前交叉韧带重建的移植物选择

本人水平有限，翻译不准之处，望各位指正，大家共同进步~Graft Selection for Anterior Cruciate Ligament Reconstruction：A Level I Systematic Review Comparing Failure Rates and Functional Outcomes前交叉韧带重建的移植物选择：一篇将失败率与功能性结局指标同时比较的Ⅰ级循证系统综述KEYWORDSAnterior cruciate ligament Bone-patellar tendon-bone composites Combined semitendinosus and gracilis hamstring tendons Revision关键词：前交叉韧带骨-髌韧带-骨移植物联合应用半腱肌和股四头肌腘绳肌腱翻修Tear of the anterior cruciate ligament (ACL) is the most common ligamentous injury of the knee. Reconstructing this ligament is often required to restore functional stability of the knee.1,2 Despite the popularity of the procedure, the preferred graft remains controversial. Ideally, the graft should have similar characteristics as the native ACL. Regardless of graft type, the biologic and mechanical properties of the graft material should provide a favorable setting for early biologic incorporation, be amenable to secure fixation, and limit potential morbidity related to donor site.前交叉韧带（ACL）撕裂是最常见的膝关节韧带损伤。

韧带重建的目的就是要恢复膝关节的功能性稳定。

尽管（重建）过程各异，但移植物的选择仍有争议。

理想的移植物应该与天然ACL具有相似的特性。

尽管移植物类型各异，但其生物学及力学特性都应该为（重建后的）早期生物学整合提供有利环境，有利于安全固定，并限制供体部位潜在的发病率。

Many graft options are available for ACL reconstruction, including different autograft and allograft tissues. Autografts include bone-patellar tendon-bone composites (PT), combined semitendinosus and gracilis hamstring tendons (HT), and quadriceps tendon. Allograft options include the same types of tendonsharvested from donors, in addition to Achilles and tibialis tendons. Tissue-engineered anterior cruciate grafts are not yet available for clinical use, but may become a feasible alternative in the future.ACL重建有多种移植物可供选择，包括自体组织移植物和异体组织移植物。

自体移植物包括骨-髌韧带-骨移植物（PT）、联合应用半腱肌骨薄肌腘绳肌腱（HT）和股四头肌腱。

除了跟腱和胫骨肌腱之外，还包括取自供者的相同类型的肌腱。

组织工程生产的ACL尚未用于临床，但其将来可能成为一种可行的ACL替代物。

For the past few decades, PT autograft has been the gold standard for ACL reconstruction. Reasons for this include the strength of the tissue, relative ease of harvest, and bone-to-bone healing with secure fixation. More recently, HT autografts have joined PT in surgeons‘ popularity.3 The recent trend toward increased use of HT resulted from concerns with use of PT relating to a potential negative effect on the knee extensor mechanism and donor site morbidity, including anterior knee pain and risk for patella fracture.4 Nevertheless, despite their increasing popularity, HT grafts also have potential limitations, including slower soft tissue graft-tunnel healing compared with bone-to-bone healing with PT grafts, potential for tunnel widening and graft laxity, and functional hamstring weakness resulting from graft harvesting.5,6在过去的几十年中，PT已经成为ACL重建（移植物选择）的金标准。

原因包括其组织强度、（移植物）较易获得和安全固定的骨骨愈合（程度）。

近来，HT移植物已越来越受到外科医生的欢迎。

鉴于PT可能对膝关节伸肌有潜在的消极影响和提高供体部位病变率（包括膝关节前疼痛和髌骨骨折），HT的应用有逐渐升高的趋势。

然而，尽管越来越受欢迎，但HT也有其潜在的限制，包括与PT的骨骨愈合相比的减慢的软组织移植物隧道愈合（速度），潜在的骨隧道扩大和移植物松弛，以及由移植物采集引起的功能性股薄肌无力。

There are several randomized controlled trials (RCTs) in the literature comparing the two most popular graft choices, PT and HT, either used as autografts or allografts. Many of the systematic reviews and meta-analyses in the literature that investigate graft choice for ACL reconstruction are biased by their inclusion of inadequately randomized trials that are not true level I studies.7–9 Also, functional outcomes,rather than graft failure, tend to be the focus of these reviews. The authors believe, however, that graft failure represents a critically important outcome measure in ACL reconstruction, which has not been given enough attention in previous systematic reviews and meta-analyses. The purpose of this systematic review is to assess whether one of the popular grafts (PT and HT) is preferable for reconstructing the ACL. For this objective the authors selected only true level I studies that compared these graft choices in functional clinical outcomes, failure rates, and other objective parameters following reconstruction of the ACL.无论是作为自体移植物还是异体移植物，对于PT和HT的选择，已有数篇随机对照试验（RCT）对其进行比较。

许多研究ACL重建移植物选择的系统综述和meta分析因为不完善的随机试验而造成偏倚，而不能称为真正的Ⅰ级循证研究。

而且，这些综述往往关注于功能性结局指标而非移植失败率。

作者认为，作为一项非常重要的ACL重建结局评价指标，移植失败率并没有在以往的系统综述和meta分析中得到足够的重视。

本综述的目的就是评估哪一种移植物（PT或HT）更适合于ACL重建。

因此，作者选择了将功能性结局指标、失败率和其他客观参数进行比较的真正的Ⅰ级循证研究。

METHODSA systematic literature review was performed using the following data sources: MEDLINE with OVID and PubMed (basic search, related articles, clinical queries search), EMBASE, and the Cochrane Central Register of Controlled Trials for relevant articles in the English language. Bibliographies of the identified articles on this topic were also reviewed. In addition, a manual search of recent pertinent hard copy journals from the previous 6 months was undertaken to identify journal articles that may not yet have been included in electronic databases.方法本系统综述的相关英文文献是从以下数据库：基于OVID 和PubMed平台的MEDLINE（基本检索、相关文献、临床疑问检索）、EMBASE和Cochrane随机对照试验注册中心。