自体Hamstring腱重建前交叉韧带术后关节镜下再视观察

Second-look arthroscopy following anterior cruciate ligament reconstruction with a hamstring tendon autograft

目的关节镜再视观察游离Hamstring腱重建前交叉韧带后在体内重塑与转归过程.方法关节镜下再视手术,观察关节镜下自体同侧游离Hamstring腱重建前交叉韧带33例.重建术至再视手术时间为2～36个月,平均11.9月.依据重建术至再视术的时间,替代腱按时段分组:1月～,4月～,7月～,10月～,13月～,18月～和25月～组.再视术重点观察评估了移植的Hamstring腱形状、色泽、张力、覆盖的滑漠组织和血管状况.结果再视关节镜下重建前交叉韧带的Hamstring腱随植入时间延长,其形态逐步向正常前交叉韧带重塑与转归;7月～组和此后各组的替代腱在关节镜视下表现为.一种几乎无滑膜和血管的灰白色粗壮的圆柱体,类似于正常的前交叉韧带组织,达到了在体内成熟的程度.结论自体游离多股Hamstring腱重建前交叉韧带术后具有良好早期存活,快速再血管化和重塑过程,其术后的重塑与成熟过程与自体髌腱的过程相似,但其在体内重塑与转归进程相对较快.

Objective To arthroscopically re - observe the remodeling and maturity process following anterior cruciate ligament （ACL） reconstruction with a hamstring tendon autograft. Methods Thirty - three patients who had undergone a previous arthroscopic ACL reconstruction with a homolateral hamstring autograft were given a second observation under arthroscope. The interval from initial reconstruction to second- look arthroscopy ranged 2 -36 months （mean, 11.9 months）. According to different intervals, the patients were grouped as 1 - , 4 - , 7 - , 10 - , 13 - , 18 - , and 25 - months. The shape, color, tension, covering synovial tissue, and vascularity of the grafts were evaluated. Results As the interval increased, the hamstring grafts tended to progress to normal ACL morphologically. Under arthroscopic observation, the tendon grafts were characterized as grayish - white thick ligamentous tissues without synovial membrane and blood vessels after 7 months following initial reconstruction, which corresponded with the maturation period of autogenous grafts and simulated normal ACL. Conclusions Remodeling and maturation of the hamstring autografts progresses with time. which is comparable to patellar tendon autografts.