骨髓浓缩物明胶海绵对膝前交叉韧带重建的影响△

Effect of tendon graft composed with bone marrow concentrate and gelatin sponge on anterior cruciate ligament reconstruc⁃ tion

摘要:

［目的］评价骨髓浓缩物（bone marrow concentrate, BMC）与明胶海绵（gelatin sponge, GS）复合移腱性移植物前交叉韧带（anterior cruciate ligament, ACL）重建的临床效果。［方法］2018 年 1 月—2020 年 1 月，90 例拟行四股腘绳肌腱单束 ACL 重建患者纳入本研究。采用随机数字表法将其分为 3 组，每组 30 例。BMC-GS 组在移植物两端包被 GS，并注入 BMC； BMC 组仅在移植物两端注入 BMC；对照组为常规移植物。比较三组围手术期、随访和影像资料。［结果］三组患者手术时间、切口总长度、术中失血量及切口愈合等级的差异均无统计学意义 （P>0.05）。随访 12 个月以上，随时推移，三组患者 VAS、IKDI、 Lysholm 评分，以及前抽屉试验、Lachman 试验和轴移试验均显著改善（P<0.05）。术后 6 月，VAS、IKDC 和 Lysholm 评分由优至劣均为 BMC-GS 组、BMC 组、对照组，差异均有统计学意义 （P<0.05），但是术前和术后 12 个月，三组间上述指标的差异均无统计学意义（P>0.05）。影像方面，随术后时间推移，三组的隧道内移植物信号强度均显著增加（P<0.05），而 SNR 值均显著下降 （P<0.05）。术后 3、6 个月，BMC-GS 组信号强度和 SNR 值均显著优于 BMC 组和对照组 （P<0.05）。［结论］ 移植物增加骨髓浓缩物与明胶海绵复合物可改进 ACL 重建的临床效果，并促进移植物腱-骨愈合。

Abstract:

[Objective] To evaluate the clinical outcome of tendon graft composed with bone marrow concentrate (BMC) and gelatin sponge (GS) in anterior cruciate ligament (ACL) reconstruction. [Methods] From January 2018 to January 2020, a total of 90 patients who were undergoing single-band ACL reconstruction with quadrupled hamstring tendon graft were enrolled in this study, and were divided into 3 groups with 30 cases in each group by random number table method. In the BMC-GS group the two ends of the tendon graft was coated with GS and injected by BMC, while in the BMC group the two ends of the graft were injected with BMC only, while conventional graft pre- pare was conducted in the control group. The perioperative, follow-up and imaging data were compared among the three groups. [Results] There were no significant differences in operative time, total incision length, intraoperative blood loss and incision healing grade among three groups (P＞0.05) . As time went during the follow-up lasted for more than 12 months, the VAS, IKDI and Lysholm scores, as well as the anterior drawer test, Lachman test and pivot-shift test improved significantly in all the three groups (P＜0.05) . At 6 months after sur- gery, VAS, IKDC and Lysholm scores were significantly ranked from superior to inferior as follows: BMC-GS group ＞ BMC group ＞ the con- trol group (P＜0.05) , but which became not statistically significant among the three groups 12 months postoperatively (P＞0.05) . As results of MRI assessment, the signal intensity of intra-tunnel graft increased significantly (P＜0.05) , whereas the signal to noise ratio (SNR) signifi- cantly decreased in all the 3 group over time (P＜0.05) . At 3 and 6 months postoperatively, the BMC-GS group proved significantly superior to the BMC and control groups in terms of signal intensity and SNR (P＜0.05) . [Conclusion] The tendon graft composed with bone marrow concentrate and gelatin- sponge does improve the clinical outcomes of ACL reconstruction, which implies that it promoted graft tendonbone healing.