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摘要 前交叉韧带重建是运动医学中最常见的手术方法之一,移植物的选择在重建和康复过程中起着重要作用,理想状态下的移植物应该与原前交叉韧带(anterior cruciate ligaments,ACL)具有相似结构和生物力学特性,同时在选择移植物时还要考虑患者生活方式和手术医生的经验。目前,主要移植物包括自体肌腱、同种异体肌腱及人工材料如LARS韧带等。由于使用同种异体肌腱重建后再次撕裂率较高,自体肌腱移植已成为前交叉韧带重建的首选。其中,骨-髌腱-骨(bone-patellar tendon-bone,BPTB)、腘绳肌腱(hamstring tendon,HT)是目前最常用的自体移植物。BPTB主要的优点在于其易于获取、良好的骨性愈合和坚强的固定,但是也存在髌腱断裂、术后膝前疼痛以及髌骨骨折的风险。相对来说,HT的操作简单、膝前疼痛少,骨关节炎的发生率更低,但是其移植物愈合延迟、膝关节松弛、术后稳定性差,容易导致骨隧道扩大、更高的翻修率。虽然各个移植物都有自己的优缺点,但最佳移植物的选择还存在着很大的争议。近年来,由于股四头肌腱(quadriceps tendon,QT)具有更好的厚度及强度、良好的解剖及生物学特性等优点,QT移植在临床上越来越受欢迎。现综述如下。
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作者简介: 杨冬冬(1995- ),男,研究生在读,中南大学湘雅医学院附属株洲医院骨科,412000。 |
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