Objective: To observe the effect and significance of autologous fibrin clot on tendon-bone healing after anterior cruciate ligament (ACL) reconstruction.
Methods: Between October 2014 and January 2016, 34 patients (34 knees) with ACL injury were enrolled in the study. During ACL reconstruction, autologous fibrin clot was used in 17 cases (trial group) and was not used in 17 cases (control group). The anterior drawer test, Lachman test, and axial displa-cement test were positive in 2 groups before operation. There was no significant difference in gender, age, causes of injury, injury side, disease cause, and preoperative knee joint activity, Lysholm score, and American Hospital for Special Surgery (HSS) score between 2 groups ( P>0.05), with comparable. The results of anterior drawer test, Lachman test, and axial displacement test were recorded and compared between 2 groups after operation. The knee joint activity, Lysholm score, and HSS score were used to evaluate the knee function recovery at 6, 24, and 48 weeks after operation; the graft signal intensity, graft signal to noise ratio, bone tunnel expansion, and graft tendon-bone node T2 value were measured.
Results: All patients were followed up 48 weeks. Surgical incision healed at stage I. No joint infection and joint adhesion occurred. The drawer test, Lachman test, and axial shift test were negative in 2 groups. At 6, 24, and 48 weeks after operation, the Lysholm score of trial group was significantly higher than that of control group ( P<0.05); there was no significant difference in knee joint activity between 2 groups ( P>0.05). The HSS score of trial group was significantly higher than that of control group at 24 and 48 weeks ( P<0.05), but no significant difference was found at 6 weeks ( P>0.05). MRI measu-rement showed that there was significant difference in graft signal intensity, bone tunnel expansion, and graft signal to noise ratio between 2 groups at 6, 24, and 48 weeks after operation ( P<0.05). There was no significant difference in graft tendon-bone node T2 value between 2 groups ( P>0.05) at 48 weeks after operation, but difference was significant at 6 and 24 weeks ( P<0.05).
Conclusion: Autologous fibrin clot can effectively enhance graft revascularization, and accelerate the process of tendon-bone healing after ACL reconstruction.
目的: 探讨自体血纤维蛋白凝块对前交叉韧带（anterior cruciate ligament，ACL）重建术后腱-骨愈合的作用及意义。.
方法: 以 2014 年 10 月—2016 年 1 月收治并符合选择标准的 34 例（34 膝）ACL 损伤患者作为研究对象，随机分为两组（ n=17）；ACL 重建术中试验组采用自体血纤维蛋白凝块，对照组不作该处理。两组患者术前前抽屉试验、Lachman 试验及轴移试验均为阳性。两组患者性别、年龄、致伤原因、损伤侧别、受伤至手术时间以及术前膝关节活动度、Lysholm 评分、美国特种外科医院（HSS）评分等一般资料比较，差异均无统计学意义（ P<0.05），具有可比性。记录并比较两组患者术后前抽屉试验、Lachman 试验及轴移试验检查结果；术后 6、24、48 周，检查患膝关节活动度、Lysholm 评分、HSS 评分，评定膝关节功能恢复情况；行 MRI 检查，测量移植物信号强度、信噪比以及骨隧道扩大程度及移植物腱-骨结点 T2 值。.
结果: 两组患者术后均获随访 48 周。术后切口均Ⅰ期愈合，无 1 例出现关节内感染及关节粘连。术后两组患者前抽屉试验、Lachman 试验及轴移试验均为阴性。术后 6、24、48 周，试验组 Lysholm 评分均明显高于对照组（ P<0.05）；而两组膝关节活动度比较差异无统计学意义（ P>0.05）。术后 6 周，两组 HSS 评分比较差异无统计学意义（ P>0.05）；24、48 周时试验组 HSS 评分明显高于对照组（ P<0.05）。MRI 复查显示，术后 6、24、48 周两组移植物信号强度、骨隧道扩大程度、移植物信噪比比较，差异均有统计学意义（ P<0.05）。术后 6、24 周两组移植物腱-骨结点 T2 值比较，差异有统计学意义（ P<0.05）；48 周时比较差异无统计学意义（ P>0.05）。.
结论: ACL 重建术中采用自体血纤维蛋白凝块，能够有效促进移植物再血管化、加快腱-骨愈合进程。.
Keywords: Anterior cruciate ligament; autologous fibrin clot; ligament reconstruction; tendon-bone healing.