机构地区:[1]漯河医学高等专科学校第二附属医院骨关节科,河南漯河462300 [2]河南省人民医院骨关节科,郑州450000
出 处:《中国修复重建外科杂志》2017年第7期799-804,共6页Chinese Journal of Reparative and Reconstructive Surgery
基 金:河南省基础与前沿技术研究计划项目(162300410093);河南省医学科技攻关项目(201602196)~~
摘 要:目的探讨自体血纤维蛋白凝块对前交叉韧带(anterior cruciate ligament,ACL)重建术后腱-骨愈合的作用及意义。方法以2014年10月—2016年1月收治并符合选择标准的34例(34膝)ACL损伤患者作为研究对象,随机分为两组(n=17);ACL重建术中试验组采用自体血纤维蛋白凝块,对照组不作该处理。两组患者术前前抽屉试验、Lachman试验及轴移试验均为阳性。两组患者性别、年龄、致伤原因、损伤侧别、受伤至手术时间以及术前膝关节活动度、Lysholm评分、美国特种外科医院(HSS)评分等一般资料比较,差异均无统计学意义(P<0.05),具有可比性。记录并比较两组患者术后前抽屉试验、Lachman试验及轴移试验检查结果;术后6、24、48周,检查患膝关节活动度、Lysholm评分、HSS评分,评定膝关节功能恢复情况;行MRI检查,测量移植物信号强度、信噪比以及骨隧道扩大程度及移植物腱-骨结点T2值。结果两组患者术后均获随访48周。术后切口均Ⅰ期愈合,无1例出现关节内感染及关节粘连。术后两组患者前抽屉试验、Lachman试验及轴移试验均为阴性。术后6、24、48周,试验组Lysholm评分均明显高于对照组(P<0.05);而两组膝关节活动度比较差异无统计学意义(P>0.05)。术后6周,两组HSS评分比较差异无统计学意义(P>0.05);24、48周时试验组HSS评分明显高于对照组(P<0.05)。MRI复查显示,术后6、24、48周两组移植物信号强度、骨隧道扩大程度、移植物信噪比比较,差异均有统计学意义(P<0.05)。术后6、24周两组移植物腱-骨结点T2值比较,差异有统计学意义(P<0.05);48周时比较差异无统计学意义(P>0.05)。结论 ACL重建术中采用自体血纤维蛋白凝块,能够有效促进移植物再血管化、加快腱-骨愈合进程。Objective To observe the effect and significance ofautologous fibrin clot on tendon-bone healing after anterior cruciate ligament (ACL) reconstruction. Methods Between October 2014 and January 2016, 34 patients (34 knees) with ACL injury were enrolled in the study. During ACL reconstruction, autologous fibrin clot was used in 17 cases (trial group) and was not used in 17 cases (control group). The anterior drawer test, Lachman test, and axial displacement test were positive in 2 groups before operation. There was no significant difference in gender, age, causes of injury, injury side, disease cause, and preoperative knee joint activity, Lysholm score, and American Hospital for Special Surgery (HSS) score between 2 groups (P〉0.05), with comparable. The results of anterior drawer test, Lachman test, and axial displacement test were recorded and compared between 2 groups after operation. The knee joint activity, Lysholm score, and HSS score were used to evaluate the knee function recovery at 6, 24, and 48 weeks after operation; the graft signal intensity, graft signal to noise ratio, bone tunnel expansion, and graft tendon-bone node T2 value were measured. Results All patients were followed up 48 weeks. Surgical incision healed at stage I. No joint infection and joint adhesion occurred. The drawer test, Lachman test, and axial shift test were negative in 2 groups. At 6, 24, and 48 weeks after operation, the Lysholm score of trial group was significantly higher than that of control group (P〈0.05); there was no significant difference in knee joint activity between 2 groups (P〉0.05). The HSS score of trial group was significantly higher than that of control group at 24 and 48 weeks (P〈0.05), but no significant difference was found at 6 weeks (P〉0.05). MRI measu- rement showed that there was significant difference in graft signal intensity, bone tunnel expansion, and graft signal to noise ratio between 2 groups at 6, 24, and 48 weeks after operation (P〈0.05). There
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