兔自体骨膜包裹同种异体肌腱移植对腱-骨愈合的影响  

EFFECTS OF AUTOLOGOUS PERIOSTEUM WRAPPING ALLOGENIC TENDON GRAFT ON TENDON-BONE HEALING INSIDE A BONE TUNNEL IN RABBITS

作　　者：龙显斌[1] 陈志伟[1] 曹盛俊[1] 

机构地区：[1]南华大学附一医院骨科,湖南衡阳421001

出　　处：《中国修复重建外科杂志》2008年第10期1255-1258,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：湖南省科委及衡阳市科委资助项目(06KJ3135;06kj31)~~

摘　　要：目的探讨兔同种异体肌腱表面包裹自体骨膜植入骨隧道对移植肌腱与骨隧道之间界面愈合的影响。方法健康4～5月龄新西兰白兔20只,体重2.5～3.0kg,随机取一侧后肢作为实验组,另一侧后肢作为对照组。以同种异体肌腱在兔胫骨干骺端建立腱-骨固定模型,实验组骨隧道肌腱表面包裹自体骨膜,骨膜生发层朝向骨隧道;对照组骨隧道肌腱表面不包裹自体骨膜。分别于术后4、8周取标本作腱-骨界面的组织学检查(n=2),并进行最大拔出负荷的生物力学测试(n=8)。结果术后4、8周标本大体观察,实验组骨隧道口周围新生骨较多;对照组新生骨少或不明显。组织学观察:术后4周实验组骨膜生发层内有大量间充质细胞增生,出现明显的膜内成骨,沿新生骨小梁周围可见大量骨母细胞呈栅形排列,新生骨小梁与骨膜延续;对照组腱-骨界面间无明显新生骨形成,有疏松结缔组织填充,腱-骨间连接较疏松。术后8周实验组新生骨和肌腱与骨隧道连接紧密,无间隙,新生骨量多,新生骨排列比较规则、整齐,腱-骨界面可见潮线形成,类似于正常腱-骨附着结构,骨膜内成纤维细胞增殖活跃,骨膜与肌腱间有较多纤维连接;对照组腱-骨界面局部有新生骨形成,排列紊乱,腱-骨间可见较多胶原纤维连接。术后4、8周,实验组最大拉出或拉断强度分别为(35.03±1.21)N/cm和(42.36±1.31)N/cm,对照组分别为(26.14±6.13)N/cm和(31.63±6.87)N/cm,两组比较差异均有统计学意义(P<0.05)。结论兔自体骨膜包裹同种异体肌腱移植可缩短腱-骨间成骨时间,提高愈合强度,加速腱-骨间愈合。Objective To explore the situation of tendon-bone healing when aUogenic tendon graft is wrapped with autologous periosteum around the tendon in rabbits. Methods Twenty healthy New Zealand white rabbits with the age of 4-5 months were used in the experiment, weighing 2.5-3.0 kg. One-side posterior limb was selected randomly as the test, and the contralateral limb was served as the control at the same time. The allogenic tendon graft was designed as a tendon-bone model in the proximal tibial metaphysis of rabbits. The portion of tendon in the bone tunnel was wrapped with autologous periosteal graft in which the cambium layer was facing the bone tunnel in the experimental group, while the portion of tendon in the bone tunnel was not wrapped with autologous periosteal graft in the control group. The histologic examination of the tendon-bone interface （n=2） and the biomechanical test for maximal pullout load （n=8） were conducted 4 and 8 weeks after operation, respec tively. Results All specimens were observed with naked eyes 4 and 8 weeks after the operation. Many new bones around bone tunnel outlet were seen in the experimental group, while a few or few new bones were seen in the control group. Four weeks after operation, histological observation showed there were a lot of proliferative mesenchymal cells in the periosteal germinal layer in the experimental group and conspicuous membrane bone formation was obvious. The arrangement of massive osteoblasts around newborn bone trabecula was similar to palisade. The newborn bone trabecula was linked with the periosteum. Some loose connective tissues and few newborn bones between the tendon graft and the bone tunnel were seen in the control group, and the connection of them was loose. Eight weeks after operation, the connection between the tendon graft and the bone tunnel was tight and no gap existed in the experimental group. The number of newborn bones was large and their arrangement was relatively regular. The tidemark line was seen between the tendon graft and t

关 键 词：骨膜 同种异体肌腱 腱-骨愈合 兔 

分 类 号：R687.2[医药卫生—骨科学]