内减张技术在辅助前交叉韧带重建中的研究进展

Research progress of internal tension relieving technique in assisting anterior cruciate ligament reconstruction

目的对内减张技术辅助肌腱移植物重建前交叉韧带(anterior cruciate ligament,ACL)的研究进展进行综述。方法广泛查阅近年来国内外关于使用内减张技术辅助ACL重建的体内外生物力学研究、动物实验和临床研究,分析总结该技术对于移植物生物力学、组织学结果以及临床效果的影响。结果基于不可降解高强度缝线带的内减张技术,可通过增强肌腱移植物的体内外生物力学强度,降低其松弛和断裂风险;组织学方面表现出良好的生物相容性,并支持肌腱移植物的术后韧带化和直接腱-骨界面愈合;临床研究显示其改善了术后关节稳定性、活动度和功能评分,配合术后加速康复能促进患者恢复至伤前运动水平,未见严重并发症。结论目前研究结果初步证实了内减张技术辅助肌腱移植物重建ACL的有效性和安全性,具备一定意义和应用前景,但还需要更多研究进一步优化内减张装置性能和相关手术技术,并明确该技术对于移植物结构重塑、生物力学功能以及临床远期效果的具体影响。

Objective To review the research progress of internal tension relieving technique in assisting anterior cruciate ligament(ACL)reconstruction with tendon grafts.Methods The in vivo and in vitro biomechanical tests,animal experiments,and clinical studies on the use of internal tensioning relieving technique assisted ACL reconstruction in recent years were extensively reviewed,the impact of this technology on the biomechanics,histological changes of grafts,and the clinical effectiveness were analyzed and summarized.Results The internal tensioning relieving technique based on non-absorbable high-strength sutures can reduce the risk of relaxation and rupture by enhancing the biomechanical strength of tendon grafts in vitro and in vivo,it shows good biocompatibility and support for the ligamentation of the tendon grafts and the establishment of the direct tendon-bone interface in terms of histology.This technique improves postoperative initial joint stability,range of motion,and functional scores in clinical practic,when combining with the enhanced recovery after surgery can effectively promote patients to return to pre-injury exercise level without serious complications.Conclusion The preliminary research results have confirmed the efficacy and safety of the internal tension relieving technique on assisting ACL reconstruction,then showes some degree of significance and prospect,but more research is needed to further optimize tension-relieving devices and related surgical techniques,and clarify the specific effects of this technique on graft’s structure remodeling,biomechanical function,and long-term clinical results.