自体韧带与LARS人工韧带编织物重建前交叉韧带:骨隧道扩大值、韧带生长因子及膝关节功能的评价  

Autologous,mixed and ligament advanced reinforcement system ligaments reconstruction of anterior cruciate ligament:evaluation of bone tunnel enlargement value,ligament growth factor and knee function

作　　者：曹福洋 许建中[1] 陆世涛 谭俊 江旭 杨猛 史简铭 常英健 Cao Fuyang;Xu Jianzhong;Lu Shitao;Tan Jun;Jiang Xu;Yang Meng;Shi Jianming;Chang Yingjian(First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China)

机构地区：[1]郑州大学第一附属医院,河南省郑州市450000

出　　处：《中国组织工程研究》2022年第21期3281-3290,共10页Chinese Journal of Tissue Engineering Research

摘　　要：背景:关节镜下前交叉韧带重建是治疗前交叉韧带损伤一种最为有效的方法,然而术中移植物的选择存在较大的争议,是临床医师面临的亟待解决的关键问题。目的:研究自体、混合及单纯LARS人工韧带应用于前交叉韧带重建后的临床效果。方法:选择郑州大学第一附属医院2016年1月至2019年1月收治的前交叉韧带损伤患者132例,均接受前交叉韧带重建手术,按所用移植物不同分3组:自体组使用患者自体半腱肌、股薄肌肌腱共同编织的韧带,混合组使用患者自体半腱肌、股薄肌肌腱与LARS人工韧带编织物,人工组使用LARS人工韧带,每组44例。术前及术后2年内,利用Lysholm评分、IKDC评分、Lachman试验、Tegner评分、HSS评分等评价患者膝关节恢复情况,同时观察患者骨隧道扩大值、韧带生长因子、生活质量及恢复时间。结果与结论:(1)混合组患者术后恢复日常活动和运动的时间早于自体组、人工组(P<0.05),术后2年的生活质量SF-36评分高于自体组、人工组(P<0.05);混合组、人工组的并发症发生率低于自体组(P<0.05);(2)3组患者术后的膝关节功能均有不同程度的恢复,混合组患者术后0.5,1,2年的Lysholm评分、IKDC评分、Tegner评分均高于自体组、人工组(P<0.05),术后1,2年的KT1000膝关节活动度小于自体组、人工组(P<0.05),术后1年的骨隧道扩大值小于自体组、人工组(P<0.05),术后0.5,1,2年的HSS评分高于自体组、人工组(P<0.05),术后2年的Lachman试验正常人数多于自体组、人工组(P<0.05);(3)混合组患者术后0.5,1,2年的韧带生长因子转化生长因子β1与碱性成纤维生长因子水平均高于自体组、人工组(P<0.05);(4)结果表明,混合韧带可作为临床前交叉韧带重建首要考虑的移植物,更有助于帮助患者及早恢复正常工作生活,但是使用混合韧带依旧存在需要提取自体肌腱及医疗费用颇高等实际问题。BACKGROUND:Anterior cruciate ligament knee reconstruction under arthroscopy is the most effective treatment for anterior cruciate ligament injury.However,the choice of graft in anterior cruciate ligament reconstruction is still controversial,which is the key problem to be solved facing clinicians.OBJECTIVE:To explore the clinical efficacy of autologous,mixed,and simple ligament advanced reinforcement system ligaments in anterior cruciate ligament reconstruction.METHODS:Totally 132 patients who were admitted to First Affiliated Hospital of Zhengzhou University from January 2016 to January 2019 and underwent anterior cruciate ligament reconstruction were enrolled in this study.These patients were divided into autologous group,mixed group,and artificial group(n=44)according to the different graft selections.Among them,the autologous group took the medial half tendon and femoral tendon of the calf tibial nodules and woven into autologous ligament for treatment.Patients in the mixed group were treated with semi-tendon,femoral tendon and ligament advanced reinforcement system artificial ligament graft.Patients with the artificial group were treated with ligament advanced reinforcement system artificial ligament.Before and 2 years after operation,Lysholm score,International Knee Documentation Committee(IKDC)score,Lachman test,Tegner score,and HSS score were used to evaluate the recovery of the knee.At the same time,the bone tunnel enlargement value,ligament growth factors,quality of life,and recovery time were observed.RESULTS AND CONCLUSION:(1)The time for patients in the mixed group to resume daily activities and exercise after surgery was earlier than that of the autologous group and the artificial group(P<0.05).The SF-36 score of the quality of life 2 years after surgery was higher in the mixed group than that of the autologous group and the artificial group(P<0.05).The complication rates of the mixed group and the artificial group were lower than that of the autologous group(P<0.05).(2)The knee joint function of th

关 键 词：骨科植入物 自体韧带 LARS韧带 混合韧带 前交叉韧带 损伤 重建 功能评分 恢复 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学]