嵌入固定法重建前交叉韧带:肌腱-骨和肌腱结的生物力学和组织学研究  

A biomechanical and histologial study of reconstruction of anterior cruciate ligament with tendon knot and bone-tendon implant fixation

作　　者：周密[1] 刘玉杰[1] 柴伟[1] 陈桂明[1] 汪爱媛[1] 田月[1] 李光辉[1] 赵斌[1] 

机构地区：[1]解放军总医院骨科,北京市100853

出　　处：《中华老年多器官疾病杂志》2006年第4期288-291,296,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：全军"十五"攻关课题资助项目(01MA123)

摘　　要：目的探讨肌腱-骨和肌腱结两种移植物重建前交叉韧带(ACL)的生物力学效果和组织学转归情况。方法生物力学部分采用猪膝关节45个模拟交叉韧带重建,实验分为:骨-髌腱-骨(B-PT-B)界面螺钉固定法(n=11)、股骨端单纯肌腱结(n=13)和肌腱-骨(n=11)嵌压固定法;猪正常膝关节(n=8)ACL作为实验对照组。观察最大载荷拔出、刚度和最大位移等指标,数据进行统计学处理。组织学部分用10只山羊膝关节为实验模型,股骨隧道呈倒置瓶颈状,分别以髌腱-胫骨结节骨块或趾长伸肌腱结为移植物,在股骨隧道内嵌压固定重建前交叉韧带。术后4、8、12、16周取材,分别进行放射学、大体形态和组织切片检查,观察隧道宽度变化及移植物的组织学转归。结果最大载荷:肌腱结和肌腱-骨嵌压固定法>B-PT-B界面螺钉固定,前者可以满足正常生理强度需求。两组移植物术后各时间点放射检查未见隧道扩大;HE染色检查显示12周后有明显的腱-骨连接形成。结论股骨端肌腱结和肌腱-骨两种移植物采用嵌压固定法重建ACL,其最大载荷强度>B-PT-B界面螺钉固定法,能满足日常生理活动需求,有利于移植物的愈合。Objective To evaluate the biomechanical and histological outcome of anterior cruciate ligament （ACL） reconstruction with tendons knot and bone-tendon implant fixation. Methods Forty-five porcine knees were divided into 4 groups： 11 knees of bone-patellar tendon-bone（B-PT-B） group had their ACL reconstructed with interface screw, 13 kness were reconstructed with tendon knot implant fixation, 11 were reconstructed with bone-tendon implant fixation, and 8 normal knees served as controls. Ultimate strength and stiffness were evaluated as the biomechanical parameters of reconstruction. For histological study, 10 goats were chosen as the animal models. A customized reamer was used to built the bottleneck-like femoral tunnel and the patellar tendon-tibial tuberosity bone block or extensor digitorum longus was taken as the autograft. The knot was tied on the tibial bony bridge for fixation. The animals were sacrificed at 4th,8th, 12th,and 16th weeks postoperatively. Radiological ,macromorphological, and histological examinations were carried out. Results Both tendon knots and bone-tendon implant fixation had greater ultimate strength than B-PT-B （P〈0.05）. Radiological studies did not find evidence of enlargement of the bone tunnel. Histological studies showed obvious bone-tendon ingrowth and bone block-tunnel incorporation 12 weeks postoperatively. Conclusions Reconstruction of ACL with tendons knot or bone-tendon implant fixation showed excellent biomechanical properties and could satisfy daily physiological demand. They also exhibited satisfactory biological fixation results.

关 键 词：交叉韧带 肌腱移植 动物实验 生物力学 组织学 

分 类 号：R684[医药卫生—骨科学]