促进前交叉韧带重建腱骨愈合的研究与进展

Research progress in promoting tendon to bone healing during anterior cruciate ligament reconstruction

背景:前交叉韧带损伤及断裂的重要治疗方法是行关节镜下前交叉韧带重建术,术后腱骨愈合的优劣与患者术后早期康复及功能恢复密切相关。尤其是腱骨愈合的时间、牢固程度等方面已经成为了评价前交叉韧带重建疗效的重要指标。目的:对近年来促进前交叉韧带重建术后腱骨愈合的研究进展进行总结并做一综述,希望能对外科医生及相关研究人员以启发,并更好地服务于基础研究及临床工作。方法:以“Anterior cruciate ligament、Tendon bone healing、knee joint、Anterior cruciate ligament reconstruction”为英文检索词,以“前交叉韧带、腱骨愈合、膝关节、前交叉韧带重建”为中文检索词,使用计算机在CNKI、万方数据库、PUBMED、FMRS检索腱骨愈合的相关文章,检索文献时限为2011年1月至2021年12月,并进行系统的归纳、总结和分析,并且讨论研究中存在的不足和未来展望。结果与结论:①随着医疗技术及研究水平的发展,现已经可以从手术方法改进、组织工程技术、术后康复优化等各方面促进前交叉韧带重建术后的腱骨愈合。②但其中一些研究仍可能存在一定的局限性:比如现有很多关于促进腱骨愈合的科研成果仅仅停留在动物实验上,尤其是一些针对于小型动物,如鼠、兔等的实验研究,由于动物体积较小,其生物力学、机体负重等方面与人类存在较大差异,故研究结果是否对人类产生同样的效果,有无远期不良反应,还需要进一步研究。③将多种促进腱骨愈合的方法联合使用时,能否产生协同促进作用,亦或是抑制削弱作用,目前国内外关于这方面的研究仍较少,这或许为腱骨愈合进一步的研究提供了新的思路。

BACKGROUND:Arthroscopic anterior cruciate ligament reconstruction is an important treatment for anterior cruciate ligament injury and fracture.Postoperative tendon to bone healing is closely related to the early postoperative rehabilitation and functional recovery of patients.In particular,the time and firmness of tendon to bone healing have become important indicators to evaluate the efficacy of anterior cruciate ligament reconstruction.OBJECTIVE:To summarize the research progress in promoting tendon to bone healing after anterior cruciate ligament reconstruction in recent years,hoping to inspire surgeons and related researchers and better serve basic research and clinical work.METHODS:Using“anterior cruciate ligament,tendon to bone Healing,knee joint,anterior cruciate ligament reconstruction”as English and Chinese search terms,related articles regarding tendon to bone healing were searched by computer in CNKI,WanFang Database,PubMed,and FMRS.The time period of literature retrieval was from January 2011 to December 2021,and systematic generalization,summary and analysis were conducted.The shortcomings and future prospects of the research are also discussed.RESULTS AND CONCLUSION:With the development of medical technology and research level,tendon to bone healing after anterior cruciate ligament reconstruction can be promoted from various aspects such as surgical method improvement,tissue engineering technology and postoperative rehabilitation optimization.However,there are also some limitations,such as a lot of research achievements to promote tendon to bone healing only stay on the animal experiment,especially the experiments of small animals(rat and rabbit).These animals are small in size and extremely different from humans in terms of biological mechanics and body mass;therefore,further research is required to explore whether these study results have the same effect in humans and whether there are long-term adverse reactions or not.There are still few studies on whether the combination of various methods to promote tendon to bone healing can produce a synergistic effect or an inhibitory effect,which may provide new ideas for further research on tendon to bone healing.