發(fā)布時(shí)間：2019-04-15 14:05

【摘要】：目的探討自體血纖維蛋白凝塊對(duì)前交叉韌帶(anterior cruciate ligament,ACL)重建術(shù)后腱-骨愈合的作用及意義。方法以2014年10月—2016年1月收治并符合選擇標(biāo)準(zhǔn)的34例(34膝)ACL損傷患者作為研究對(duì)象,隨機(jī)分為兩組(n=17);ACL重建術(shù)中試驗(yàn)組采用自體血纖維蛋白凝塊,對(duì)照組不作該處理。兩組患者術(shù)前前抽屜試驗(yàn)、Lachman試驗(yàn)及軸移試驗(yàn)均為陽(yáng)性。兩組患者性別、年齡、致傷原因、損傷側(cè)別、受傷至手術(shù)時(shí)間以及術(shù)前膝關(guān)節(jié)活動(dòng)度、Lysholm評(píng)分、美國(guó)特種外科醫(yī)院(HSS)評(píng)分等一般資料比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。記錄并比較兩組患者術(shù)后前抽屜試驗(yàn)、Lachman試驗(yàn)及軸移試驗(yàn)檢查結(jié)果;術(shù)后6、24、48周,檢查患膝關(guān)節(jié)活動(dòng)度、Lysholm評(píng)分、HSS評(píng)分,評(píng)定膝關(guān)節(jié)功能恢復(fù)情況;行MRI檢查,測(cè)量移植物信號(hào)強(qiáng)度、信噪比以及骨隧道擴(kuò)大程度及移植物腱-骨結(jié)點(diǎn)T2值。結(jié)果兩組患者術(shù)后均獲隨訪48周。術(shù)后切口均Ⅰ期愈合,無(wú)1例出現(xiàn)關(guān)節(jié)內(nèi)感染及關(guān)節(jié)粘連。術(shù)后兩組患者前抽屜試驗(yàn)、Lachman試驗(yàn)及軸移試驗(yàn)均為陰性。術(shù)后6、24、48周,試驗(yàn)組Lysholm評(píng)分均明顯高于對(duì)照組(P0.05);而兩組膝關(guān)節(jié)活動(dòng)度比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后6周,兩組HSS評(píng)分比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);24、48周時(shí)試驗(yàn)組HSS評(píng)分明顯高于對(duì)照組(P0.05)。MRI復(fù)查顯示,術(shù)后6、24、48周兩組移植物信號(hào)強(qiáng)度、骨隧道擴(kuò)大程度、移植物信噪比比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后6、24周兩組移植物腱-骨結(jié)點(diǎn)T2值比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);48周時(shí)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 ACL重建術(shù)中采用自體血纖維蛋白凝塊,能夠有效促進(jìn)移植物再血管化、加快腱-骨愈合進(jìn)程。
[Abstract]:Objective to investigate the effect and significance of autologous blood fibrin clot on tendon-bone healing after anterior cruciate ligament (anterior cruciate ligament,ACL) reconstruction. Methods from October 2014 to January 2016, 34 patients (34 knees) with ACL injury were randomly divided into two groups (n = 17). Autologous blood fibrin clot was used in the experimental group during ACL reconstruction, but not in the control group. The anterior drawer test, Lachman test and axisymmetric test were all positive in both groups. Sex, age, cause of injury, side injury, time from injury to operation, preoperative knee motion, Lysholm score and (HSS) score of American special surgical hospital were compared between the two groups. The differences were not statistically significant (P0.05), and were comparable. The results of anterior drawer test, Lachman test and axial shift test were recorded and compared between the two groups, and the knee joint activity, Lysholm score and HSS score were evaluated at 6, 24, 48 weeks after operation. The graft signal intensity, signal-to-noise ratio (SNR), bone tunnel enlargement and T _ 2 value of tendon-bone node were measured by MRI. Results the patients in both groups were followed up for 48 weeks. There was no intra-articular infection and joint adhesion in all cases. The anterior drawer test, Lachman test and axial shift test were negative in the two groups after operation. 6, 24, 48 weeks after operation, the Lysholm scores in the experimental group were significantly higher than those in the control group (P0.05), but there was no significant difference in the knee motion between the two groups (P0.05). 6 weeks after operation, there was no significant difference in HSS scores between the two groups (P0.05). The HSS score of the experimental group was significantly higher than that of the control group at 24 and 48 weeks after operation (P0.05). 6, 24 and 48 weeks after operation, the signal intensity of graft, the extent of bone tunnel enlargement, and the signal-to-noise ratio of the graft were significantly different between the two groups (P0.05). There was significant difference in T _ 2 value of tendon-bone node between the two groups at 6 and 24 weeks after operation (P0.05), but there was no significant difference at 48 weeks (P0.05). Conclusion autogenous blood fibrin clot can effectively promote graft revascularization and accelerate tendon-bone healing in ACL reconstruction.
【作者單位】： 漯河醫(yī)學(xué)高等�？茖W(xué)校第二附屬醫(yī)院骨關(guān)節(jié)科;河南省人民醫(yī)院骨關(guān)節(jié)科;
【基金】：河南省基礎(chǔ)與前沿技術(shù)研究計(jì)劃項(xiàng)目(162300410093) 河南省醫(yī)學(xué)科技攻關(guān)項(xiàng)目(201602196)~~
【分類號(hào)】：R687.4

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