Anterolateral rotatory instability in vivo correlates tunnel position after anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft

AIM To quantitatively assess rotatory and anterior-posterior instability in vivo after anterior cruciate ligament(ACL) reconstruction using bone-patellar tendon-bone(BTB) autografts, and to clarify the influence of tunnel positions on the knee stability.METHODS Single-bundle ACL reconstruction with BTB autograft was performed on 50 patients with a mean age of 28 years using the trans-tibial(TT)(n = 20) and trans-portal(TP)(n = 30) techniques. Femoral and tibial tunnel positions were identified from the high-resolution 3 D-CT bone models two weeks after surgery. Anterolateral rotatory translation was examined using a Slocum anterolateral rotatory instability test in open magnetic resonance imaging(MRI) 1.0-1.5 years after surgery, by measuring anterior tibial translation at the medial and lateral compartments on its sagittal images. Anterior-posterior stability was evaluated with a Kneelax3 arthrometer.RESULTS A total of 40 patients(80%) were finally followed up. Femoral tunnel positions were shallower(P < 0.01) and higher(P < 0.001), and tibial tunnel positions were more posterior(P < 0.05) in the TT group compared with the TP group. Anterolateral rotatory translations in reconstructed knees were significantly correlated with the shallow femoral tunnel positions(R = 0.42, P < 0.01), and the rotatory translations were greater in the TT group(3.2 ± 1.6 mm) than in the TP group(2.0 ± 1.8 mm)(P < 0.05). Side-to-side differences of Kneelax3 arthrometer were 1.5 ± 1.3 mm in the TT, and 1.7 ± 1.6 mm in the TP group(N.S.). Lysholm scores, KOOS subscales and reinjury rate showed no difference between the two groups.CONCLUSION Anterolateral rotatory instability significantly correlated shallow femoral tunnel positions after ACL reconstruction using BTB autografts. Clinical outcomes, rotatory and anterior-posterior stability were overall satisfactory in both techniques, but the TT technique located femoral tunnels in shallower and higher positions, and tibial tunnels in more posterior positions than the TP technique, thus increased the anterolateral rotation. Anatomic ACL reconstruction with BTB autografts may restore knee function and stability.

内侧髌股韧带重建的研究进展

髌股关节不稳是一种常见的膝关节损伤,主要见于年轻患者,明显影响患者的日常生活和运动功能。内侧髌股韧带(MPFL)是髌骨内侧限制髌骨外向脱位的主要稳定结构,也是髌骨不稳发生时必然要损坏的结构。因此,通过MPFL重建恢复髌骨的稳定性为必要措施。虽然MPFL重建在临床上应用较为广泛,但部分手术细节,如股骨隧道和髌骨隧道定位、移植物材料选择、移植物固定角度、移植物张力选择等方面是否影响疗效仍存在争议。近年来,生物力学研究和临床研究的不断深入为术式的优化提供了可靠的循证依据。本文笔者将对MPFL重建的研究新进展进行综述。

Degradable magnesium alloy suture promotes fibrocartilaginous interface regeneration in a rat rotator cuff transosseous repair model

Despite transosseous rotator cuff tear repair using sutures is widely accepted for tendon-bone fixation,the fibrocartilaginous enthesis regeneration is still hardly achieved with the traditional sutures.In the present work,degradable magnesium(Mg)alloy wire was applied to suture supraspinatus tendon in a rat acute rotator cuff tear model with Vicryl Plus 4±0 absorbable suture as control.The shoulder joint humerus-supraspinatus tendon complex specimens were retrieved at 4,8,and 12 weeks after operation.The Mg alloy suture groups showed better biomechanical properties in terms of ultimate load to failure.Gross observation showed that hyperplastic response of the scar tissue at the tendon-bone interface is progressively alleviated over time in the both Mg alloy suture and Vicryl suture groups.In the histological analysis,for Mg alloy suture groups,chondrocytes appear to proliferate at 4 weeks postoperatively,and the tendon-bone interface showed an orderly structural transition zone at 8 weeks postoperatively.The collagenous fiber tended to be aligned and the tendon-bone interlocking structures apparently formed,where transitional structure from unmineralized fibrocartilage to mineralized fibrocartilage was closer to the native fibrocartilaginous enthesis.In vivo degradation of the magnesium alloy wire was completed within 12 weeks.The results indicated that Mg alloy wire was promising as degradable suture with the potential to promotes fibrocartilaginous interface regeneration in rotator cuff repair.

Canine ACL reconstruction with an injectable hydroxyapatite/collagen paste for accelerated healing of tendon-bone interface

Healing of an anterior cruciate ligament(ACL)autologous graft in a bone tunnel occurs through the formation of fibrovascular scar tissue,which is structurally and compositionally inferior to normal fibrocartilaginous insertion and thus may increase the reconstruction failure and the rate of failure recurrence.In this study,an injectable hydroxyapatite/type I collagen(HAp/Col I)paste was developed to construct a suitable local microenvironment to accelerate the healing of bone-tendon interface.Physicochemical characterization demonstrated that the HAp/Col I paste was injectable,uniform and stable.The in vitro cell culture illustrated that the paste could promote MC3T3-E1 cells proliferation and osteogenic expression.The results of a canine ACL reconstruction study showed that the reconstructive ACL had similar texture and color as the native ACL.The average width of the tunnel,total bone volume,bone volume/tissue volume and trabecular number acquired from micro-CT analysis suggested that the healing of tendon-bone interface in experimental group was better than that in control group.The biomechanical test showed the maximal loads in experimental group achieved approximately half of native ACL’s maximal load at 24 weeks.According to histological examination,Sharpey fibers could be observed as early as 12 weeks postoperatively while a typical four-layer transitional structure of insertion site was regenerated at 48 weeks in the experimental group.The injectable HAp/Col I paste provided a biomimetic scaffold and microenvironment for early cell attachment and proliferation,further osteogenic expression and extracellular matrix deposition,and in vivo structural and functional regeneration of the tendon-bone interface.

Nano-calcium silicate mineralized fish scale scaffolds for enhancing tendon-bone healing

Tendon-bone healing is essential for an effective rotator cuff tendon repair surgery,however,this remains a significant challenge due to the lack of biomaterials with high strength and bioactivity.Inspired by the high-performance exoskeleton of natural organisms,we set out to apply natural fish scale(FS)modified by calcium silicate nanoparticles(CS NPs)as a new biomaterial(CS-FS)to overcome the challenge.Benefit from its“Bouligand”microstructure,such FS-based scaffold maintained excellent tensile strength(125.05 MPa)and toughness(14.16 MJ/m^(3)),which are 1.93 and 2.72 times that of natural tendon respectively,allowing it to well meet the requirements for rotator cuff tendon repair.Additionally,CS-FS showed diverse bioactivities by stimulating the differentiation and phenotypic maintenance of multiple types of cells participated into the composition of tendon-bone junction,(e.g.bone marrow mesenchymal stem cells(BMSCs),chondrocyte,and tendon stem/progenitor cells(TSPCs)).In both rat and rabbit rotator cuff tear(RCT)models,CS-FS played a key role in the tendon-bone interface regeneration and biomechanical function,which may be achieved by activating BMP-2/Smad/Runx2 pathway in BMSCs.Therefore,natural fish scale-based biomaterials are the promising candidate for clinical tendon repair due to their outstanding strength and bioactivity.

Biological approaches to the repair and regeneration of the rotator cuff tendon-bone enthesis:a literature review

Entheses are highly specialised organs connecting ligaments and tendons to bones,facilitating force transmission,and providing mechanical strengths to absorb forces encountered.Two types of entheses,fibrocartilaginous and fibrous,exist in interfaces.The gradual fibrocartilaginous type is in rotator cuff tendons and is more frequently injured due to the poor healing capacity that leads to loss of the original structural and biomechanical properties and is attributed to the high prevalence of retears.Fluctuating methodologies and outcomes of biological approaches are challenges to overcome for them to be routinely used in clinics.Therefore,stratifying the existing literature according to different categories(chronicity,extent of tear,and studied population)would effectively guide repair approaches.This literature review supports tissue engineering approaches to promote rotator cuff enthesis healing employing cells,growth factors,and scaffolds period.Outcomes suggest its promising role in animal studies as well as some clinical trials and that combination therapies are more beneficial than individualized ones.It then highlights the importance of tailoring interventions according to the tear extent,chronicity,and the population being treated.Contributing factors such as loading,deficiencies,and lifestyle habits should also be taken into consideration.Optimum results can be achieved if biological,mechanical,and environmental factors are approached.It is challenging to determine whether variations are due to the interventions themselves,the animal models,loading regimen,materials,or tear mechanisms.Future research should focus on tailoring interventions for different categories to formulate protocols,which would best guide regenerative medicine decision making.

Bone marrow mesenchymal stem cell-derived exosomal microRNAs target PI3K/Akt signaling pathway to promote the activation of fibroblasts

BACKGROUND Fibroblast plays a major role in tendon-bone healing.Exosomes derived from bone marrow mesenchymal stem cells(BMSCs)can activate fibroblasts and promote tendon-bone healing via the contained microRNAs(miRNAs).However,the underlying mechanism is not comprehensively understood.Herein,this study aimed to identify overlapped BMSC-derived exosomal miRNAs in three GSE datasets,and to verify their effects as well as mechanisms on fibroblasts.AIM To identify overlapped BMSC-derived exosomal miRNAs in three GSE datasets and verify their effects as well as mechanisms on fibroblasts.METHODS BMSC-derived exosomal miRNAs data(GSE71241,GSE153752,and GSE85341)were downloaded from the Gene Expression Omnibus(GEO)database.The candidate miRNAs were obtained by the intersection of three data sets.TargetScan was used to predict potential target genes for the candidate miRNAs.Functional and pathway analyses were conducted using the Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)databases,respectively,by processing data with the Metascape.Highly interconnected genes in the protein-protein interaction(PPI)network were analyzed using Cytoscape software.Bromodeoxyuridine,wound healing assay,collagen contraction assay and the expression of COL I andα-smooth muscle actin positive were applied to investigate the cell proliferation,migration and collagen synthesis.Quantitative real-time reverse transcription polymerase chain reaction was applied to determine the cell fibroblastic,tenogenic,and chondrogenic potential.RESULTS Bioinformatics analyses found two BMSC-derived exosomal miRNAs,has-miR-144-3p and hasmiR-23b-3p,were overlapped in three GSE datasets.PPI network analysis and functional enrichment analyses in the GO and KEGG databases indicated that both miRNAs regulated the PI3K/Akt signaling pathway by targeting phosphatase and tensin homolog(PTEN).In vitro experiments confirmed that miR-144-3p and miR-23b-3p stimulated proliferation,migration and collagen synthesis of NIH3T3 fibroblasts.Interfering with PTEN affected the phosphorylation of Akt and thus activated fibroblasts.Inhibition of PTEN also promoted the fibroblastic,tenogenic,and chondrogenic potential of NIH3T3 fibroblasts.CONCLUSION BMSC-derived exosomes promote fibroblast activation possibly through the PTEN and PI3K/Akt signaling pathways,which may serve as potential targets to further promote tendon-bone healing.

关节镜下同种异体骨-髌腱-骨双束重建膝关节前交叉韧带的临床比较研究

目的探讨关节镜下同种异体骨-髌腱-骨(bone-patellar tendon-bone,BPTB)移植物双束重建膝关节前交叉韧带(anterior cruciate ligament,ACL)的中期临床效果。方法 2003年7月～2007年7月,61例ACL断裂患者接受关节镜下BPTB重建ACL手术,按术式和移植物分为3组:异体BPTB双束组(20例),异体BPTB单束组(21例),自体BPTB单束组(20例)。3组平均随访时间分别为(41.6±3.0)、(42.3±3.9)、(42.5±2.7)月。通过膝关节查体、IKDC2000主观评分、Lysholm评分、Tegner评分、膝前痛、常规KT-2000、后推KT-2000及Biodex等速肌力测试系统评估手术效果。结果 3组间的IKDC2000、Lysholm、Tegner评分、大腿围度差值、肌力和常规KT-2000等指标差异无显著性(P>0.05)。异体双束组的Pivotshift阳性发生率(5%,1/20)是异体单束组的1/6(29%,6/21),自体单束组的1/4(20%,4/20)。异体双束组的后推KT-200030°位前移度(中位数15磅0.5 mm,20磅0.5 mm,30磅0.9 mm)明显低于其他两组(P<0.05)。异体双束组(15%,3/20)和异体单束组(10%,2/21)的膝前痛发生率明显低于自体单束组(75%,15/20)(χ2=24.201,P=0.000)。结论同种异体BPTB双束重建ACL能够更好地恢复膝关节整体前向及旋转稳定性,减少并发症,可以作为髁间窝较宽的患者ACL初次解剖重建的理想手术方法。

同种异体肌腱重建膝关节前交叉韧带的研究进展与临床应用

背景:同种异体移植物在膝关节前交叉韧带重建的相关基础及临床实践中有着积极的推动作用与重要地位。目的:归纳总结近年来同种异体移植物在膝关节前交叉韧带重建中的应用及研究进展。方法:以"allograft tends OR allografts、intra-articular knee ligament OR anterior cruciate ligament OR ACL"为检索词,检索2012年1月至2018年2月PubMed、Embase等数据库中发表的相关文献,语言设定为英文。结果与结论:国内膝关节前交叉韧带重建使用同种异体肌腱的相关研究目前仍处在发展阶段。目前,对于前交叉韧带重建中使用同种异体移植物或自体移植物的优劣暂无定论。对于选择同种异体移植物的担忧主要来源于可能存在感染及愈合缓慢等问题。对于同种异体移植及自体移植术后效果比较,不同试验得出的结果差异较大。所反映出的结论大致为:2种移植物术后患者膝关节功能无差异,或自体移植后患者膝关节功能较好。有研究表明,同种异体移植物可能会增高二次手术的风险。因此,同种异体肌腱在膝关节前交叉韧带重建的临床应用中面临着诸多挑战。

自体与同种异体骨-髌腱-骨重建前交叉韧带术后胫骨骨隧道演变过程的MRI对比研究

目的 利用MRI比较自体与同种异体骨 髌腱 骨(bone patellartendon bone ,B PT B)重建前交叉韧带(anteriorcruciateligament ,ACL)术后胫骨骨隧道的变化过程。方法 将5 0例B PT B重建ACL患者,分成A、B两组,A组为自体组2 0例,B组为同种异体组3 0例。分别于术后1、6周、3～4、5～6、7～8、9～10、12～13、15～16、18～19、2 1～2 2个月进行磁共振(magneticresonanceimage ,MRI)检查,采用胫骨骨隧道斜轴状位扫描技术,扫描序列包括:T1WI、T2WI、GE T1WI、GE STIR。动态观察骨隧道内的MRI信号变化,并比较术后6周、3～4、5～6个月骨隧道扩大情况。结果 术后6周骨隧道扩大增幅最为显著(P <0 0 5 )。术后3个时间段上比较两组骨隧道扩大程度均无显著性差异(P >0 0 5 )。MRI动态观察发现,A组术后5～8个月,移植物与骨隧道之间已发生骨性愈合;而B组将延迟到术后7～13个月。结论 MRI是准确评价骨隧道的一种无创手段;同种异体B PT B在胫骨骨隧道内的愈合相对延迟;自体组与同种异体组术后胫骨骨隧道扩大的程度基本相当。

同种异体骨-髌腱-骨组织移植重建前交叉韧带36例临床分析

目的：回顾性研究并评估采用同种异体骨-髌腱-骨组织移植重建前交叉韧带患者的临床疗效。方法：从2004年12月至2006年8月,对36例ACL损伤病例进行了同种异体骨-髌腱-骨组织移植重建。男性16例,女性20例;平均年龄28岁（15~56岁）;急性损伤11例,慢性损伤25例。对所有患者进行了主观评估（包括手术前后Lysholm评分、IKDC评分和症状改善情况）和客观评估（包括Lachman试验、轴移试验、KT-1000测量,以及关节活动范围）,并对比了患者术前以及术后的MR影像和关节镜手术探查影像,还对术后发热情况以及并发症进行了记录。结果：本组病例平均随访23.6个月（12~32个月）。主观评估：术前Lyshrolm评分为63.61±13.4分（46~90分）,术后最终评分为98.03±3.6分（85~100分）,与术前对比差异有统计学意义（P〈0.01）;术后IKDC评分总体优良率达到91.7%。客观评估：KT-1000测量结果：术前两侧胫骨前移的差别为7.05±2.15mm（2-11mm）,术后最终测量值为1.15±1.43mm（0-6mm）,与术前对比差异有统计学意义（P〈0.01）。所有患者均未出现明显的术后并发症以及病毒和细菌感染。1例患者移植物松弛度增加,给予固缩治疗后好转。另1例部分韧带磨损,但主观评估良好,给予清创和髁间窝成形术处理。结论：短期观察显示,采用同种异体骨-髌腱-骨组织移植重建ACL能够获得满意的临床疗效,具备有效性和安全性。

关节镜下单隧道单束与三隧道双束不同植入物重建前交叉韧带:膝关节稳定性及活动功能

背景:课题组设计关节镜下三隧道Femoral-Intrafix固定双束重建前交叉韧带,目的是恢复膝关节的旋转稳定性和前交叉韧带的功能,但是其临床效果尚未得到证实。目的:评价关节镜下单隧道单束和三隧道Femoral-Intrafix固定双束重建后膝关节功能恢复的情况。方法:回顾性分析2013年6月至2015年6月60例前交叉韧带损伤患者的临床资料,移植物均使用自体腘绳肌腱,其中30例采用单隧道单束重建,股骨端采用endobutton式纽扣悬吊固定,胫骨端采用Milagro界面螺钉挤压固定;30例采用三隧道Femoral-Intrafix固定双束重建,股骨端采用Femoral Intrafix固定系统进行单隧道双束固定,胫骨端采用Milagro界面螺钉双隧道挤压固定。记录2组患者围手术期的指标;重建前及末次随访时进行前抽屉试验,Lachman征检查,轴移试验,Lysholm评分和IKDC评分以评估2组前交叉韧带功能恢复情况。结果与结论:(1)所有患者均获得随访,单隧道单束重建及三隧道双束重建组随访时间分别为(25±4),(28±3)个月;(2)2组患者重建后均无螺钉脱落、深静脉血栓形成、重建韧带再断裂及关节内感染现象;(3)2组患者末次随访时关节活动达到正常范围,前抽屉试验阳性率、Lachman征阳性率、轴移试验阳性率较重建前均明显降低(P<0.05);三隧道双束重建组末次随访时轴移试验阳性率显著低于单隧道单束重建组(P<0.05);(4)2组患者末次随访时Lysholm评分和IKDC评分均较重建前明显提高(P<0.05),且末次随访时2组间患者膝关节Lysholm评分、IKDC评分比较无显著性意义(P>0.05);(5)结果提示,关节镜下前交叉韧带单隧道单束和三隧道Femoral-Intrafix固定双束重建前交叉韧带的近期临床疗效满意,均能显著改善患者膝关节的稳定性及活动功能,但三隧道Femoral-Intrafix固定双束重建前交叉韧带后能更好恢复膝关节的旋转稳定性。

带骨瓣的髌腱中1/3重建前交叉韧带

目的 评价带骨瓣的髌腱中 1/ 3重建前交叉韧带的效果。方法 1994年 4月～ 1996年 8月 ,共利用带骨瓣的自体髌腱中 1/ 3重建前交叉韧带 8例。结果 8例均获得 5个月～ 3年随访 ,平均 2 6个月。优 4例 ,良 3例 ,可 1例。术前 5例有明显膝关节不稳定感 ,术后均消失 ;术前 8例均存在 L anchman试验或 /和前抽屉试验阳性 ,术后有 1例呈前抽屉试验阳性 ;所有患者均能基本满足日常生活要求 ,1例仍残存膝关节疼痛。 3例术后存在不同程度的膝关节僵直 ,经过 CPM康复训练后膝关节屈伸活动度可达 0°～ 90°以上。结论 带骨瓣的髌腱中 1/ 3重建前交叉韧带是恢复膝关节功能的理想方法。

深低温处理对异种骨-髌腱-骨移植排斥反应的影响

目的:观察深低温处理对异种骨-髌腱-骨(BPB)移植排斥反应的影响。方法:采用大鼠股部肌袋模型法探讨深低温处理对异种BPB移植免疫反应的影响,通过观察外周血T细胞活化和植入物组织形态学变化情况来判定免疫反应程度。结果:新鲜未处理异种BPB移植后3 d CD4+/CD8+细胞CD25+表达率即显著升高,与自体移植组比较有显著差异(P<0.05),术后14 d达高峰,且维持该峰值至术后35 d仍无下降;深低温处理的异种BPB移植后CD4+/CD8+细胞CD25+的表达明显受到抑制,表达时间推迟,至术后14 d才有轻度升高,术后3 d起各时点与未处理组比较,均P<0.05。组织学检查发现,深低温处理组骨、腱组织周围见少量淋巴细胞浸润,但未侵入组织内,无组织坏死,腱束结构清楚,胶原排列规则;新鲜异种移植组可见大量斑片状淋巴细胞弥漫性浸润骨及胶原组织周围及其中,可见骨碎片,腱结构不清,胶原排列紊乱,部分切片可见较多的嗜酸性粒细胞和多核巨细胞等炎症细胞。结论:深低温处理能显著降低异种BPB免疫原性,抑制排斥反应发生。

关节镜下膝交叉韧带重建中自体与异体肌腱移植物的疗效比较

背景:国内多数研究表明异体与自体肌腱重建交叉韧带的疗效相近,均是良好的移植物,近期疗效满意。目的:比较自体与异体肌腱移植物在关节镜下膝交叉韧带重建中的临床疗效。方法:将100例膝关节交叉韧带断裂患者随机分2组,每组50例,均在关节镜下进行交叉韧带重建手术,自体肌腱组移植物采用自体肌腱,异体肌腱组移植物采用同种异体肌腱。比较两组患者治疗前和出院时的关节稳定性及活动度;出院后1,3,6,9个月,随访观察两组肌力恢复程度、Werner髌股痛评分及Lysholm评分。结果与结论:①关节稳定性:两组出院时的的Lachman试验阳性率、轴移试验阳性率均较治疗前明显改善(P<0.05);出院时,两组Lachman试验阳性率、轴移试验阳性率比较差异均无显著性意义;②关节活动度:治疗后,两组关节伸直活动度、屈曲活动度比较差异均无显著性意义;③随访情况:两组治疗后不同时间点的肌力恢复程度、Werner髌股痛评分及Lysholm评分均较治疗明显改善(P<0.05);出院后1,3,6,9个月,两组间各指标比较差异均无显著性意义;④结果表明:自体与异体肌腱移植物在关节镜下膝交叉韧带重建中均能够明显改善患者关节稳定性和活动度,具有较好的近期临床疗效。

自体骨髌腱骨和腘绳肌腱重建前交叉韧带疗效的Meta分析

目的通过Meta分析来比较自体骨髌腱骨和腘绳肌腱重建前交叉韧带的疗效。方法资料来源Medline,Cochrane图书馆和中国知网,检索1999年至2009年关于前交叉韧带断裂使用自体骨髌腱骨和腘绳肌腱治疗的文献,采用Meta分析的方法,运用RevMan4.2软件进行数据处理,对术后膝关节的体格检查和膝关节功能进行综合分析。结果 15篇文献入选本研究,轴移试验阳性的OR值为1.39[95%C(I0.82～2.36),P=0.23],Lachman试验阳性的OR值为1.30[95%C(I0.90～1.88),P=0.17],膝前疼痛的OR值为0.43[95%C(I0.30～0.61),P=0.000],伸膝受限(>5°)的OR值为0.44[95%CI(0.24～0.79),P=0.007]。结论腘绳肌腱重建前交叉韧带术后膝关节出现疼痛和伸膝受限的发病率低于骨髌腱骨,而膝关节稳定性方面二者没有显著的差别。

MRI评价自体骨-髌韧带-骨与股四头肌腱行前交叉韧带重建后移植物成熟度及膝关节的功能

背景:前交叉韧带重建术中一般采用自体骨-髌韧带-骨、股四头肌腱或腘绳肌肌腱作为移植物,其中关节内移植物的成熟度是前交叉韧带重建后恢复患者运动的关键。目的:分析使用自体骨-髌韧带-骨与自体股四头肌腱行前交叉韧带重建后的移植物成熟度及患者膝关节功能差异。方法:选择2018年6月至2020年1月在佛山市中医院行前交叉韧带重建术的患者60例,其中男50例,女10例,年龄17-42岁,韧带重建使用自体骨-髌韧带-骨移植物者27例,使用自体股四头肌腱移植物者33例。韧带重建后3,6,12个月,比较两组移植物股骨端、中段、胫骨端3个区域的MRI信噪比;比较两组患者国际膝关节评分委员会膝关节评估量表(IKDC)评分、Lysholm主观评分及双侧膝关节KT-1000差值;对比两组患者韧带重建后12个月的膝关节步态差异。研究获得佛山市中医院医学伦理委员会批准,批准号:2018003。结果与结论:(1)韧带重建后3,6,12个月,两组间移植物股骨端、中段的MRI信噪比比较差异无显著性意义(P>0.05),股四头肌腱组移植物胫骨端MRI信噪比高于骨-髌韧带-骨组(P>0.05);(2)韧带重建后3,6,12个月,两组间的IKDC评分Lysholm主观评分及双侧膝关节KT-1000差值比较差异无显著性意义(P>0.05);(3)韧带重建后12个月,两组患者膝关节步态分析比较差异无显著性意义(P>0.05);(4)结果表明,使用自体骨-髌韧带-骨移植物行前交叉韧带重建后的移植物成熟度优于自体股四头肌腱,但成熟度不同并不影响患者韧带重建后的功能恢复。

人体骨-髌腱-骨及半月板移植物浸提液的细胞毒性研究

目的:探讨ACL重建及半月板修复所用异体移植物的组织安全性。方法:分别以不同浓度梯度人体骨-髌腱-骨和半月板移植物浸提液培养NIH3T3细胞,光镜下观察细胞形态,MTT法检测受试物中存活细胞百分比,其结果与DMEM培养液(阴性对照组)及苯酚(阳性对照组)中存活细胞百分比进行比较。结果:光镜下各种浓度移植物浸提液培养的细胞形态均正常,存活率均大于97%,明显优于阳性对照组。结论:本实验中人体骨-髌腱-骨和半月板移植物未见细胞毒性。

股四头肌与骨-髌腱-骨自体移植对前交叉韧带重建的Meta分析

目的:通过Meta分析比较股四头肌与骨-髌腱-骨自体移植对前交叉韧带重建手术疗效的影响。方法:计算机检索建库至2019年5月PubMed、EMbase、Cochrane图书馆、万方数据库和中国知网发表的比较股四头肌、骨-髌腱-骨自体移植物的病例对照研究文献,根据纳入与排除标准进行文献筛选、质量评价及数据提取,采用Review Manager 5.3统计学软件对患膝与健膝前向移位差值、Lachman试验、轴移试验、Lysholm评分、IKDC(International Knee Documentation Committee)客观等级、膝前疼痛和移植失败率进行Meta分析。结果:共纳入6篇文献,915例患者,其中股四头肌自体移植495例,骨-髌腱-骨自体移植420例。Meta分析结果显示:股四头肌自体移植与骨-髌腱-骨自体移植在胫骨向前移位差值>3 mm[OR=1.53,95%CI(0.68,3.44),P=0.31],3~5 mm[OR=0.64,95%CI(0.31,1.35),P=0.24],>5 mm[OR=1.18,95%CI(0.33,4.22),P=0.80],Lachman试验阴性率[OR=0.88,95%CI(0.38,2.02),P=0.76],轴移试验阴性率[OR=0.63,95%CI(0.24,1.68),P=0.36]方面比较差异无统计学意义。两组在Lyshlom评分[MD=-0.56,95%CI(-2.00,0.89),P=0.45],IKDC客观等级A或B级[OR=0.87,95%CI(0.47,1.60),P=0.66]及移植失败率[OR=0.76,95%CI(0.28,2.02),P=0.58]方面比较差异无统计学意义;在减少膝前疼痛方面,股四头肌自体移植优于骨-髌腱-骨自体移植[OR=0.16,95%CI(0.09,0.29),P<0.00001]。结论:股四头肌自体移植的临床和功能结果以及移植物存活率与骨-髌腱-骨自体移植相当,且股四头肌自体移植可以明显减少膝前疼痛。对于前交叉韧带重建患者,股四头肌自体移植可作为前交叉韧带重建合适的移植替代物。

早期康复锻炼对ACL重建术后胫骨隧道的影响

目的探讨早期不同康复训练方案对膝关节前交叉韧带(ACL)重建术后胫骨骨道增宽的影响。方法将34例用同种异体骨-髌腱-骨(B-PT-B)重建ACL的患者分为2组,A组16例。男8例,女8例;平均年龄(32.7±15.6)岁。手术采用同种异体B-PT-B重建ACL进行ACL单束重建,术后采用普通的康复方案进行功能康复;B组18例,男8例,女10例;平均年龄(33.1±14.8)岁。手术采用同种异体B-PT-B重建ACL进行ACL单束重建,同时接受半月板缝合修复手术,术后采用保守的康复训练方案进行康复治疗。2组患者均在术后12个月采用CorelDRAW8.0软件对测量X线片上胫骨骨隧道关节面内口的直径;同时采用lysholm评分评价ACL重建术后临床疗效。结果34例同种异体B-PT-B重建ACL患者中有29%(10例)出现胫骨骨隧道的增宽;与术后采用普通的康复方案的A组相比,术后采用保守的康复训练方案进行康复治疗的B组患者骨隧道的增宽程度明显减小。术后12个月A和B组的临床lysholm疗效评分分别为(92.5±4.5)和(94.5±5.5),两组之间的临床疗效差异无显著性,P>0.05。结论早期不同的康复训练方案将影响同种异体B-PT-B重建ACL术后胫骨骨隧道的愈合,但对膝关节的功能恢复影响不大。