摘要
学术背景:前交叉韧带重建是前交叉韧带损伤的主要治疗方案,近年来,应用腘绳肌肌腱重建前交叉韧带的研究进展迅速。目的:总结前交叉韧带的解剖学、生物力学和重建手术方式,以及应用腘绳肌肌腱重建前交叉韧带的相关进展。检索策略:应用计算机检索PubMed数据库1990-01/2007-10与应用腘绳肌肌腱重建前交叉韧带相关的文章,检索词"anterior cruciate ligament,hamstring tendons,reconstruction,tendon regeneration,bone tunnel enlargement",限定文献语言种类为English。初检索到文献92篇,阅读标题和摘要进行初筛,纳入标准:有关应用腘绳肌肌腱重建前交叉韧带的文章,排除因研究目的与本研究无关者和内容重复性的研究,最后共纳入文章42篇,来源于动物实验2篇,系统评价/Meta分析2篇,临床研究38篇。文献评价:其中22个实验研究了前交叉韧带的解剖、生物力学、重建手术方式和临床结果;9个实验研究了前交叉韧带重建后的骨隧道扩大问题;11个实验研究了腘绳肌肌腱取材后的再生问题。资料综合:随着对前交叉韧带双束解剖和生物力学认识的深入,以及单束重建对旋转稳定性控制不良,对前交叉韧带重建技术提出了更高的要求,应用腘绳肌肌腱双束重建前交叉韧带成为主流术式。前交叉韧带重建术后骨隧道的扩大是多因素的生物学和生物力学过程,可能导致重建术后初始稳定性下降和翻修手术中移植物的固定出现严重问题。双束前交叉韧带重建的首选移植物--腘绳肌肌腱,在取材后大部分可以出现再生,并能部分恢复功能,更加增加了骨科医生利用它作为前交叉韧带重建移植物的兴趣。前交叉韧带重建术后骨隧道的扩大仍然是一个值得关注的重要问题。结论:前交叉韧带双束的解剖和生物力学研究为手术方案的改进奠定了基础,双束重建前交叉韧带对膝关节旋转稳定性具有更好的控制。
BACKGROUND： Anterior cruciate ligament reconstruction is the major treatment for anterior cruciate ligament injury. Studies on anterior cruciate ligament reconstruction with hamstring tendons developed rapidly.
OBJECTIVE： To summarize anatomy, biodynamics and surgery approaches of anterior cruciate ligament, and the progress of anterior cruciate ligament reconstruction with hamstring tendons. RETRIEVAL STRATEGY： Pubmed database was undertaken to identify relevant articles on anterior cruciate ligament reconstruction with hamstring tendons published from January 1990 to October 2007 with the key words of ＂anterior cruciate ligament, hamstring tendons, reconstruction, tendon regeneration, bone tunnel enlargement＂ in English. Ninety-two articles were selected primarily, and checked by reading titles and abstracts. Inclusive criteria： articles on anterior cruciate ligament reconstruction with hamstring tendons were included. Excusive criteria： articles with different aims and repetitive contents were excluded. Totally 42 articles were included, of which 2 articles were on animals, 2 articles on system evaluation/Meta analysis and 38 articles on clinical research.
LITERATURE EVALUATION： Of them, 22 articles were on anatomy, biodynamics, surgery approaches and clinical results of anterior cruciate ligament, 9 on bone tunnel enlargement of anterior cruciate ligament after reconstruction and 11 on regeneration of hamstring tendons after harvest.
DATA SYNTHESIS： With the deep understanding of double-bundle dissection and biodynamics of anterior cruciate ligament and bad control of single-bundle reconstruction on rotary stability, double-bundle anterior cruciate ligament reconstruction with hamstring tendons has become the major treatment. Bone tunnel enlargement of anterior cruciate ligament after reconstruction is multifactorial process of biology and biodynamics, possibly resulting in reduction in primary stability after reconstruction and severe problems in graft fixation in revision surgery. Most hamstring tendons （first selected graft of double-bundle anterior cruciate ligament reconstruction） can regenerate, and partially recover its function, which determined its foundation for anterior cruciate ligament reconstruction used by orthopedists. Bone tunnel enlargement of anterior cruciate ligament after reconstruction still deserves further studies.
CONCLUSION： Double-bundle dissection and biodynamics of anterior cruciate ligament lay the foundation for improving surgery scheme. Double-bundle anterior cruciate ligament reconstruction can better control rotary stability of knee joint.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第20期3930-3934,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
