损伤前交叉韧带修复及促进移植物愈合的策略  

Strategies for repairing injured anterior cruciate ligament and promoting graft healing

作　　者：白晨 杨文骞 孟志超 王宇泽[2] Bai Chen;Yang Wenqian;Meng Zhichao;Wang Yuze(Shanxi Medical University,Taiyuan 030001,Shanxi Province,China;Department of Orthopedics of Second Affiliated Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学,山西省太原市030001 [2]山西医科大学附属第二医院骨科,山西省太原市030001

出　　处：《中国组织工程研究》2024年第9期1457-1463,共7页Chinese Journal of Tissue Engineering Research

基　　金：山西省青年科技研究基金(201901D211505),项目负责人:王宇泽。

摘　　要：背景:近些年,对于前交叉韧带损伤的治疗日益成熟,但是,临床上对于前交叉韧带损伤的手术时机、手术方式的选择、移植物的选择及促进移植物愈合的方法等问题还存在争议。目的:总结前交叉韧带损伤的手术时机、手术方式、移植物选择和促进移植物愈合方法的最新研究进展,为前交叉韧带损伤寻找新的治疗方向。方法:从PubMed、中国知网、万方数据、维普、SinoMed、ScienceDirect、Springer和Cochrane图书馆数据库进行前交叉韧带损伤相关文献的检索,最终经过筛选纳入相关文献72篇进行综述分析。结果与结论:①在手术时机方面:前交叉韧带早期重建与延迟重建相比,早期重建可减缓半月板的损伤、提高生活质量、促进功能恢复,然而手术时机的不同是否会加速软骨损伤,目前还无定论。②在手术方式方面:关节镜下前交叉韧带重建术是前交叉韧带损伤的常用手术方式;前交叉韧带动态内稳定修复术在短期和长期疗效中,都可以带来和传统前交叉韧带重建术相似的结局。③在移植物的选择方面:自体腘绳肌肌腱是前交叉韧带移植物的首要选择;骨-髌腱-骨移植物和同种异体移植物作为次要选择。④在促进移植物愈合的策略方面:缝合带加强可以增加膝关节稳定性,保证移植物的愈合;干细胞通过抗炎作用、血管生成作用、抑制骨溶解和促进软骨细胞分化促进移植物的腱-骨愈合;保留前交叉韧带残端可以维持膝关节稳定、促进本体感觉恢复,为移植物的愈合提供先决条件;富血小板血浆促进移植物愈合的有效性有待商榷;而生物材料、基因治疗及干细胞治疗等促进肌腱愈合的方法还停留在分子和动物研究阶段,未来还需要进行临床转化。BACKGROUND:In recent years,the treatment of anterior cruciate ligament injury has become more and more mature.However,there are still disputes about the timing of surgery,the choice of surgical methods,the choice of grafts,and the methods to promote graft healing after anterior cruciate ligament injury.OBJECTIVE:To summarize the latest research progress of surgical timing,surgical methods,graft selection and methods to promote graft healing after anterior cruciate ligament injury,and to find new treatment directions for anterior cruciate ligament injury.METHODS:Relevant articles concerning anterior cruciate ligament injury were retrieved from PubMed,CNKI,WanFang Date,VIP,SinoMed,ScienceDirect,Springer and Cochrane Library.After the screening,72 related articles were finally included.RESULTS AND CONCLUSION:(1)Surgical timing:Compared with delayed anterior cruciate ligament reconstruction,early reconstruction can reduce meniscus injury,elevate quality of life,and improve functional recovery.However,it is still uncertain whether the different operation timing will accelerate cartilage injury.(2)Surgical methods:Arthroscopic anterior cruciate ligament reconstruction is a common surgical method for anterior cruciate ligament injury.Dynamic internal stabilization repair of anterior cruciate ligament can bring similar results to traditional anterior cruciate ligament reconstruction in short-term and long-term effects.(3)Graft selection:Autogenous hamstring tendon is the first choice of anterior cruciate ligament graft,while bone-patellar tendon-bone grafts and allografts are the secondary choices.(4)Among the methods to promote graft healing,suture band strengthening can increase knee joint stability and ensure graft healing.Stem cells promote the tendon-bone healing of grafts through anti-inflammatory action,angiogenesis,inhibition of osteolysis and promotion of chondrocyte differentiation.Preserving the residual end of the anterior cruciate ligament can maintain the stability of the knee joint,promote the recovery of

关 键 词：前交叉韧带损伤 前交叉韧带重建 移植物 移植物愈合 延迟重建 LARS 股四头肌肌腱 干细胞 基因 生物材料 

分 类 号：R459.9[医药卫生—治疗学] R363[医药卫生—临床医学] R605