骨-髌腱-骨自体移植重建前十字韧带的研究  

Reconstruction of ACL with free autogenous B-PT-B grafts

作　　者：滕星[1] 王满宜[1] 黄啸原[1] 荣国威[1] 黎广平[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华骨科杂志》2005年第8期491-496,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨使用骨-髌腱-骨自体移植重建前十字韧带(ACL)术后1年内重建物生物力学性能和组织学变化。方法在39只成年犬单侧后肢行骨-髌腱-骨自体移植重建ACL手术。术后分别在4、8、12、26和52周时处死动物,对正常对照侧ACL和手术侧重建物在屈膝90°行拉力试验直到完全断裂,记录断裂位置,计算横断面积、强度、刚度和应力,观察关节内和隧道内韧带转化过程及隧道内骨块-隧道壁、髌腱-隧道壁和骨块-髌腱三个界面的组织学愈合过程。结果术后隧道内骨块-隧道壁界面4周时愈合;髌腱-隧道壁界面52周时有Sharpey样纤维跨过,出现潮线,软骨细胞有成行排列的趋势;术后骨块-髌腱界面未钙化的纤维软骨层消失,52周时仍未重现;韧带在关节内和隧道内部分的转化过程相似,其结构均于26周时与正常ACL相似。生物力学试验显示所有重建物均在韧带部断裂。52周时,移植髌腱的强度、刚度和应力分别为对照侧的38%、58%和50%,差异有统计学意义。骨隧道内的骨-骨界面术后4周时愈合,早于骨-腱界面;骨-腱界面52周时表现为间接止点,界面出现成行排列趋势的软骨细胞,界面的愈合过程仍在继续。结论用挤压螺钉固定的重建物在手术4周以后,力学薄弱处始终位于韧带本身,在指导患者进行康复锻炼时不必担心固定止点的力学性能。挤压螺钉固定的止点不仅在术后即刻稳定,而且在止点愈合、韧带化过程中仍然保持力学性能可靠。术后1年时虽然韧带在组织学上与正常ACL相似,但力学性能显著低于正常,在剧烈活动时患者需配带支具等进行保护。Objective To investigate the characteristics of grafts after reconstruction of ACL with autogenous bone-patellar tendon-bone（B-PT-B）grafts. Methods Reconstruction of anterior crueiate ligament with free B-PT-B autograft fixed with interference screw was performed on 39 adult dogs. Mechanical testing was conducted on the grafts by translating the tibia anteriorly with the knee in 90 degrees of flexion.until complete failure. Failure site, cross sectional area, strength, stiffness and stress were documented. After decalcification and HE staining, the transformation of the intra-tunnel and intra-articular ligaments was evaluated, and the histological observation was conducted for the healing in the bone-tunnel, patellar tendontunnel and bone-patellar tendon interface. Results Union occurred in the bone-tunnel interface at 4th week. The patellar tendon-tunnel interface was linked by Sharpey＇s like fibers at 52nd week, the cement line and the tendency of chondrocyte lining were found. Mechanical testing of graft revealed that the rupture always occurred at mid-portion of ligaments instead of pulling-out from the tunnel under tension stress. Compared with the control group, the strength, stiffness and stress of the graft were 38%, 58% and 50% of normal anterior cruciate ligament at 52nd week respectively. Conclusion The union in the bone-tunnel interface occurs at 4th week, much earlier than the healing of the patellar tendon-tunnel interface. The healing of the tendon to tunnel presents to be indirect insertion at 52nd week with alignment of chondrocytes, which signifies the still ongoing of healing process at the interface. After fixation with interference screw for 4 weeks, the tendon proved to be the weakest part in bone-tendon-bone complex. No need to worry about the biomechanical character of the new insertion site during rehabilitation activities. The attachment fixed by interference screw is stable not only immediately after surgery, but also during the healing of the insertion and the transformation of l

关 键 词：前交叉韧带 动物实验 生物力学 组织学 骨-髌腱-骨 前十字韧带 自体移植 重建 生物力学性能 生物力学试验 

分 类 号：R687[医药卫生—骨科学]