关节镜下置入固定自体腘绳肌重建前交叉韧带

BACKGROUND: Arthroscopic reconstruction is a common method in the treatment of anterior cruciate ligament injury, in which tendon fixation is an important part. OBJECTIVE: To investigate the clinical effect of absorbable screw fixation with autologous hamstring for anterior cruciate ligament reconstruction under arthroscopy. METHODS: Totally 47 cases of anterior cruciate ligament reconstruction were included, containing 27 male patients and 20 female patients, aged from 18-48 years old, and all patients underwent the absorbable screw fixation with autologous hamstring implantation. After12-month follow-up, patients underwent Lysholm, Tegner, and IKDC scoring before treatment and after 1, 3, 6 and 12 months, respectively. Additionally, anterioposterior lateral X-ray and MRI reexamination were performed, and adverse reactions were recorded at 12 months after treatment. RESULTS AND CONCLUSION: Postoperative knee instability symptoms such as “weak legs” walking gait recovered to normal levels, and the wound all reached the primary healing. Moreover, the Lysholm, Tegner and IKDC scores at 3, 6 and 12 months after treatment were significantly higher than those before treatment (P < 0.05). There were no incision infection, nerve injury, deep vein thrombosis and other adverse events except hemarthrosis of the knee joint in one case. After 12 months of treatment, the imaging examinations showed that there was no enlargement of the bone tunnel, and no significant change in the joint space. In conclusion, the absorbable screw fixation with autologous hamstring for the reconstruction of anterior cross ligament has good fixing effect and little trauma, and significantly improves the extremity function of patients.      

膝前交叉韧带损伤后垂直起跳能力评价：运动力学指标的有效性

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     

前交叉韧带重建股骨隧道悬吊固定方式对骨道及移植物变化的近期影响

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.     

同种异体肌腱重建膝关节前交叉韧带：效果及免疫排斥反应

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.     

前交叉韧带断裂和重建的临床流行病学分析

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     

带血管蒂髌韧带修复前交叉韧带损伤：计算机导航辅助关节镜的应用

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     

Transphyseal reconstruction of the anterior cruciate ligament using hamstring autograft in skeletally immature adolescents

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.     

关节镜下自体肌腱单双束重建后交叉韧带：前瞻性队列研究

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。     

双股钢丝前交叉韧带前后挤夹固定修复胫骨嵴撕脱骨折

 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