关节镜下髋臼盂唇重建的移植物选择

Graft selection for acetabular labrum reconstruction under arthroscopy

背景:目前髋臼盂唇损伤的手术治疗方法包括清创、修复、再固定以及髋臼盂唇重建。盂唇重建是最近兴起的一种手术方式,采用自体或异体移植物进行修补盂唇缺损,目前用于修补的移植物选择有很多,其近期的随访也表明该方法可以很好地恢复盂唇结构和功能,而且与清创切除、修复等方法相比具有一定的优势,但还没有证据表明重建的长期效果如何,哪种情况、哪种移植物更适合。目的:综述关节镜下髋臼盂唇重建的移植物选择。方法:在PubMed、GeenMedica等数据库中检索2000至2019年发表与髋臼盂唇重建相关的文献,关键词为“labrum,reconstruction,graft,hip,acetabulum”,尤以近10年文章为主。结果与结论:①目前用于修补髋臼盂唇的移植物有很多,包括自体移植物(髂胫束、股薄肌和半腱肌、股四头肌肌腱、股直肌肌腱、关节囊)和同种异体移植物(腓骨短肌、阔筋膜张肌),其近期的随访表明这些移植物可以很好地恢复盂唇结构,使髋关节恢复运动;②但作为一种新兴手术方式,所以目前缺乏长期随访和前瞻性比较研究来证明髋臼盂唇重建的长期效果如何,哪种情况、哪种移植物更适合;③在今后的研究中,需要对不同移植物的中远期疗效进行比较,以供临床选择。而且随着科学技术的发展,人工复合材料的问题不断得以解决,也将成为更有前景的替代物。

BACKGROUND:Currently,surgical treatment for acetabular labrum injury includes debridement,repair,refixation and acetabular labrum reconstruction.Labrum reconstruction is a newly developed surgical method,which uses autograft or allograft to repair labrum defect.At present,there are many options for graft repair,and the recent follow-up shows that this method can well restore the structure and function of the labrum,and has certain advantages over debridement,excision,and repair.However,no study has shown the long-term effect of reconstruction,and which situation and which graft are more suitable.OBJECTIVE:To review graft selection of acetabular labrum reconstruction under arthroscopy.METHODS:PubMed and GeenMedica databases were retrieved for studies on acetabular labrum reconstruction published from 2000 to 2019,especially in the past 10 years.The key words were“labrum,reconstruction,graft,hip,acetabulum”.RESULTS AND CONCLUSION:(1)There are a number of options for graft repair,including autograft(iliotibial band,gracilis and semitendinosus,quadriceps tendon,rectus femoris tendon,joint capsule)and allograft(peroneus brevis,tensor fascia lata).Recent follow-up shows that these grafts can restore labrum structures and hip movement.(2)However,as an emerging surgical procedure,there is currently a lack of long-term follow-up and prospective comparative studies to prove the long-term effects of reconstruction and prove which grafts are more suitable in which conditions.(3)In future studies,we need to compare the medium and long-term efficacy of different grafts for clinical selection.With the development of science and technology,the problem of artificial composite materials has been solved,and will become a more promising alternative.