骨隧道大小对前交叉韧带止点转归的影响  

EFFECT OF BONE TUNNEL DIAMETER ON ANTERIOR CRUCIATE LIGAMENT INSERTION OUTCOME

作　　者：张培[1] 刘泉[1] 周建生[1] 刘振华[1] 肖玉周[1] 项平[2] 胡汝麒[1] 

机构地区：[1]蚌埠医学院第一附属医院骨科,安徽蚌埠233000 [2]蚌埠医学院第一附属医院中心实验室,安徽蚌埠233000

出　　处：《中国修复重建外科杂志》2008年第5期528-532,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：安徽省卫生厅科学研究基金资助项目(2002A015)~~

摘　　要：目的观察前交叉韧带(anterior cruciate ligament,ACL)重建中不同直径骨隧道对移植韧带止点转归的影响。方法日本大耳兔90只,雌雄不拘,体重2.5～3.0kg,随机分为3组,每组30只。制备ACL止点转归动物模型,分成移植韧带直径(d)与骨隧道直径(D)之比(d/D)为1/1组(A组)、1/1.5组(B组)和1/2组(C组)。观察术后一般情况,并于术后4、8和16周每组处死10只动物,行移植止点大体、组织学观察及最大抗拉力载荷实验。结果3组动物术后伤口愈合佳。平均双下肢行走时间:A组1.5d、B组2.0d及C组3.5d。大体观察:术后4周,A、B组骨隧道口软组织生长多于C组;8周A、B组骨隧道口已无缝隙,C组无改善;16周A、B组与正常韧带止点相同,C组未形成止点结构。组织学观察:术后4周各组肌腱与骨隧道间充满疏松结缔组织;8周A、B组潮线结构不连续,C组未见潮线样结构;16周A、B组出现连续潮线样结构,C组仍未形成潮线样结构。术后4周,A、B及C组最大抗拉力载荷分别为(75.44±7.06)、(91.37±6.14)和(126.91±4.61)N;8周为(74.31±4.81)、(88.30±7.46)和(124.34±8.44)N;16周为(62.20±5.32)、(71.53±5.99)和(83.62±5.69)N;术后各时间点A、B组间最大抗拉力载荷差异无统计学意义(P>0.05),A、B组与C组间差异有统计学意义(P<0.01)。结论在ACL重建中d/D为1/1.5时,对止点转归无明显影响,但d/D小于此范围将影响移植物止点的转归。Objective To observe the histology change of the insertion using different diamertrical bone tunnel in anterior cruciate ligament （ACL） reconstruction. Methods Ninety Japanese rabbits were selected, wihout female and male limit, weighing 2.5-3.0 kg, and were randomly divided into 3 groups, 30 in each group. The ratio of transplantation ligament diameter and bone tunnel diameter was 1/1 （group A）, the ratio was 1/1.5 （group B）, and the ratio was 1/2 （group C）. Bone tunnel observation and histology observation were carried out in the 4th, 8th and 16th weeks postoperat ively. Results Wound healed well in 3 groups. The mean time of walking functional recovery was 1.5, 2.0 and 3.5 days in groups A, B and C respectively. After 4 weeks of operation, more soft tissues at tunnel entry were observed in group A and group B than in group C; after 8 weeks of operation, there was no crevice at bone-tunnel entry of the groups A and B, there was no improvement in group C; after 16 weeks of operation, groups A and B showed the normal insertion, group C had no normal insertion. Histology observation： in groups A, B and C, bone-tunnel was filled with loose connective tissue after 4 weeks of operation; group A and group B emerged the discontinuation ACL insertion tidal line after 8 weeks of operation, group C had no insertion; groups A and B emerged the similarity normal ACL insertion tidal line structure after 16 weeks of operation, but group C had no this structure. The results of ultimate tensile strength in groups A, B and C were （75.44 ± 7.06）, （91.37 ± 6.14） and （126.91 ± 4.61） N respectively at 4 weeks; the results were （74.31 ± 4.81）, （88.30 ± 7.46） and （124.34±8.44） N respectively at 8 weeks; and the results were （62.20 ± 5.32）, （71.53 ± 5.99） and （83.62 ± 5.69） N respectively at 16 weeks. There was no significant difference between group A and group B （P 〉 0.05）, and there were significant differences between groups A, B and group C （P 〈 0.05）. Conc

关 键 词：前交叉韧带 止点 转归 骨隧道 兔 

分 类 号：R687.2[医药卫生—骨科学]