切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 708 -714. doi: 10.3877/cma.j.issn.1674-134X.2023.05.017

综述

前交叉韧带保留残端重建促进膝关节功能的研究进展
梁家敏, 黄子荣, 崔家鸣, 钟名金, 冯文哲, 陈康, 胡艳, 欧阳侃, 杨雷, 王大平, 王满宜, 朱伟民†()   
  1. 518035　深圳大学第一附属医院(深圳市第二人民医院)；518061　深圳大学医学部
    518035　深圳大学第一附属医院(深圳市第二人民医院)
  • 收稿日期:2022-10-31 出版日期:2023-10-01
  • 通信作者: 朱伟民
  • 基金资助:
    深圳市科技计划基础研究(JCY20210324102607021); 深圳市工业和信息化局项目(201806081524201510); 深圳市第二人民医院临床研究项目(2023yjlcyj030)

Research progress in anterior cruciate ligament retain residual reconstruction for promoting knee joint function

Jiamin Liang, Zirong Huang, Jiaming Cui, Mingjin Zhong, Wenzhe Feng, Kang Chen, Yan Hu, Kan Ouyang, Lei Yang, Daping Wang, Manyi Wang, Weimin Zhu†()   

  1. Department of Sports Medicine, Shenzhen Second People’s Hospital/ the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China; Shenzhen University Health Science Center, Shenzhen 518061, China
    Department of Sports Medicine, Shenzhen Second People’s Hospital/ the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
  • Received:2022-10-31 Published:2023-10-01
  • Corresponding author: Weimin Zhu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

梁家敏, 黄子荣, 崔家鸣, 钟名金, 冯文哲, 陈康, 胡艳, 欧阳侃, 杨雷, 王大平, 王满宜, 朱伟民. 前交叉韧带保留残端重建促进膝关节功能的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 708-714.

Jiamin Liang, Zirong Huang, Jiaming Cui, Mingjin Zhong, Wenzhe Feng, Kang Chen, Yan Hu, Kan Ouyang, Lei Yang, Daping Wang, Manyi Wang, Weimin Zhu. Research progress in anterior cruciate ligament retain residual reconstruction for promoting knee joint function[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(05): 708-714.

前交叉韧带保留残端重建技术与非保留残端重建技术对促进膝关节腱骨愈合、膝关节本体感觉恢复、移植韧带滑膜化与再血管化程度上是否有差异一直存在争议。本文通过检索2018年1月至2022年9月的相关文献，归纳、总结和讨论保留残端重建前交叉韧带对骨隧道、本体感觉恢复、移植韧带滑膜化与再血管化、早期膝关节功能恢复的影响。保留残端重建前交叉韧带的优点是促进腱骨愈合、利于早期本体感觉的恢复、促进移植韧带滑膜化与再血管化，继而加速膝关节功能恢复，临床医生应根据患者前交叉韧带断裂的残端类型选择术式，对于满足残端保留条件的患者，应尽可能保留残端重建前交叉韧带。

关键词: 膝关节, 前交叉韧带重建

There are debates in residual end preservation technique in anterior cruciate ligament reconstruction whether it would promote the bone-tendon healing, knee proprioception recovery, vascularization of synovial membrane and transplanted ligament. This article retrieved the literatures from January 2018 to September 2022, and provided induction, summary and discussion of the influence of residual preservation in anterior cruciate ligament reconstruction on bone tunnel, proprioception recovery, vascularization of synovial membrane and transplanted ligament, and early knee function recovery. Preservation residual anterior cruciate ligament reconstruction shows advantages in promoting early tendon bone healing and vascularization of synovial membrane and transplanted ligament, and is also conducive to the recovery of proprioception, which in turn accelerate the knee joint function recovery. Clinical doctors should base on the residual type of the anterior cruciate ligament rupture in patients, for patients who meet the conditions of residual reserves, surgeons shall retaine the tissue as far as possible during anterior cruciate ligament reconstruction.

Key words: Knee joint, Anterior cruciate ligament reconstruction
[1]
Georgoulis AD, Pappa L, Moebius U, et al. The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL as a possible source of re-innervation of the ACL autograft[J]. Knee Surg Sports Traumatol Arthrosc, 2001, 9(6): 364－368.
[2]
沙霖，赵金忠．前交叉韧带胫骨侧残端中机械感受器的计数研究[J]．中国修复重建外科杂志，2010，24(11)：1318－1322.
[3]
Gao F, Zhou J, He C, et al. A morphologic and quantitative study of mechanoreceptors in the remnant stump of the human anterior cruciate ligament[J]. Arthroscopy, 2016, 32(2): 273－280.
[4]
Banios K, Raoulis V, Fyllos A, et al. Anterior and posterior cruciate ligaments mechanoreceptors: areview of basic science[J/OL]. Diagnostics, 2022, 12(2): 331. DOI: 10.3390/diagnostics12020331.
[5]
许锦煌，黄建荣，尹萍，等. 保留残端对前交叉韧带重建术后恢复的临床意义[J]. 中国临床解剖学杂志，2015, 33(5): 584－587.
[6]
Song GY, Zhang J, Li X, et al. Biomechanical and biological findings between acute anterior cruciate ligament reconstruction with and without an augmented remnant repair: a comparative in vivo animal study[J]. Arthroscopy, 2016, 32(2): 307－319.
[7]
Iwaasa T, Tensho K, Koyama S, et al. Clinical outcome of a new remnant augmentation technique with anatomical double-bundle anterior cruciate ligament reconstruction: comparison among remnant preservation, resection, and absent groups[J]. Asia Pac J Sports Med Arthrosc Rehabil Technol, 2021, 25: 22－29.
[8]
Tang J, Zhao J. Sandwich-style anterior cruciate ligament reconstruction: double-bundle anterior cruciate ligament reconstruction with In-between remnant preservation[J/OL]. Arthrosc Tech, 2021, 10(4): e1095－e1102. DOI: 10.1016/j.eats.2020.12.012.
[9]
臧业峰，朱卫洁，赵希春，等. 自体富血小板血浆联合关节镜下保留残端重建术治疗前交叉韧带损伤的临床研究[J]. 中国中医骨伤科杂志，2019, 27(9): 25－28.
[10]
臧业峰，姜鑫，朱卫洁，等. 富血小板血浆对前交叉韧带重建后髌股关节退变的影响[J]. 中国矫形外科杂志，2021, 29(5): 423－427.
[11]
Suh DW, Yeo WJ, Han SB, et al. Remnant preservation with tensioning can improve the clinical outcome after anterior cruciate ligament reconstruction[J/OL]. J Orthop Surg, 2022, 30(1): 23094990211073378. DOI: 10.1177/23094990211073378.
[12]
Ouanezar H, Blakeney WG, Fernandes LR, et al. Clinical outcomes of single anteromedial bundle biologic augmentation technique for anterior cruciate ligament reconstruction with consideration of tibial remnant size[J]. Arthroscopy, 2018, 34(3): 714－722.
[13]
Su C, Kuang SD, Liu WJ, et al. Clinical outcome of remnant-preserving and I．D.E.A.L. femoral tunnel technique for anterior cruciate ligament reconstruction[J]. Orthop Surg, 2020, 12(6): 1693－1702.
[14]
Takahashi T, Takeshita K. Remnant tissue preserved transtibial anterior cruciate ligament reconstruction with femoral tunnel created behind the resident’s ridge[J/OL]. Arthrosc Tech, 2021, 10(11): e2501－e2506. DOI: 10.1016/j.eats.2021.07.033.
[15]
牛国庆，彭智浩，温建强，等. 关节镜下袖套状保留残端与不保留残端重建前交叉韧带的疗效比较[J]. 临床骨科杂志，2022, 25(3): 374－379.
[16]
韦钊岚，韦朝喜，易伟林，等. "长袖套"保留残迹前交叉韧带重建术[J]. 中国矫形外科杂志，2021, 29(24): 2261－2264.
[17]
Sabzevari S, Shaikh H, Marshall B, et al. The femoral posterior fan-like extension of the ACL insertion increases the failure load[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(4): 1113－1118.
[18]
何青松，庄雷霆，安子豪等．倒刺线环扎固定技术对前交叉韧带保残重建的疗效影响[J]．中国修复重建外科杂志，2019, 33(02)：149－153.
[19]
Singh I, Singh A. Remnant-preserving anterior cruciate ligament reconstruction: remnant envelope technique[J/OL]. Arthrosc Tech, 2020, 9(11): e1805－e1812. DOI: 10.1016/j.eats.2020.08.002.
[20]
王江涛，肇刚，步建立等．前交叉韧带保残重建术中保残策略病例对照研究[J]．中国骨伤，2021，34(12)：1095－1102.
[21]
Höher J, Möller HD, Fu FH. Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction？[J]. Knee Surg Sports Traumatol Arthrosc, 1998, 6(4): 231－240.
[22]
姬广伟，许洪涛，滕学仁，等. 前交叉韧带重建术中是否保留韧带残端对胫骨骨道扩大的影响[J]. 中国骨与关节损伤杂志，2020, 35(12): 1307－1309.
[23]
Yanagisawa S, Kimura M, Hagiwara K, et al. The remnant preservation technique reduces the amount of bone tunnel enlargement following anterior cruciate ligament reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(2): 491－499.
[24]
Naraoka T, Kimura Y, Tsuda E, et al. Does remnant preservation influence tibial tunnel enlargement or graft-to-bone integration after double-bundle anterior cruciate ligament reconstruction using hamstring autografts and suspensory fixation? A computed tomography and magnetic resonance imaging evaluation[J/OL]. Orthop J Sports Med, 2018, 6(8): 2325967118790238. DOI: 10.1177/2325967118790238.
[25]
舒莉，郭晓斐，柴浩，等. 关节镜下残端保留在交叉韧带重建术的效果及对关节稳定性和本体感觉的影响[J]. 疑难病杂志，2019, 18(3): 275－279.
[26]
马子越，巨啸晨，张磊，等. 保留与不保留残端重建前交叉韧带后移植物腱骨愈合的比较[J]. 中国组织工程研究，2021, 25(4): 582－587.
[27]
江昭林. 关节镜下自体半腱肌、股薄肌肌腱保留残端重建前交叉韧带的疗效[J]. 临床骨科杂志，2021, 24(2): 224－227.
[28]
吴俊涛. 关节镜下残端保留在前交叉韧带重建术患者中的应用观察[J]. 医学理论与实践，2021, 34(13): 2267－2269.
[29]
Masuda T, Kondo E, Onodera J, et al. Effects of remnant tissue preservation on tunnel enlargement after anatomic double-bundle anterior cruciate ligament reconstruction using the hamstring tendon[J/OL]. Orthop J Sports Med, 2018, 6(12): 2325967118811293. DOI: 10.1177/2325967118811293.
[30]
Liu W, Wu Y, Wang X, et al. ACL stump and ACL femoral landmarks are equally reliable in ACL reconstruction for assisting ACL femoral tunnel positioning[J]. Knee Surg Sports Traumatol Arthrosc, 2023, 31(1): 219－228.
[31]
Kosy JD, Walmsley K, Gordon EA, et al. Remnant preservation does not affect accuracy of tibial tunnel positioning in single-bundle ACL reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2021, 29(4): 1157－1163.
[32]
Koyama S, Tensho K, Shimodaira H, et al. A new remnant preservation technique reduces bone tunnel enlargement after anatomic double-bundle anterior cruciate ligament reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(6): 2020－2028.
[33]
王晓桐，朱康，马胡晶. 膝关节ACL断裂关节镜下自体腘绳肌腱单束重建术中保留残端的可行性[J]. 大医生，2019, 4(2): 32－33.
[34]
孙磊，吴波，田敏，等. 兔保留与切除残迹前交叉韧带重建生物力学的比较[J/CD]. 中华关节外科杂志(电子版), 2013, 7(1): 81－85.
[35]
Moutzouros V, Jildeh TR. Hybrid remnant-sparing anterior cruciate ligament repair-reconstruction[J/OL]. Arthrosc Tech, 2021, 10(7): e1717－e1721. DOI: 10.1016/j.eats.2021.03.019.
[36]
Kim BH, Kim JI, Lee O, et al. Preservation of remnant with poor synovial coverage has no beneficial effect over remnant sacrifice in anterior cruciate ligament reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(8): 2345－2352.
[37]
Takahashi T, Kimura M, Hagiwara K, et al. The effect of remnant tissue preservation in anatomic double-bundle ACL reconstruction on knee stability and graft maturation[J]. J Knee Surg, 2019, 32(6): 565－576.
[38]
Okutan AE, Kalklşlm M, Gürün E, et al. Tibial slope, remnant preservation, and graft size are the most important factors affecting graft healing after ACL reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(5): 1584－1593.
[39]
Nayak M, Nag HL, Nag TC, et al. Ultrastructural and histological changes in tibial remnant of ruptured anterior cruciate ligament stumps: a transmission electron microscopy and immunochemistry-based observational study[J]. Musculoskelet Surg, 2020, 104(1): 67－74.
[40]
Mesnier T, Cavaignac M, Marot V, et al. Knee anterolateral ligament reconstruction with knotless soft anchor: shallow fixation prevents tunnel convergence[J/OL]. Arthrosc Tech, 2022, 11(4): e511－e516. DOI: 10.1016/j.eats.2021.11.024.
[41]
Wang H, Liu Z, Li Y, et al. Is remnant preservation in anterior cruciate ligament reconstruction superior to the standard technique? A systematic review and meta-analysis[J/OL]. Biomed Res Int, 2019, 2019: 1652901. DOI: 10.1155/2019/1652901.
[42]
张磊，岳娜，谢崇新，等. 保残与不保残重建前交叉韧带移植腱血管、神经再生的比较[J]. 中华实验外科杂志，2018, 35(2): 304－307.
[43]
Liu Y, Li C, Ma N, et al. Proprioceptive and clinical outcomes after remnant preserved anterior cruciate ligament reconstruction: assessment with minimal confounding factors[J]. Orthop Surg, 2022, 14(1): 44－54.
[44]
陈敏，林佳俊，刘文革. 保留残端长度对自体腘绳肌腱单束重建前交叉韧带的效果影响[J]. 实用骨科杂志，2020, 26(8): 693－699.
[45]
冯馨元，白伦浩. 保留前交叉韧带残端对膝关节稳定性的意义[J]. 中国组织工程研究，2019, 23(4): 525－531.
[46]
王勇. 关节镜下保留残端重建术治疗前交叉韧带损伤的疗效观察[J]. 中国实用医刊，2019, 46(7): 52－54.
[47]
罗学辉，杜绍龙. 膝关节镜下前交叉韧带保留残端重建对本体感觉及功能恢复的影响[J]. 广东医学，2019, 40(20): 2946－2949.
[48]
罗奋棋，徐杰. 对比观察保留与非保留残端前交叉韧带重建的临床疗效与价值[J]. 中国医学创新，2018, 15(27): 50－53.
[49]
柴浩，吴婷，舒莉，等. 保留与不保留残端重建前交叉韧带后本体感觉恢复的比较[J]. 中国组织工程研究，2019, 23(15): 2332－2337.
[50]
Adriansyah D, Santoso A, Sibarani TS, et al. Mechanoreceptor analysis on femoral and tibial site remnant of anterior cruciate ligament injury using immunohistochemistry[J/OL]. Ann Med Surg, 2022, 78: 103849. DOI: 10.1016/j.amsu.2022.103849.
[51]
Nayak M, Nag HL, Gaba S, et al. Quantitative correlation of mechanoreceptors in tibial remnant of ruptured human anterior cruciate ligament with duration of injury and its significance: an immunohistochemistry-based observational study[J/OL]. J Orthop Traumatol, 2018, 19(1): 5. DOI: 10.1186/s10195-018-0498-7.
[52]
Bali K, Dhillon MS, Vasistha RK, et al. Efficacy of immunohistological methods in detecting functionally viable mechanoreceptors in the remnant stumps of injured anterior cruciate ligaments and its clinical importance[J]. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1): 75－80.
[53]
Kulczycka P, Larbi A, Malghem J, et al. Imaging ACL reconstructions and their complications[J]. Diagn Interv Imaging, 2015, 96(1): 11－19.
[54]
Delaloye JR, Murar J, Vieira TD, et al. Knee extension deficit in the early postoperative period predisposes to Cyclops syndrome after anterior cruciate ligament reconstruction: a risk factor analysis in 3633 patients from the SANTI study group database[J]. Am J Sports Med, 2020, 48(3): 565－572.
[55]
Demiraǧ B, Ermutlu C, Aydemir F, et al. A comparison of clinical outcome of augmentation and standard reconstruction techniques for partial anterior cruciate ligament tears[J]. Jt Dis Relat Surg, 2012, 23(3): 140－144.
[56]
Sonnery-Cottet B, Colombet P. Partial tears of the anterior cruciate ligament[J]. Orthop Traumatol Surg Res, 2016, 102(1 Suppl): S59－S67.
[57]
宋长志，郑闽前，纪标，等. 关节镜下退行性股骨髁间窝前交叉韧带撞击症的诊断和治疗[J/CD]. 中华关节外科杂志(电子版), 2014, 8(2): 185－188.
[58]
李晨曦，周敬滨，丁杰，等. 股骨髁间窝宽度和前交叉韧带胫骨端左右径相关性及其与前交叉韧带损伤的关系[J]. 中国运动医学杂志，2016, 35(12): 1148－1153.
[1] 黄子荣, 罗渝鑫, 杨文瀚, 陈小虎, 谢环宇, 朱伟民. 前交叉韧带重建对膝关节稳定性影响的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 847-854.
[2] 樊绪国, 赵永刚, 杨砚伟. 腓骨在膝骨关节炎作用的研究观点[J]. 中华关节外科杂志(电子版), 2023, 17(06): 855-859.
[3] 夏传龙, 迟健, 丛强, 连杰, 崔峻, 陈彦玲. 富血小板血浆联合关节镜治疗半月板损伤的临床疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 877-881.
[4] 赵之栋, 李众利. 骨关节炎早期诊治的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 689-693.
[5] 李锐颖, 危望, 王达志, 时志斌. 深度学习技术在膝关节疾病中的研究现状与展望[J]. 中华关节外科杂志(电子版), 2023, 17(05): 722-725.
[6] 方心俞, 黄昌瑜, 胡洪新, 林溢铭, 陈旸, 张楠心, 张文明. 膝关节软骨下不全骨折的治疗选择与疗效分析[J]. 中华关节外科杂志(电子版), 2023, 17(04): 583-587.
[7] 郭璐琦, 赵雅琦, 李霁欣, 周兰, 林金鹏, 张子砚, 李俊杰, 王少白. 免荷矫形器对膝骨关节炎的生物力学影响的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(04): 560-565.
[8] 郭春花, 徐晓燕, 何劼, 刘晓洁, 孟庆芳, 杨曦, 江珉, 刘铁成. 反重力跑台系统在前交叉韧带重建术后步行训练的应用[J]. 中华关节外科杂志(电子版), 2023, 17(04): 485-491.
[9] 吴香敏, 吴鹏. 超声引导下收肌管阻滞联合腘动脉与膝关节后囊间隙阻滞在老年患者全膝关节置换术中的应用效果[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 516-522.
[10] 中华医学会骨科分会关节学组. 中国髋、膝关节置换日间手术围手术期管理专家共识[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 321-332.
[11] 邱红生, 林树体, 梁朝莹, 劳世高, 何荷. 模拟现实步态训练对膝关节前交叉韧带损伤的功能恢复及对跌倒恐惧的影响[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 343-350.
[12] 周晓强, 孙超, 虞宵, 金宇杰, 李志强, 张向鑫, 陈广祥. 同一患者同期行全膝和单髁置换术的早期临床疗效[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 275-281.
[13] 张子砚, 曾红, 许苑晶, 郭璐琦, 王金武, 王少白, 任富超, 缪伟强, 戴尅戎, 王茹. 膝关节生物力学标志物预测膝关节炎研究进展[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 315-320.
[14] 付庆鹏, 邓晓强, 高伟, 姜福民, 范永峰, 吴海贺, 齐岩松, 包呼日查, 徐永胜. 新型股骨测量定位器在全膝关节置换术中的临床应用[J]. 中华临床医师杂志(电子版), 2023, 17(9): 980-987.
[15] 刘新光, 杨滨, 刘晨, 王晓华, 张克. 股骨前皮质切割在前、后参考系统全膝关节置换术中发生的对比研究及锯片摆动偏差分析[J]. 中华临床医师杂志(电子版), 2023, 17(05): 507-512.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号