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人工移植物重建前交叉韧带术后远期临床的相关研究
中文摘要

前交叉韧带(Anterior Cruciate Ligament,ACL)断裂是运动人群中较为常见的损伤之一,常发生在需急停急转(Cutting)或膝关节轴向旋转(Pivoting)的运动中,如足球、篮球、橄榄球和高山滑雪。ACL重建术现已成为治疗ACL损伤的可靠方法。手术目的在于恢复关节稳定性,避免因关节不稳造成继发损伤,帮助患者最终重返运动。移植物选择一直是ACL重建术的热点话题。传统移植物包括自体移植物和同种异体移植物,虽然在大量报道中显示令人满意的临床疗效,但传统移植物存在例如供区并发症与疾病传播风险等自身无法克服的缺陷。此外,应用传统移植物的患者在术后重返伤前运动水平常需9至12个月。康复进程出现反复的病例中,重返运动时间将变得更长。总体而言,传统移植物重建ACL术后重返运动情况差强人意。 理论上,人工移植物克服了传统移植物的自身缺陷,同时具有术后快速康复和早期重返运动的优势。但将人工移植物应用于ACL重建的早期尝试大都以失败告终。近十年来,某些人工移植物在报道中显示令人满意的短期和中期疗效,但远期临床疗效存在争议。 本研究从三个方面对当前人工韧带重建ACL的远期临床预后进行评价:1.与自体腘绳肌腱重建ACL相比的远期临床疗效;2.失败情况以及导致失败的原因; 3.与传统移植物相比的术后远期影像学骨关节炎(Osteoarthritis,OA)的发生情况。研究同时对ACL重建术后远期影像学OA与症状间关系以及其发生的风险因素进行探究,并对ACL重建术后远期影像学OA的发生率进行了系统综述和荟萃分析。 关键词:前交叉韧带;人工移植物;传统移植物;远期临床疗效;失败;骨关节炎 中国图书分类号:R87

英文摘要

The anterior cruciate Ligament (ACL) tear is not rare among active sports population, especially for those participating in games involving knee cutting and pivoting, like soccer, basketball, American football, and alpine skiing. As a typical injury in orthopedic sports medicine, the injury now could be treated by ACL reconstruction. The goal of the surgery is to restore the joint stability, to prevent secondary injury due to instability, and to help the patients return to sport. The graft choice has been a longstanding topic of the technique. Traditional grafts, including autografts and allografts, were proved of satisfactory clinical outcomes in literature, while they all bore certain defects, respectively the donor-site morbidities and risk of disease transmission. Moreover, it could take a period of 9 to 12 months or even more to rehab and return to pre-injury level activity for patients undergone ACL reconstruction using traditional grafts. This made a return to sport after ACL reconstruction more often less satisfactory. Theoretically, the using of synthetics in the ACL reconstruction could avoid the defects of traditional grafts, enjoying the merits of a fast recovery and early return to sport. However, the initial attempts of synthetics in the ACL reconstruction mostly failed. Recently, some synthetics showed satisfactory short- and mid-term outcomes in the ACL reconstruction. But their long-term issues were still controversial. This long-term clinical research of the ACL reconstruction using synthetics was launched from there aspects: 1. long-term clinical outcomes compared with the ACL reconstruction using hamstring autograft;2. failure rate and related reasons; 3. long-term radiographic osteoarthritis (OA) rate compared with ACL reconstruction using traditional grafts. Furtherly, the researcher investigated the symptoms and function among the cases of radiographic OA and analyzed the risk factor for the development of moderate radiographic OA after surgery. A systematic review and meta-analysis were finally made on the prevalence of radiographic OA long-term after ACL reconstruction. Keyword: Anterior Cruciate Ligament; Synthetics; Traditional Graft; Long-term Outcomes; Failure; Osteoarthritis Chinese Library Classification: R87

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