前交叉韧带重建术后肌腱移植物成熟度的研究进展

Research progress in tendon graft maturity after anterior cruciate ligament reconstruction

成功的前交叉韧带重建术(ACLR)后移植物在关节内重塑及成熟的过程通常被称为"韧带化",此生物愈合过程是肌腱样移植物逐渐成熟向韧带样移植物转化的过程。ACLR后常运用核磁信噪比评价移植物的成熟度。保留原生前交叉韧带(ACL)残端重建、骨隧道的位置及形态、移植物选择、移植物与骨髓道之间的角度以及移植物远端血运状况是关节内移植物成熟的影响因素。保留腘绳肌腱止点重建ACL、联合细胞学方法、富血小板血浆(PRP)、生长因子以及术后物理治疗和康复训练等方法可促进关节内移植物成熟。目前虽探索出多种方法促进移植物成熟的研究,但多数尚在动物实验阶段,并未在临床推广应用,还需进行长期的研究。

After successful anterior cruciate ligament reconstruction(ACLR) reconstruction, the process of tendon graft remodeling and maturation in the joint is often called "ligamentation". This process of biological healing is the process of tendon-like graft maturing and transforming into ligament-like graft. Magnetic resonance imaging signal-to-noise ratio is often used to evaluate the maturity of the tendon graft after ACLR. Retaining the original anterior cruciate ligament(ACL) stump, the location and shape of bone tunnel, the selection of grafts, the angle between the graft and the bone marrow canal, and the blood supply of the distal part of the graft are the factors affecting the maturation of intra-articular grafts. ACL reconstruction with preservation of hamstring tendon insertion, combined cytology, platelet-rich plasma(PRP), growth factor, post-operative physiotherapy and rehabilitation training can promote the maturation of intra-articular grafts. Although a variety of methods have been explored to promote the research of tendon graft maturity, most of them are still in the animal experiment stage, not in the clinical application, and still need long-term research.