韧带增强重建系统人工韧带重建前交叉韧带中期疗效分析  

Mid-term clinical results of ligament advanced reinforcement system artificial ligament in anterior cruciate ligament reconstruction

作　　者：李利南[1] 张卫国[1] 王立德[1] 张羽飞[1] 王福生[1] 

机构地区：[1]大连医科大学附属第一医院骨外科,116011

出　　处：《中华创伤杂志》2013年第8期756-761,共6页Chinese Journal of Trauma

摘　　要：目的评估韧带增强重建系统（1igament advancement reinforcement system，LARS）人工韧带重建前交叉韧带（anterior cruciate ligament，ACL）术后3～7年膝关节功能，了解LARS人工韧带在人体组织内的形态变化。方法选择符合标准的LARS人工韧带重建ACL患者57例（58膝），根据伤后至手术时间分为急、慢性损伤两组，对其进行多指标回顾性分析。其中对再手术患者（3例4膝）LARS人工韧带取材行组织学观察。结果LARS人工韧带重建ACL术后关节功能、膝关节运动水平明显高于术前（P〈0．01）；两组间膝关节功能的主观评分及客观评估差异无统计学意义（P〉0．05）；X线片及MRI显示平均1．5年骨隧道呈不同程度进行性扩大，关节稳定性与骨隧道扩大程度无明显相关性（P〉0．05），胫骨和股骨骨隧道扩大发生率差异无统计学意义（P〉0．05）。组织学观察可见术后2年有规则排列纤维组织长入LARS人工韧带内，单束及成捆聚酯纤维间见广泛纤维连接。结论（1）LARS人工韧带重建ACL能够较好地恢复膝关节稳定性及功能。（2）骨隧道扩大现象存在，1．5年后趋于稳定，关节稳定性与术后骨隧道扩大程度无相关性。（3）急性损伤与慢性损伤术后的各项评估资料对比一致。（4）人体正常纤维组织结构能够规律地长入LARS人工材料。Objective To evaluate the knee joint function at 3-7 years after anterior cruciate ligament （ACL） reconstruction with ligament advanced reinforcement system （LARS） artificial ligament and assess the morphologic changes of LARS artificial ligament in human tissues. Methods Fifty-seven patients （58 knees ） undergone ACL reconstruction with LARS artificial ligament were recruited to this multi-factor retrospective study and divided into acute injury group and chronic injury group according to time between injury and operation. LARS artificial ligament harvested from the three patients （4 knees ） who had an additional surgery were observed histologically. Results Knee joint function and range of movement were significantly improved after surgery （P 〈 0. 01 ） , however subjective and objective estima- tion on knee joint function presented no statistical differences between the two groups （P 〉 O. 05）. X-ray fihns and MRI revealed different degree of bone tunnel progressive augmentation in average l. 5 years, indistinctive correlation of knee joint stability with bone tunnel augmentation （ P 〉 0. 5 ） as well as no statistical difference concerning incidence of tibial and femoral bone tunnel augmentation （ P 〉 0. 05 ）. Histological observation revealed well-arranged fiber tissue growth into LARS artificial ligament as well as fibrous joint among single-beam polyester fibers as well as a bundle of polyester fibers at postoperative 2 years. Conclusions （1） LARS artificial ligament gains a satisfactory knee joint stability and function in ACL reconstruction. （2） There exists bone tunnel augmentation that tends to stability at postoperative 1.5 years, but knee joint stability is not correlated to the extent of bone tunnel augmentation after surgery. （3） Postoperative data evaluation of acute injury and chronic injury is the same. （4） Human normal fibrous tissues grow into LARS artificial ligament regularly.

关 键 词：膝损伤 前交叉韧带 LARS人工韧带 

分 类 号：R687.4[医药卫生—骨科学]