前十字韧带重建术后腱-骨愈合的研究进展

Research advances on tendon-bone healing in anterior cruciate ligament reconstruction

前十字韧带断裂是膝关节常见的运动损伤，断裂后易继发关节不稳致退变加速，并最终导致骨关节炎形成。经过不断地探索和改进，关节镜下肌腱移植物重建前十字韧带是目前处理此类损伤并获得功能康复的主要方法。肌腱重建后的肌腱与骨道之间经过一系列组织结构改建可最终形成完全的腱-骨愈合，其愈合情况受多种因素的影响并最终制约手术的远期疗效。文献报道约有11％～32％的重建手术患者术后疗效不满意，约有10％的患者需再次手术治疗。因此，关于腱-骨愈合的研究一直是运动医学领域的研究热点。现阶段，虽然国内外学者对腱-骨愈合生理学基础、影响及促进因素等方面进行了大量地研究，但对腱-骨基本愈合的过程尚未完全达成共识，且对如何促进腱-骨愈合也见仁见智。通过回顾相关文献，可全面了解腱-骨愈合的基础、影响因素以及促进腱-骨愈合的方法。

Rupture of anterior cruciate ligament （ACL） is a common sports injury. It will cause knee osteoarthritis because of joint instability and acceleration of degenerative changes after injury. Arthroscopic reconstruction with a tendon graft is a com- mon procedure to achieve function recovery. A series of histological changes and structural modification happened between the ten- don and bone tunnel after ACL reconstruction and complete tendon-bone healing was achieved finally. A number of factors affects the healing process which determined the long-term result of the treatment. Published literatures reported that about 11%-32% pa- tients underwent ACL reconstruction were not satisfied with the results and 10% of them required reoperation. Studies on the ten- don-bone healing have long been a research hotspot in sports medicine. Controversy still remains not only on the fundamental heal- ing process but also on the stimulating factors despite of a large amount of researches on its physiological basis, influencing fac- tors, et al. This article provides a review of the basis and influence factors of the healing process, and summarizes the methods to accelerate the process of tendon-bone healing.