应用重组合异种骨促进前交叉韧带重建术后腱-骨愈合的研究  

Effect of reconstituted bone xenografts on tendon-to-bone healing after anterior cruciate ligament reconstruction

作　　者：潘玮敏[1] 胡蕴玉[1] 魏义勇 毕龙[1] 曹峥[1] 刘民[1] 杨小彬[1] 

机构地区：[1]第四军医大学西京医院全军骨科研究所,西安710032

出　　处：《中国矫形外科杂志》2009年第16期1250-1253,共4页Orthopedic Journal of China

基　　金：军队科研基金课题(编号:06Z057)

摘　　要：[目的]通过影像学、组织学及生物力学手段探讨重组合异种骨(RBX)对前交叉韧带重建术后腱-骨愈合的影响。[方法]25只新西兰白兔,利用双侧趾长伸肌肌腱重建前交叉韧带(ACL),其中一侧移植物两端固定有RBX,另一侧作为对照组,分别于术后2、6、12周取材,进行Micro-CT扫描,组织学染色(包括HE、甲苯胺蓝)以及生物力学检测,观察腱-骨之间愈合状况。[结果]影像学结果显示,术后6、12周RBX治疗组腱-骨之间的骨矿化组织密度(BMD)数值均高于对照组,并具有显著性差异;组织学结果显示,术后2周,RBX组腱-骨之间被大面积不规则分布的软骨样细胞填充;术后6周,治疗组的腱-骨之间已见大量成熟软骨细胞,并开始分泌基质。而对照组术后腱-骨间一直被纤维样结缔组织连接,至术后12周,治疗组部分标本出现类ACL正常肌腱止点。生物力学结果同样证实,RBX组的最大牵拉力均显著高于对照组。[结论]RBX可显著提高ACL重建术后腱-骨之间的愈合,较早恢复膝关节功能。[Objective ] To investigate the effect of reconstituted bone xenografts （RBX） on tendon-to-bone healing by means of imaging,histological and biomechanical studies. [ Method] Anterior cruciate ligament （ACL） reconstruction was performed bilaterally in 25 skeletally mature rabbits using long digital extensor tendon grafts. RBX were implanted into the treated knee of each rabbit ,with the contralateral knees as controls. Every three rabbits were killed at 2,6 and 12 weeks postoperatively for routine histological studies. The samples were processed through Micro CT and subsequent HE and toludine blue staining. The remaining 16 rabbits were sacrificed at 6 and 12 weeks. Their femur-tendon graft-tibia complexes were harvested for subsequent mechanical testing. [ Result] At 6 and 12 weeks after operation,the values of BMD in the RBX group were higher than those in the control group （ P 〈 0.05 ）. Histological findings of the interface between the tendon and bone were different in the two groups. Two weeks after operation,large areas of chondrocyte-like ceils that were fairly disorganized were noted between the tendon and bone in the treat- ment group. Six weeks after operation,more abundant bone formation around the tendon was observed and at 12 weeks,an immature insertion strueture was seen in the treatment group. In biomeehanical evaluation, the maximum pull-out load of the tendon from the bone tunnel in the treatment group was significantly higher than that in the control group 6 and 12 weeks after operation. [ Conclusion] RBX can augment the healing of tendon to bone after ACL reconstruction in a rabbit model.

关 键 词：重组合异种骨 前交叉韧带重建 肌腱 骨道 腱骨愈合 

分 类 号：R687[医药卫生—骨科学]