前十字韧带重建术后骨隧道扩大的原因及应对研究进展  

Progress on the causes and management of bone tunnel enlargement after anterior cruciate ligament reconstruction

作　　者：冯建豪 徐一宏 徐卫东 Feng Jianhao;Xu Yihong;Xu Weidong(Department of Orthopaedics,Tongji Hospital,Tongji University,Shanghai 200065,China;Department of Joint Surgery,First Affili ated Hospital of Naval Medical University(Shanghai Changhai Hospital),Shanghai 200433,China)

机构地区：[1]同济大学附属同济医院骨科,上海200065 [2]海军军医大学第一附属医院(上海长海医院)关节骨病外科,上海200433

出　　处：《中华骨科杂志》2023年第18期1241-1247,共7页Chinese Journal of Orthopaedics

基　　金：海军军医大学第一附属医院"十四五"学科固海计划(GH145-16)。

摘　　要：前十字韧带(anterior cruciate ligament, ACL)损伤是膝关节常见的运动性损伤, 可导致膝关节不稳定、运动障碍及继发创伤性骨关节炎, 严重影响患者生活质量。由于ACL损伤后难以自愈, 临床上通常采用关节镜下ACL重建的方式治疗, 以恢复膝关节稳定性与运动功能。但越来越多的研究发现ACL重建后普遍存在骨隧道扩大的现象。多种生物学(如免疫排斥、局部炎症)和机械性(如骨隧道定位偏移、移植物固定不当和激进康复等)因素被认为是引起骨隧道扩大的主要原因。目前针对骨隧道扩大是否会影响临床疗效尚存争议, 但多数学者认为骨隧道扩大不利于翻修术中骨隧道的制作和移植物的固定。因此, 最大限度地降低术后骨隧道扩大具有积极的临床意义。现有方法主要包括选择自体移植物、使用独立骨道定位技术、改良骨隧道钻取方式、采用保残重建与全内重建、制定渐进性的个体化康复方案以及通过富血小板血浆、自体骨膜包裹移植物等生物方法增强移植物的腱-骨愈合。本文通过对ACL重建术后骨隧道扩大的原因及应对措施进行综述, 以期为减少或避免术后骨隧道扩大提供理论依据与帮助。Anterior cruciate ligament(ACL)injury is a common sports injury of the knee joint,which can lead to knee instability,dyskinesia and secondary traumatic osteoarthritis,which seriously affects the quality of life of patients.As it is difficult to self-heal after ACL injury,arthroscopic ACL reconstruction is commonly used as a clinical treatment to restore knee stability and motion function.However,more and more studies have found that bone tunnel enlargement is common after ACL reconstruction.A variety of biological(such as immunological rejection,local inflammation)and mechanical(such as offset bone tunnel positioning,improper graft fixation,and aggressive rehabilitation)factors are considered to be important causes of bone tunnel enlargement.It is still controversial whether the enlargement of bone tunnels affects clinical outcomes,but most researchers believe that the enlargement of bone tunnels is detrimental to the creation of bone tunnels and the fixation of grafts in revision surgery.Therefore,minimizing postoperative bone tunnel enlargement has positive clinical implications.The existing methods mainly include the selection of autografts,the use of independent bone tunnel positioning technology,modified bone tunnel drilling method,the use of remnant preservation technique and all-inside technique,the development of progressive individualized rehabilitation programs,and biological methods such as platelet-rich plasma and autogenous periosteum wrapping graft to enhance graft tendon-bone healing.This article reviews the causes and countermeasures of bone tunnel enlargement after ACL reconstruction to provide theoretical basis and help reduce or avoid bone tunnel enlargement after ACL reconstruction.

关 键 词：膝关节 前交叉韧带重建 关节镜检查 综述 

分 类 号：R687.4[医药卫生—骨科学]