前交叉韧带重建术中移植物胫骨端固定方式研究进展  

Research progress of tibial-graft fixation methods on anterior cruciate ligamentreconstruction

作　　者：杨登军 王福科[1] 张奇爱 张瑶璋 申屠昊鹏 王凡 YANG Dengjun;WANG Fuke;ZHANG Qiai;ZHANG Yaozhang;SHENTU Haopeng;WANG Fan(Department of Sports Medicine,the First Affiliated Hospital of Kunming Medical University,Kunming Yunnan,650032,P.R.China)

机构地区：[1]昆明医科大学第一附属医院运动医学科,昆明650032

出　　处：《中国修复重建外科杂志》2023年第9期1162-1168,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：云南省骨关节疾病临床医学中心项目(ZX2019-03-04);云南省高层次人才培养支持计划“名医专项”(RLMY2020009)。

摘　　要：目的 对前交叉韧带(anterior cruciate ligament,ACL)重建术中移植物胫骨端固定方式的研究进行综述,以期为临床提供参考。方法 广泛查阅近年来国内外关于ACL重建移植物胫骨端固定方式的文献,并对影响固定方式选择的因素进行总结分析。结果 ACL重建术中移植物胫骨端固定时,主要考虑膝关节屈曲角、移植物张力及移植物固定装置3个因素。目前主要选择在膝关节屈曲0°或30°位固定移植物,研究显示30°位固定后膝关节稳定性更好,而0°位固定后伸膝受限发生率降低。在移植物张力方面,选择接近90 N张力水平或膝关节屈曲30°位时患膝前后松弛度恢复至相对于健侧膝关节过度约束2 mm,可获得良好疗效;关于移植物固定装置,界面螺钉仍是移植物胫骨端固定最常用方式;随着近年来全内ACL重建术式的推广,皮质悬吊固定可能成为主流。结论 关节镜下重建是ACL断裂主要治疗手段,但移植物胫骨端尚无最佳固定方式,各固定方式优劣有待进一步研究。Objective To review the studies about the tibial-graft fixation methods on anterior cruciate ligament(ACL)reconstruction,in order to provide clinical reference.Methods The literature about the tibial-graft fixationmethods on ACL reconstruction at home and abroad was extensively reviewed,and the factors that affect the selection offixation methods were summarized.Results The knee flexion angle,graft tension,and graft fixation device are mainlyconsidered when the tibial-graft was fixed on ACL reconstruction.At present,the graft is mainly fixed at 0°/30°of kneeflexion.The study shows that the knee joint is more stable after fixed at 30°,while the incidence of knee extensionlimitation decrease after fixed at 0°.In terms of graft tension,a good effectiveness can be obtained when the tension level isclose to 90 N or the knee flexion is 30°to recover the affected knee over-restrained 2 mm relative to the healthy knee.Interms of the graft device,the interference screw is still the most commonly used method of tibial-graft fixation,with thedevelopment of all-inside ACL reconstruction in recent years,the cortical button fixation may become the mainstream.Conclusion Arthroscopic reconstruction is the main treatment of ACL rupture at present.However,there is no optimalfixation method for the tibial-graft,the advantages and disadvantages of each fixation methods need to be further studied.

关 键 词：前交叉韧带 膝关节屈曲角 移植物张力 移植物固定 

分 类 号：R687.3[医药卫生—骨科学]