[自体纤维蛋白凝块对前交叉韧带重建术后腱骨愈合的影响]
[Effect of autologous fibrin clot on tendon-bone healing after anterior cruciate ligament reconstruction].
作者信息
Liu Penghe, Dai Zhipeng, Zhao Jiajun, Zhang Zhen, Huang Suizhu
机构信息
Department of Joint Surgery, the Second Affiliated Hospital of Luohe Medical College, Luohe Henan, 462300, P.R.China.
Department of Joint Surgery, People's Hospital of Henan Province, Zhengzhou Henan, 450000, P.R.China.
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jul 15;31(7):799-804. doi: 10.7507/1002-1892.201701089.
OBJECTIVE
To observe the effect and significance of autologous fibrin clot on tendon-bone healing after anterior cruciate ligament (ACL) reconstruction.
METHODS
Between October 2014 and January 2016, 34 patients (34 knees) with ACL injury were enrolled in the study. During ACL reconstruction, autologous fibrin clot was used in 17 cases (trial group) and was not used in 17 cases (control group). The anterior drawer test, Lachman test, and axial displa-cement test were positive in 2 groups before operation. There was no significant difference in gender, age, causes of injury, injury side, disease cause, and preoperative knee joint activity, Lysholm score, and American Hospital for Special Surgery (HSS) score between 2 groups ( >0.05), with comparable. The results of anterior drawer test, Lachman test, and axial displacement test were recorded and compared between 2 groups after operation. The knee joint activity, Lysholm score, and HSS score were used to evaluate the knee function recovery at 6, 24, and 48 weeks after operation; the graft signal intensity, graft signal to noise ratio, bone tunnel expansion, and graft tendon-bone node T2 value were measured.
RESULTS
All patients were followed up 48 weeks. Surgical incision healed at stage I. No joint infection and joint adhesion occurred. The drawer test, Lachman test, and axial shift test were negative in 2 groups. At 6, 24, and 48 weeks after operation, the Lysholm score of trial group was significantly higher than that of control group ( <0.05); there was no significant difference in knee joint activity between 2 groups ( >0.05). The HSS score of trial group was significantly higher than that of control group at 24 and 48 weeks ( <0.05), but no significant difference was found at 6 weeks ( >0.05). MRI measu-rement showed that there was significant difference in graft signal intensity, bone tunnel expansion, and graft signal to noise ratio between 2 groups at 6, 24, and 48 weeks after operation ( <0.05). There was no significant difference in graft tendon-bone node T2 value between 2 groups ( >0.05) at 48 weeks after operation, but difference was significant at 6 and 24 weeks ( <0.05).
CONCLUSION
Autologous fibrin clot can effectively enhance graft revascularization, and accelerate the process of tendon-bone healing after ACL reconstruction.
目的
观察自体纤维蛋白凝块在前交叉韧带（ACL）重建术后对腱骨愈合的影响及意义。
方法
选取2014年10月至2016年1月间34例ACL损伤患者（34膝）纳入研究。在ACL重建术中，17例使用自体纤维蛋白凝块（试验组），17例未使用（对照组）。两组术前前抽屉试验、Lachman试验及轴移试验均为阳性。两组患者在性别、年龄、损伤原因、损伤侧、病因及术前膝关节活动度、Lysholm评分、美国特种外科医院（HSS）评分等方面比较，差异均无统计学意义（>0.05），具有可比性。记录并比较两组术后前抽屉试验、Lachman试验及轴移试验结果。采用膝关节活动度、Lysholm评分及HSS评分评估术后6、24及48周时膝关节功能恢复情况；测量移植物信号强度、移植物信噪比、骨隧道扩大情况及移植物腱骨结合部T2值。
结果
所有患者均随访48周。手术切口Ⅰ期愈合。未发生关节感染及关节粘连。两组抽屉试验、Lachman试验及轴移试验均为阴性。术后6、24及48周时，试验组Lysholm评分显著高于对照组（<0.05）；两组膝关节活动度比较，差异无统计学意义（>0.05）。术后24及48周时，试验组HSS评分显著高于对照组（<0.05），但术后6周时差异无统计学意义（>0.05）。MRI测量显示，术后6、24及48周时，两组移植物信号强度、骨隧道扩大情况及移植物信噪比比较，差异均有统计学意义（<0.05）。术后48周时，两组移植物腱骨结合部T2值比较，差异无统计学意义（>0.05），但术后6及24周时差异有统计学意义（<0.05）。
结论
自体纤维蛋白凝块可有效促进移植物血管化，加速ACL重建术后腱骨愈合进程。
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