前交叉韧带重建后二次关节镜探查关节软骨的转归分析  

Posttraumatic progression of cartilage degeneration following anterior cruciate ligament reconstruction:a second-look arthroscopic analysis

作　　者：卢明峰 赵立连[1] 邢基斯[1] 何利雷[1] 许挺[1] 王昌兵[1] Lu Mingfeng;Zhao Lilian;Xing Jisi;He Lilei;Xu Ting;Wang Changbing(Department of Sport Medicine,Affiliated Foshan TCM Hospital of Guangzhou University of Chinese Medicine,Foshan 528000,Guangdong Province,China)

机构地区：[1]佛山市中医院运动医学科,广东省佛山市528000

出　　处：《中国组织工程研究》2021年第2期222-227,共6页Chinese Journal of Tissue Engineering Research

基　　金：广东省医学科学技术研究(20161181228306),项目负责人:赵立连。

摘　　要：背景:骨前交叉韧带重建能够恢复膝关节稳定性,降低对半月板和软骨的机械应力,从而避免包括创伤性关节炎在内的继发损伤的发生与发展。然而,一些研究表明前交叉韧带重建并不能完全阻止骨关节炎的发生发展,重建后中长期的影像学检查可发现明显的骨关节炎改变,因此目前对于前交叉韧带重建预防继发性软骨损害与继发性骨关节炎的作用仍存在争议,同时前交叉韧带重建后软骨的变化情况,尤其是早期变化,并未被完全阐明。目的:分析关节镜下前交叉韧带重建和二次关节镜探查时关节软骨变化情况。方法:回顾性分析2015年7月到2016年7月期间在佛山市中医院运动医学科采用自体腘绳肌腱行前交叉韧带重建并进行了二次关节镜探查的50例病例,关节镜下探查前交叉韧带重建和二次探查时软骨损伤及愈合情况,同时分析重建时年龄对于关节软骨的影响。试验于2015-06-13经佛山市中医院伦理委员会的批准,批准号20160315。结果与结论:①所有患者均未发生感染、移植物吸收等并发症,二次探查时Lysholm评分、国际膝关节评分委员会评分、Tegner评分、KT-1000侧侧差值较重建前明显改善(P<0.05);②前交叉韧带初次重建与二次探查关节软骨情况对比,所有患者关节软骨均有恶化趋势,其中除胫骨内侧平台、股骨外侧髁关节软骨外,髌骨下、滑车、股骨内侧髁、胫骨外侧平台关节软骨较初次重建时均有较为明显恶化(P<0.05);③初次前交叉韧带重建时,年龄在30岁以下和30岁以上的患者关节软骨状况接近(P>0.05),而在关节镜二次探查时,30岁及以上的前交叉韧带重建患者髌骨下、滑车、股骨外侧髁、胫骨内、外侧平台软骨状况较30岁以下患者明显更差(P<0.05);④结果提示采用自体腘绳肌腱重建前交叉韧带能够获得较好的膝关节稳定性及功能,然而即使在重建后早期,创伤后骨关节�BACKGROUND:Anterior cruciate ligament(ACL)reconstruction can restore the stability of knee joint,reduce the mechanical stress on meniscus and cartilage,and avoid the occurrence and development of secondary injury including traumatic arthritis.However,some studies have shown that ACL reconstruction cannot completely prevent the occurrence and development of osteoarthritis,and significant changes in osteoarthritis can be found in the long-term imaging examination after operation.Therefore,there is still controversy about the role of ACL reconstruction in preventing secondary cartilage damage and secondary osteoarthritis,and the changes in cartilage after ACL reconstruction,especially at early stage after ACL reconstruction,have not been fully elucidated.OBJECTIVE:To analyze articular cartilage changes during arthroscopic anterior cruciate ligament reconstruction and second-look arthroscopic evaluation.METHODS:From July 2015 to July 2016,50 cases of ACL reconstruction with hamstring tendon and second-look arthroscopic exploration were analyzed retrospectively.The cartilage damage and healing between the ACL reconstruction and second-look exploration were recorded.At the same time,the influence of age on articular cartilage was analyzed.The study protocol was approved by the Ethics Committee of Foshan TCM Hospital with an approval No.20160315.RESULTS AND CONCLUSION:No infection,graft absorption and other complications occurred in all patients.During the second-look exploration,the Lysholm score,International Knee Documentation Committee evaluation score,Tegner score and KT-1000 lateral difference were significantly improved compared with those before operation(P<0.05).During the second-look exploration,the articular cartilage of all patients had a trend of deterioration;except for the medial tibial platform and the lateral femoral condyle,subpatellar,trochlear,medial femoral condyle and tibial lateral platform articular cartilage tissues were significantly worsened compared with those after the initial ACL reconstruc

关 键 词：关节镜 前交叉韧带 关节软骨 二次探查 膝 年龄 

分 类 号：R459.9[医药卫生—治疗学] R684.3[医药卫生—临床医学]