生物骨传导性骨水泥促进前交叉韧带重建术腱骨愈合的研究进展英文

生物骨传导性骨水泥促进前交叉韧带重建术腱骨愈合的研究进展英文 第 1 8卷 第 1 6期 中国矫形外科杂志 Vol118 No1162 0 1 0年 8月 O rthoped ic Journa l of Ch ina Aug12010 ?英文原著 O riginal A rticle ? O steoconductive bone cem en t enhances tendon 2bone hea lin g i an ter ior n a cruc i te ligam en t recon struction 3 3 3 Guan2 ing Kuang 邝冠明 M W ai2Pen Yau 邱伟鹏 Foon2 ian L im 林凤年 Kwong2Yuen Chiu 曲广运 W illiam W. Lu 吕维加 L D epa rtm en t of O rthopaed ics and Traum atology L i Ka S h ing Faculty of M ed icine the U n iversity of Hong Kong Pokfu lam Hong Kong SAR China Abstract: The utility of soft tissue autograft ham string autograft for ACL reconstruction has grown in popularity in the past 10 years The long2term clinical outcome is depended on the osteointegration of the tendon graft w ithin the bone tunnel tendon 2 . bone healing . However one of the most concerned lim itations of soft tissue grafts in ACL reconstruction is that it needs an ex2 tremely long tim e to develop a secure tendon 2bone healing It is reported that local app lication of osteoconductive bone cements . seem s to be a p rom ising strategy to enhance tendon2bone healing in ACL reconstruction anim al models Such osteoconductive bone . cements are mainly calcium phosphate 2based cements The p resent paper reviewed the relative papers and tried to elucidate the . p rogress in this research area. Key words: anterior cruciate ligament graft healing tendon tunnel Ch in ese L ibrary C la ssif ica tion Num ber:R687 D ocum en t Code:A Article I : 1005 - 8478 2010 16 - 1349 - 05 D 生物骨传导性骨水泥促进前交叉韧带重建术腱骨愈合的研 究进展 / /香港大学矫形与创伤外科学系 中国香港特别行政区 摘 要 : 近 10 年来 应用软组织移植物行前交叉韧带重建术越来越普遍 。手术的远期疗效 主要取决于肌腱移植 物能否在骨隧道内达到坚强的腱 - 骨愈合 。但是 目前面临 的问题是肌腱移植物在骨隧道内获得腱 - 骨愈合所需要的 时间相当长 。研究发现 在腱 - 骨界面局部应用生物骨传导性的骨水泥能有效地促进肌腱移植物的骨愈 合 。这类骨水 泥主要是磷酸钙 。本文就生物骨传导性骨水泥促进前交叉韧带重建 术腱 - 骨愈合的研究进展作一综述 。 关键词 : 前交叉韧带 移植物 愈合 肌腱 隧道 中图分类号 : R687 文献标志码 : A 文章编号 : 1005 - 8478 2010 16 - 1345 - 041 I troduction n . ward fixation devices such as interference screw s or tunnels After Anterior cruciate ligament ACL rup ture is one of the com 2 buttons are inserted into the tunnels to fix the tendon graft onto the 1 7 - 8 monest injuries in sport medicine . Once injured or rup tured the tunnel wall . The initial stability of the tendon graft is p rovided 2 - 3 9,11 ACL has poor ability to heal spontaneously . Therefore surgical by the internal fixation however the long tim e stability of theinterventions w ith autogenic or allogenic tendon grafts are usually tendon graft in the bone tunnels depends on the healing of the ten2 4,6 . This requires a secure bone in2 12,14 required to reconstruct the normal function of the ACL . During don graft in the bone tunnels 14,16 the reconstruction surgery two bone tunnels are created in tibia and tegration to the tendon graft .femur respectively and the tendon graft is p laced through these Currently one of the most concerned lim itations of soft tissue grafts in ACL reconstruction is that it needs an extremely long tim e3 Correspond in g author: Guan 2 ing Kuang M to regenerate a tendon2bone attachment sim ilar a normal Departm ent of O rthopaedics and Traumatology Room 906 Lab B lock 17,19 one . Studies have shown that a comp lete bone integration of LKS Faculty of Medicine 21 Sassoon Road the University of Hong tendon graft takes more than 6 months in most of anim al ACL re2 Kong Pokfulam Hong Kong . In addition to the surgical and postoper2 19 - 20 construction models Address: L9 - 06 Laboratory B lock 21 Sassoon Road Pokfulam Hong ative variables such as tunnel m isp lacement graft2tunnel diameter Kong Tel: 852 2818 - 9913 Fax: 852 2818 - 5210 E 2 mail: . kuanggm gmail com match and subop tim al fixation methods the biological and bio2 m is3 3 Co2Correspond in g author: Professor W illiam W Lu mechanical factors w ithin the bone tunnel m ight p lay p ivotal role in the long2ter healing p rocess 21 - 22 Departm ent of O rthopaedics and Traumatology Room 907 Lab B lock m . Inflammatory reaction at the 21 Sassoon Road Pokfulam the University of Hong Kong Hong Kong tendon2bone interface insufficiency of undifferentiated cells and 1349第 1 8 卷 第 1 6期 中国矫形外科杂志 Vol118 No1162 0 1 0年 8月 O rthoped ic Journa l of Ch ina Aug12010continuous m icro 2 motion of the tendon graft w ithin the bone tunnel . and have gotten encouraging resultsare all responsible for the tendon 2bone healing in a manner of fi2 37 w In a study from Tai an the authors established an anteriorbrous formation. Moreover it is believed that a mechanical stable cruciate ligament reconstruction model in New Zealand white rab2environment is essential for a tendon graft to achieve p rom ising bits The tendon graft used in the study was sem itendinosus auto2 . .bone integration in the tunnels . graft In the experim ental group the researcher injected 0. 5 m l A t the early healing period which refers to less than 12 weeks CPC into the tendon 2bone interface after the tendon graft wasafter surgery the tendon graft is linked to bone tunnel wall by fi2 . p laced into the bone tunnelsbrous tissues which are typ ically called quot Sharpey quot fi2 The tendon 2bone interface was free of cement in the control group. 3 week after operation many grow ing bone islands were ob2 19 - 20 23,25 bers . Fig 1 However lack of evidence to p rove that .this fibrous tissue along w ith the internal fixation is enough to served w ithin CPC in the tendon 2bone interface. The surface of themaintain the tendon2bone stability and enable the patients to re2 tendon graft and the bone tunnel wall was bonded with new ly for2sume their daily activities A lthough the rehabilitation of the pa2 . med bone tissue rned bone tissue. 6 weeks after operation new ly for . The po2 26 tients should start as early as possible after operation was w idely distributed in the tendon bone interface. The collagentential risk of tendon graft laxity or even pulling out from the bone fibers were matured and organized well anchoring perpendicularly . A s a result patients are com 2 on the surface of the tendon graft A t 24 weeks post2 27 - 28 tunnels is still not elim inated . operation anmonly required to undergo a restricted rehabilitation p rotocol after apparent osteointegration was observed in the tendon 2bone inter2operation w ithout any aggravating activities at least six months to . face resembling a comp lete histological healing The tendon graftp rotect this relative quot weakquot tendon 2bone interface until comp lete was connected to the bone tunnel wall by bony tissue. However 29 tendon osteointegration . So it is advisable to find app roaches to new bone formation was observed on the control group only until 12accelerate the healing p rocess and to imp rove the healing quality of weeks after operation. In the same year another research group from Japan conduc2 30 the tendon graft in the bone tunnel .2 Applica tion of ca lc ium phospha te 2ba sed bone cem en t 38 m ted a si ilar study . In this study a rabbit ACL reconstruction Recently numerous strategies have been investigated to accel2 model was used. A flexor degitorum longus tendon was selected as 31 erate the tendon healing p rocess . Among these strategies local . the graft Before inserting the tendon graft into the bone tunnelsapp lication of bioactive bone cement seem s to be a p rom ising ap 2 2containing solution and a 2 they treated the tendon graft w ith a Ca 31 2-p roach .