兔膝关节内侧副韧带重度损伤后重建手术对关节软骨保护作用的研究  

Protection of articular cartilage by reconstruction after grade III injury of medial collateral ligament of knees in rabbits

作　　者：陈游[1] 冯颜杰[1] 张春雷[1] 张催[1] 朱迎春[1] 

机构地区：[1]中南大学湘雅二医院骨科,湖南长沙410011

出　　处：《中国现代医学杂志》2010年第21期3226-3229,3235,共5页China Journal of Modern Medicine

基　　金：湖南省自然科学基金(No:07JJ5062)

摘　　要：目的通过动物实验研究自体肌腱移植重建膝关节内侧副韧带对膝关节软骨退变的影响,为临床使用肌腱重建手术治疗严重膝内侧副韧带损伤,进而减少骨性关节炎的发生提供实验依据。方法取24只成年新西兰大白兔,两侧膝关节内侧副韧带(MCL)于中段完全切断做成自身对照模型。随机选取实验组,模拟人半腱肌腱重建内侧副韧带进行手术,对照组未行重建手术。术后4、12、16及24周分别安乐死处死6只兔子,通过组织学切片、免疫组织化学和电镜观察膝关节软骨细胞的凋亡及其凋亡调控基因BCL-2的表达情况。结果组织学观察:实验组软骨的表面情况及软骨细胞的排列、形态均好于对照组,而且24周时对照组出现了大量的软骨陷窝内细胞消失。免疫组织化学:实验组和对照组均可见BCL-2阳性表达细胞,实验组中的BCL-2阳性表达细胞所占百分比与对照组比较,差异有显著性(P<0.05)。透射电镜:实验组各组仅出现退变的软骨细胞,未见凋亡的软骨细胞,对照组各组均出现了退变的软骨细胞和凋亡的软骨细胞,在24周组尤其严重。结论 MCL重度损伤后用半腱肌腱重建MCL,能够使软骨细胞的排列和形态较好的维持。MCL重度损伤后用半腱肌腱重建MCL能够减缓软骨的退变,减少软骨细胞的凋亡。【Objective】 To research the effect of medial collateral ligament（MCL） reconstruction using the tendon autograft on the degradation of the cartilage of knee joint in rabbits,so as to provide experimental evidence on healing serious injury of MCL using the reconstruction of tendon in clinic and to reduce the osteoarthritis.【Methods】 Twenty-four ripe New Zealand rabbits were taken.Knee joint medial collateral ligaments（MCL） of both sides were cut from the middle,in order to create self contrast models.Experimental groups were randomly selected.Simulating semi-tendinous tendon was used on the reconstruction of MCL.The contrast group did not carry out the reconstruction surgery.Six rabbits were euthanized respectively in 4,12,16 and 24 weeks after surgery.Through histological section,immunohistochemistry and electron microscope,the cell apoptosis of knee joint cartilage and the expression of apoptosis regulating gene BCL-2 were observed.【Results】 Histological observation： the external situation and arrangement of cartilage in experimental group were better than those in contrast group.Lots of chondrocytes were vanished in 24 w in contrast group.Immunohistochemistry： There were BCL-2 positive chondrocytes in both experimental group and contrast group.Compared with contrast group,the percentage of BCL-2 positive chondrocytes was distinct（P 0.05）.Transmission electron microscope： Some degenerative chondrocytes were only found in every experimental group.All contrast groups had both degeneration and apoptosis which were especially serious in 24 w group.【Conclusion】 After severe injury of MCL,the techniques of reconstruction of semi-tendinous tendon are used to maintain the arrangement and configuration of chondrocytes.Reconstruction of MCL by semi-tendinous tendon after severe aspiration injury could slow down the degeneration of cartilage and decrease apoptosis of chondrocytes.

关 键 词：内侧副韧带 半腱肌腱 重建术 软骨退变 细胞凋亡 

分 类 号：R686.5[医药卫生—骨科学]