中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (2): 222-227.doi: 10.3969/j.issn.2095-4344.2960

• 软骨组织构建 cartilage tissue construction • 上一篇    下一篇

前交叉韧带重建后二次关节镜探查关节软骨的转归分析

卢明峰,赵立连,邢基斯,何利雷,许  挺,王昌兵   

  1. 佛山市中医院运动医学科,广东省佛山市   528000
  • 收稿日期:2019-12-27 修回日期:2020-01-06 接受日期:2020-03-04 出版日期:2021-01-18 发布日期:2020-11-21
  • 通讯作者: 赵立连,博士,副主任医师,副教授,佛山市中医院运动医学科,广东省佛山市 528000
  • 作者简介:卢明峰,男,1991年生,江西省赣州市人,汉族,2018年广州中医药大学毕业,硕士,医师,目前就职于广东省佛山市中医院,主要从事于关节与运动医学方向的研究。
  • 基金资助:
    广东省医学科学技术研究(20161181228306)

Posttraumatic progression of cartilage degeneration following anterior cruciate ligament reconstruction: a second-look arthroscopic analysis

Lu Mingfeng, Zhao Lilian, Xing Jisi, He Lilei, Xu Ting, Wang Changbing   

  1. Department of Sport Medicine, Affiliated Foshan TCM Hospital of Guangzhou University of Chinese Medicine, Foshan 528000, Guangdong Province, China
  • Received:2019-12-27 Revised:2020-01-06 Accepted:2020-03-04 Online:2021-01-18 Published:2020-11-21
  • Contact: Zhao Lilian, MD, Associate chief physician, Associate professor, Department of Sport Medicine, Affiliated Foshan TCM Hospital of Guangzhou University of Chinese Medicine, Foshan 528000, Guangdong Province, China
  • About author:Lu Mingfeng, Master, Physician, Department of Sport Medicine, Affiliated Foshan TCM Hospital of Guangzhou University of Chinese Medicine, Foshan 528000, Guangdong Province, China
  • Supported by:
    the Medical Science and Technology Research of Guangdong Province, No. 20161181228306

摘要:

文题释义:
前交叉韧带重建:前交叉韧带损伤是常见的运动损伤,损伤后常导致膝关节前后向不稳定,目前临床采用自体腘绳肌腱作为移植物,通过关节镜下单束重建前交叉韧带,恢复膝关节的稳定性及功能。
膝关节软骨:是由髌骨软骨、股骨软骨及胫骨软骨构成,主要作用是避免外力的震动和冲击,保护骨头避免磨损,缓解关节的压力,软骨越厚,关节寿命越长,关节软骨由于没有血管、神经及淋巴组织,一旦损伤确实无法修复。

背景:骨前交叉韧带重建能够恢复膝关节稳定性,降低对半月板和软骨的机械应力,从而避免包括创伤性关节炎在内的继发损伤的发生与发展。然而,一些研究表明前交叉韧带重建并不能完全阻止骨关节炎的发生发展,重建后中长期的影像学检查可发现明显的骨关节炎改变,因此目前对于前交叉韧带重建预防继发性软骨损害与继发性骨关节炎的作用仍存在争议,同时前交叉韧带重建后软骨的变化情况,尤其是早期变化,并未被完全阐明。
目的:分析关节镜下前交叉韧带重建和二次关节镜探查时关节软骨变化情况。
方法:回顾性分析2015年7月到2016年7月期间在佛山市中医院运动医学科采用自体腘绳肌腱行前交叉韧带重建并进行了二次关节镜探查的50例病例,关节镜下探查前交叉韧带重建和二次探查时软骨损伤及愈合情况,同时分析重建时年龄对于关节软骨的影响。试验于  2015-06-13经佛山市中医院伦理委员会的批准,批准号20160315。
结果与结论:①所有患者均未发生感染、移植物吸收等并发症,二次探查时Lysholm 评分、国际膝关节评分委员会评分、Tegner评分、  KT-1000侧侧差值较重建前明显改善(P < 0.05);②前交叉韧带初次重建与二次探查关节软骨情况对比,所有患者关节软骨均有恶化趋势,其中除胫骨内侧平台、股骨外侧髁关节软骨外,髌骨下、滑车、股骨内侧髁、胫骨外侧平台关节软骨较初次重建时均有较为明显恶化(P < 0.05);③初次前交叉韧带重建时,年龄在30岁以下和30岁以上的患者关节软骨状况接近(P > 0.05),而在关节镜二次探查时,30岁及以上的前交叉韧带重建患者髌骨下、滑车、股骨外侧髁、胫骨内、外侧平台软骨状况较30岁以下患者明显更差(P < 0.05);④结果提示采用自体腘绳肌腱重建前交叉韧带能够获得较好的膝关节稳定性及功能,然而即使在重建后早期,创伤后骨关节炎的变化仍在进展,因此在接受前交叉韧带重建的患者中,有必要注意骨关节炎的进展和膝关节症状的出现。

https//orcid.org/0000-0002-4264-8492(赵立连) 

中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程

关键词: 关节镜,  前交叉韧带,  关节软骨,  二次探查,  膝, 年龄

Abstract: BACKGROUND: Anterior cruciate ligament (ACL) reconstruction can restore the stability of knee joint, reduce the mechanical stress on meniscus and cartilage, and avoid the occurrence and development of secondary injury including traumatic arthritis. However, some studies have shown that ACL reconstruction cannot completely prevent the occurrence and development of osteoarthritis, and significant changes in osteoarthritis can be found in the long-term imaging examination after operation. Therefore, there is still controversy about the role of ACL reconstruction in preventing secondary cartilage damage and secondary osteoarthritis, and the changes in cartilage after ACL reconstruction, especially at early stage after ACL reconstruction, have not been fully elucidated. 
OBJECTIVE: To analyze articular cartilage changes during arthroscopic anterior cruciate ligament reconstruction and second-look arthroscopic evaluation.
METHODS: From July 2015 to July 2016, 50 cases of ACL reconstruction with hamstring tendon and second-look arthroscopic exploration were analyzed retrospectively. The cartilage damage and healing between the ACL reconstruction and second-look exploration were recorded. At the same time, the influence of age on articular cartilage was analyzed. The study protocol was approved by the Ethics Committee of Foshan TCM Hospital with an approval No. 20160315.
RESULTS AND CONCLUSION: No infection, graft absorption and other complications occurred in all patients. During the second-look exploration, the Lysholm score, International Knee Documentation Committee evaluation score, Tegner score and KT-1000 lateral difference were significantly improved compared with those before operation (P < 0.05). During the second-look exploration, the articular cartilage of all patients had a trend of deterioration; except for the medial tibial platform and the lateral femoral condyle, subpatellar, trochlear, medial femoral condyle and tibial lateral platform articular cartilage tissues were significantly worsened compared with those after the initial ACL reconstruction (P < 0.05). There was no significant difference in the condition of articular cartilage between the patients under 30 years and over 30 years old in the initial ACL reconstruction (P > 0.05). During the second-look exploration, the patients with anterior cruciate ligament reconstruction who were 30 years old and above had significantly worse subpatellar, trochlear, medial femoral condyle, lateral femoral condyle and tibial lateral platform cartilage tissues than those under 30 years (P < 0.05). The results suggest that the reconstruction of ACL with autogenous hamstring tendon can achieve better stability and function of the knee joint. However, even in the early postoperative period, osteoarthritis is still progressing. Therefore, it is necessary for patients with ACL reconstruction to pay attention to the progression of osteoarthritis and the appearance of knee joint symptoms.

Key words: arthroscopy,  anterior cruciate ligament,  articular cartilage,  second look,  knee,  age

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