自体髌腱与四股腘绳肌腱移植重建前交叉韧带安全性的Meta分析

Objective To compare clinical outcomes of patellar tendon and 4-strand hamstring autografts in single-bundle endoscopic reconstruction of anterior cruciate ligament(ACL). Methods The digital databases(PubMed,Embase,Cochrane Central Register of Controlled Trials,CBM)were searched for randomized controlled trials (RCTs)comparing patellar tendon with hamstring autografts for reconstruction of ACL.In addition.the reference lists from related original studies and review articles were hand-searched.The Cochrane Collaboration's tool for assessing risk of bias and Cochrane collaboration's RevMan 5.0 software were used for assessing trial methodological quality and data analyses. Results Fourteen RCTs were included.There were 1232 participants who met inclusion criteria in all studies.Meta-analyses showed that no statisticallv significant differences were found in graft failure rate after single-bundle reconstruction of the ACL at mean follow-ups of 2 to 3 years (RR=0.69,95%C/0.34 to 1.38,P=0.29,of 5 years (RR=0.37,95%CI 0.09 to 1.55,P=0.18),of 10 years(P=0.94)or when 3 subgroups combined(RR=0.71,95%CI 0.39 t0 1.31.P=0.28).The diffe-rence in≥5°extensor deficit was not statistically significant between the 2 groups(RR=1.63.95%CI 0.85 to 3.16,P=0.14).Anterior knee pain and kneeling pain or discomfort showed significantlv differences between the 2 groups at a mean follow-up of 2 years(P<0.05),but did not at follow-ups of 5 years and 10 years(P>0.05). Conclusions In single-bundle endoscopic ACL reconstruction.patellar tendon and 4-strand hamstring autografts have similar rates of graft failure and knee motion deficits.The patellar tendon autograft may have higher rates of anterior knee pain and kneeling pain or discomfort at an early stage after operation than the 4-strand hamstring autografi,but there may be no such differences on a long-term basis.     

关节镜下髌韧带和六股异体腘绳肌腱单束重建前交叉韧带的临床研究

目的 比较关节镜下采用髌韧带和六股异体腘绳肌腱单束重建前交叉韧带的临床效果.方法 回顾性分析2006年10月至2009年12月我科采用关节镜下异体移植物单束重建前交叉韧带(ACL)的108例患者的临床资料,其中六股异体腘绳肌腱58例(腘绳肌腱组),异体髌韧带50例(髌韧带组).术后应用Lachman和pivot-shift试验以及KT-1000评估膝关节稳定性,按照国际膝关节评分委员会(IKDC)、Lysholm膝关节评分评价膝关节功能.结果 术后患者随访时间12～38个月,平均为28.6个月.腘绳肌腱组KT-1000检查示双侧膝关节前向松弛度差异为(1.2±1.2)mm,显著小于髌韧带组(1.8±1.5)mm,差异具有统计学意义(P＜0.05).腘绳肌腱组轴移试验阴性55例(94.8%),阳性3例(5.2%),髌韧带组阴性41例(82.0%),阳性9例(18.0%),差异具有统计学意义(P＜0.05).术后腘绳肌腱组和髌韧带组IKDC评分为(90±5)分和(89±5)分,Lysholm评分为(94±5)分和(93±6)分,两组比较差异无统计学意义(P＞0.05).结论 关节镜下单束重建前交叉韧带采用六股异体腘绳肌腱较髌韧带能够明显提高膝关节稳定性.

Abstract：

Objective To compare the outcome of arthroscopic single-bundle anterior cruciate ligament(ACL)reconstruction with six-strand hamstring tendon and patellar tendon allograft.Methods From October 2006 to December 2009,108 patients with arthroscopic single-bundle ACL reconstruction were retrospectively reviewed,with 58 patients with six-strand hamstring tendon(Group H),and 50 patients with patellar tendon allograft(Group P).Patients were available for clinical evaluation with KT-1000 arthrometer measurements,Lachman and pivot-shift test,and knee function with the Internationa]Knee Documentation Committee(IKDC),Lysholm scores.Results All the patients were followed up at an average of 28.6 months(range 12-38 months).The average side-to-side difference was lesser for group H(1.2 ± 1.2)mm than group P(1.8 ±1.5)mm(P＜0.05).On the pivot-shift test,55(94.8%)patients were negative and 3(5.2%)were positive in group H,whereas 41(82.0%)were negative and 9(18.0%)were positive in group P,with significant difference between two groups(P＜0.05).All knee function scores were improved postoperatively,without statistically significant difference between the two groups(P＞0.05).Conclusion Arthroscopic single-bundle ACL reconstruction with six-strand hamstring tendon will achieve better knee stability than patellar tendon allograft.     

关节镜下自体腘绳肌腱重建前交叉韧带进展

长期以来,关节镜下重建前交叉韧带(anterior cruciate ligament ACL)以自体骨-髌腱-骨移植应用较多[1].但由于自体骨-髌腱-骨供区并发症的影响,近年许多学者主张应用自体腘绳肌腱移植重建ACL,本文就自体腘绳肌腱重建ACL的有关问题予以综述.……     

关节镜下自体腘绳肌腱重建前交叉韧带进展

长期以来，关节镜下重建前交叉韧带(anterior cruciate ligament ACL)以自体骨-髌腱-骨移植应用较多。但由于自体骨-髌腱-骨供区并发症的影响，近年许多学者主张应用自体腘绳肌腱移植重建ACL，本文就自体腘绳肌腱重建ACL的有关问题予以综述。     

关节镜下同种异体胫前肌腱与自体腘绳肌腱重建前交叉韧带远期效果的比较

目的:对比同种异体胫前肌腱(tibialis anterior allograft,TAA)与自体腘绳肌腱(hamstring tendon autograft,HTA)重建前交叉韧带(anterior cruciate ligament,ACL)的10年随访临床疗效.方法:回顾分析2007年3月至2010年3月单束重...     

关节镜下应用髌腱和腘绳肌腱行前交叉韧带重建的分析比较

前交叉韧带(ACL)重建应用何种组织移植最好,目前仍存在争议。该文通过文献资料分析探讨一个假设:应用髌腱移植行ACL重建比应用腘绳肌腱能使膝关节更加稳定。ACL重建的目的是稳定膝关节,达到这个目的必须减少移植物并发症。髌腱移植的缺点:髌股关节间疼痛、四头肌肌力减弱,髌腱断裂可能以及髌骨骨折;腘绳肌腱移植的缺点:潜在的腘绳肌肌腱减弱及固定螺钉凸出或疼痛。有关ACL重建的文献有很多,但很少有对髌腱和腘绳肌腱移植行ACL重建进行直接比较的研究,从而帮助患者和     

关节镜下LARS人工韧带重建急性期前交叉韧带损伤的 临床疗效观察

<正>前交叉韧带(anterior cruciate ligament,ACL)损伤在我国主要由运动创伤及交通伤引起,较为常见,目前提倡早期重建ACL以恢复膝关节稳定性[1]。目前常用于ACL重建的移植物包括自体骨-髌腱-骨、自体腘绳肌腱和异体肌腱等,均取得     

关节镜下自体腘绳肌肌腱重建前交叉韧带术后并发症研究进展

前交叉韧带(ACL)对于膝关节的稳定性起着重要作用,损伤可引起膝关节功能不稳及其继发的关节病变。目前关节镜下ACL重建是治疗ACL损伤的主要治疗方法。ACL重建术的移植物有自体骨-腱-骨和腘绳肌肌腱、同种异体肌腱、人工韧带等,其中自体腘绳肌肌腱移植物因创伤少、操作简便、临床效果佳等优点,被临床医师广泛应用。但自体腘绳肌肌腱重建ACL术后仍存在少量并发症,如膝关节感染、关节纤维化、骨隧道扩大、神经损伤等。该文就自体腘绳肌肌腱重建ACL术后并发症研究进展作一综述。     

腓骨长肌腱与腘绳肌腱重建前交叉韧带中期疗效比较

目的 比较关节镜下自体同侧腓骨长肌腱(peroneus longus tendon, PLT)与同侧腘绳肌腱(hamstring tendon, HT)重建前交叉韧带(anterior cruciate ligament, ACL)的中期疗效。方法 回顾性分析2016年1月至2018年12月收治的81例ACL损伤患者的临床资料,分别采用腓骨长肌腱(PLT组,37例)和腘绳肌腱(HT组,44例)行关节镜下ACL重建。所有患者术后6、 12个月及以后每年至少一次进行临床及影像评估。采用IKDC评分及Lysholm评分评价患者术后膝关节功能恢复情况,采用AOFAS评分评价踝关节功能,行前抽屉试验、Lachman试验评估膝关节稳定性。结果 所有患者均获随访,其中PLT组随访30～54个月,平均(37.3±14.1)个月,HT组随访26～52个月,平均(36.7±14.3)个月。术后伤口均Ⅰ期愈合,围手术期无感染、血管神经损伤等并发症。PLT组无供区疼痛及踝关节失稳情况。HT组出现髌前疼痛4例(9.1%),予口服非甾体抗炎药后缓解。术后各时点两组Lysholm评分、 IKDC评分均较术前明显改善...     

关节镜下LARS韧带与自体腘绳肌腱重建前交叉韧带的早期临床疗效比较

目的回顾性研究LARS韧带和自体腘绳肌腱重建前交叉韧带(ACL)的早期临床疗效。方法自2008年7月～2011年2月对54例ACL损伤分别行关节镜下LARS韧带和自体腘绳肌腱重建ACL,腘绳肌腱组31例,LARS韧带组23例,分别对其术前术后行Lysholm、Tegner、IKDC评分,并选取最近一次随访结果进行统计分析。结果术后LARS韧带组的膝关节Lysholm、Tegner、IKDC评分略高于腘绳肌腱组,但两组差异无统计学意义(P>0.05)。结论 LARS韧带和自体腘绳肌腱重建ACL能明显改善患者的功能,LARS韧带组和自体韧带组有相似的早期疗效,且恢复时间明显缩短。     

Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts

The authors review the current knowledge on donor site–related problems after using different types of autografts for anterior cruciate ligament (ACL) reconstruction and make recommendations on minimizing late donor-site problems. Postoperative donor-site morbidity and anterior knee pain following ACL surgery may result in substantial impairment for patients. The selection of graft, surgical technique, and rehabilitation program can affect the severity of pain that patients experience. The loss or disturbance of anterior sensitivity caused by intraoperative injury to the infrapatellar nerve(s) in conjunction with patellar tendon harvest is correlated with donor-site discomfort and an inability to kneel and knee-walk. The patellar tendon at the donor site has significant clinical, radiographic, and histologic abnormalities 2 years after harvest of its central third. Donor-site discomfort correlates poorly with radiographic and histologic findings after the use of patellar tendon autografts. The use of hamstring tendon autografts appears to cause less postoperative donor-site morbidity and anterior knee problems than the use of patellar tendon autografts. There also appears to be a regrowth of the hamstring tendons within 2 years of the harvesting procedure. There is little known about the effect on the donor site of harvesting fascia lata and quadriceps tendon autografts. Efforts should be made to spare the infrapatellar nerve(s) during ACL reconstruction using patellar tendon autografts. Reharvesting the patellar tendon cannot be recommended due to significant clinical, radiographic, and histologic abnormalities 2 years after harvesting its central third. It is important to regain full range of motion and strength after the use of any type of autograft to avoid future anterior knee problems. If randomized controlled trials show that the long-term laxity measurements following ACL reconstruction using hamstring tendon autografts are equal to those of patellar tendon autografts, we recommend the use of hamstring tendon autografts because there are fewer donor-site problems.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 971–980     

A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament

Objectives

Controversies exist over which type of graft is best for the reconstruction of the anterior cruciate ligament (ACL). The purpose of this systematic review was to evaluate the effectiveness of ACL reconstruction using either hamstring (HT) autografts or bone-patellar tendon-bone (BPTB) autografts.

Methods

We searched the Cochrane Library, MEDLINE and EMBASE for published randomized controlled trials (RCT) comparing HT autografts with BPTB autografts for ACL reconstruction. Data analyses were performed using Cochrane Collaboration RevMan 5.0.

Results

Nine RCTs (738 patients) met the inclusion criteria. The combined results of the meta-analysis indicated there was a significantly lower rate of negative Pivot test [relative risk (RR) 0.87, 95?% confidence intervals (CI) 0.79–0.96, P?=?0.004], anterior knee pain (RR 0.66, 95?% CI 0.45–0.96, P?=?0.03) and of kneeling pain (RR 0.49, 95?% CI 0.27–0.91, P?=?0.02) in the HT group than in the BPTB group.

Conclusions

ACL reconstruction with HT autografts or BPTB autografts achieved similar postoperative effects in terms of restoring knee joint function. HT autografts were inferior to BPTB autografts for restoring knee joint stability, but were associated with fewer postoperative complications.     

关节镜下自体4股腘绳肌腱双束与单束重建前交叉韧带后膝关节稳定性及功能评分的meta分析

[目的]评价关节镜下自体4股腘肌腱双束与单束重建前交叉韧带的临床效果.[方法]计算机检索CENTRAL、PubMed、Embase、CBM等数据库,获取自体4股腘绳肌腱移植双束与单束重建前交叉韧带的随机对照试验,根据Cochrane协作网推荐的随机对照试验偏倚评估工具对纳入研究的方法学进行评估,并使用RevMan5.0对数据进行Meta分析.[结果]共纳入10篇文献,693例前交叉韧带损伤患者纳入Meta分析,结果显示:双束重建组术后KT2000或KT1000测量值与单束重建组的差异有统计学意义(SMD=-0.27,95% CI(-0.53,-0.01),P=0.04);轴移试验阴性(RR=1.35,95% CI(1.16,1.56),P<0.000 1)、弱阳性(RR=0.37,95% CI(0.18,0.74),P=0.005)、阳性(RR =0.17,95% CI (0.06,0.66),P=0.01)的差异均有统计学意义.功能评分中IKDC主观评分(SMD=0.03,95% CI(-0.21,0.28),P=0.79)和Lysholm评分(SMD=-0.25,95% CI(-0.53,0.02),P=0.07)均无统计学意义.[结论]自体4股腘绳肌腱双束重建前交叉韧带在恢复膝关节的前直向稳定性和旋转稳定性方面优于单束重建;但功能评分相似.     

自体Hamstring腱重建前交叉韧带术后关节镜下再视观察

目的关节镜再视观察游离Hamstring腱重建前交叉韧带后在体内重塑与转归过程.方法关节镜下再视手术,观察关节镜下自体同侧游离Hamstring腱重建前交叉韧带33例.重建术至再视手术时间为2～36个月,平均11.9月.依据重建术至再视术的时间,替代腱按时段分组:1月～,4月～,7月～,10月～,13月～,18月～和25月～组.再视术重点观察评估了移植的Hamstring腱形状、色泽、张力、覆盖的滑漠组织和血管状况.结果再视关节镜下重建前交叉韧带的Hamstring腱随植入时间延长,其形态逐步向正常前交叉韧带重塑与转归;7月～组和此后各组的替代腱在关节镜视下表现为.一种几乎无滑膜和血管的灰白色粗壮的圆柱体,类似于正常的前交叉韧带组织,达到了在体内成熟的程度.结论自体游离多股Hamstring腱重建前交叉韧带术后具有良好早期存活,快速再血管化和重塑过程,其术后的重塑与成熟过程与自体髌腱的过程相似,但其在体内重塑与转归进程相对较快.     

自体四股胭绳肌腱单束与双束重建前交叉韧带临床疗效的对比研究

目的探讨关节镜下自体四股胭绳肌腱单束与双束重建前交叉韧带的临床疗效。方法2006年3月～2009年11月在关节镜下采用自体四股胭绳肌腱重建前交叉韧带46例,其中单束组26例,双束组20例,分别于术后3、6、12、18个月随访,比较2组膝关节稳定性,并按照IKDC膝关节评分标准进行疗效评价。结果末次随访（术后18个月）：双束组IKDC主观评分（89．2±4．5）分与单束组（85．7±4．9）分有统计学性差异（t=2．539,P=0．015）,2组前抽屉试验、Laehman试验阳性率均无统计学差异[7．7％（2／26）VS．0（0／20）,P=0．498;30．8％（8／26）VS．15．0％（3／20）,x2=1．878,P=0．391]。结论关节镜下白体四股胴绳肌腱单束与双束重建前交叉韧带均具有膝关节前向稳定性好等优点,但双束重建前交叉韧带膝关节主观评分优于单束重建。     

Short-term recovery after anterior cruciate ligament reconstruction: a prospective comparison of three autografts

Sixty-four patients with three different autografts were prospectively evaluated following anterior cruciate ligament (ACL) reconstruction for motion return, thigh girth, quadriceps activity, assistive device usage, and duration of pain medication usage. The quadriceps tendon group achieved knee extension sooner than the patellar tendon group. The hamstring group used assistive devices for less time than the patellar tendon group. The quadriceps group required less pain medication than either of the groups. There are significant differences in short-term pain medication requirements and restoration of function among patients following ACL reconstruction using different autografts.     

自体腘绳肌肌腱重建前交叉韧带的研究进展

前交叉韧带（ACL）损伤是膝关节的常见损伤。手术重建已成为治疗ACL损伤后膝关节不稳的首选方法。与传统的髌韧带重建方法相比，采用腘绳肌肌腱（HT）重建具有取材部位病损少、膝前疼痛和跪地疼痛发生率低等优点。本文就HT重建ACL的基础和临床研究进行综述。     

Hamstring tendon autograft better than bone patellar-tendon bone autograft in ACL reconstruction: a cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis

Background Current debate on treatment options for anterior cruciate ligament (ACL) reconstruction complicate the choice between hamstring and bone patellartendon bone autografts. We hypothesized a priori that cumulative meta-analysis (a form of sensitivity analysis) might show that the evidence for reduction of morbidity by hamstring grafts could have been reached at an earlier time. Furthermore, we hypothesized a priori that modern state-of-the-art hamstring graft fixation technique would give similar results regarding stability as bone-patellar tendon-bone autografts.

Methods We performed a cumulative meta-analysis and sensitivity analysis based on femoral graft fixation techniques to compare hamstring autograft and bonepatellar tendon-bone autografts in ACL reconstruction derived from a previously published meta-analysis.

Results Cumulatively, that hamstring autograft reduces anterior knee pain had already reached statistical significance in 2001 (relative risk 0.49 (95%CI: 0.32-0.76; p = 0.001, I2 = 0%)). The modern endobutton hamstring graft fixation technique (2 studies) yielded similar stability in the Lachman test as bone-patellar tendon-bone grafts, with a relative risk of 1.1 (95%CI: 0.82-1.5; p = 0.6, I2 = 0%). Exclusion of the endobutton group explains the increased laxity in the hamstring graft group.

Interpretation Cumulative meta-analysis strengthens the evidence for reduced morbidity using hamstring tendon autograft for anterior cruciate ligament reconstruction. Sensitivity analysis focusing on state-of-the-art hamstring graft fixation techniques further weakens the evidence that bone-patellar tendon-bone autografts provide better stability.     

关节镜下自体腘绳肌腱重建内侧髌股韧带治疗复发性髌骨脱位

目的探讨关节镜下采用自体腘绳肌腱重建内侧髌股韧带治疗复发性髌骨脱位的疗效。方法 2005年1月-2010年1月,对22例(22膝)复发性髌骨脱位患者采用关节镜下外侧支持带松解,取自体腘绳肌腱重建内侧髌股韧带治疗。男5例,女17例;年龄15～19岁,平均17.3岁。髌骨脱位3～8次,平均4次。主要临床症状为患膝关节疼痛、肿胀、无力,活动受限。髌骨倾斜试验、恐惧试验、内侧髌股韧带止点处压痛、髌骨向外推移时恐惧征均呈阳性。根据国际膝关节文献委员会(IKDC)评分标准,膝关节功能主观评分为(36.7±4.7)分,Lysholm评分为(69.3±3.8)分。X线片示患者髌骨向外倾斜。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间18～49个月,平均34个月。术后患者关节疼痛、肿胀、无力等症状较术前明显改善。随访期间患者髌骨脱位无复发。末次随访时,IKDC膝关节功能主观评分为(92.4±5.3)分,Lysholm评分为(91.7±5.2)分,与术前比较差异均有统计学意义(P<0.05)。结论关节镜下取自体腘绳肌腱重建内侧髌股韧带可明显改善髌骨稳定性,是治疗复发性髌骨脱位的有效方法之一。