保留残迹对骨隧道封闭前交叉韧带重建移植物关节内愈合的影响  

Effect of preserved remnant on intra - articular graft healing under blockage of bone tunnels in anterior cruciate ligament reconstruction

作　　者：高加智[1] 孙磊[1] 

机构地区：[1]解放军第88医院全军骨科中心,山东泰安271000

出　　处：《中国矫形外科杂志》2013年第18期1877-1881,共5页Orthopedic Journal of China

摘　　要：[目的]探讨保留残迹对骨隧道封闭状态下前交叉韧带(anterior cruciate ligament,ACL)重建移植物关节内愈合的影响。[方法]采用成年新西兰兔30只为实验动物,切断双侧ACL,一侧保留2 mm胫骨与股骨端ACL残迹,对侧完全切除残迹,取其跟腱为移植物,且移植物-骨隧道界面均用聚乙烯膜封闭,行ACL重建。将动物随机分为3亚组,分别于术后第4、8和12周行大体形态与组织学评估。[结果]术后4、8、12周,保留残迹组移植物无明显松弛,被滑膜覆盖,表面有新生血管形成,而切除残迹组移植物松弛、变细,滑膜覆盖与血管增生缓慢,各时间点保留残迹组的大体形态评分均高于切除残迹组,两组间差异均有统计学意义(P<0.05)。术后各时间点,保留残迹组移植物在细胞增殖、血管再生、胶原纤维改建、基质糖蛋白合成等方面均优于切除残迹组,两组间各时间点组织学评分差异均有统计学意义(P<0.05)。[结论]保留残迹可促进骨隧道封闭状态下ACL重建移植物关节内段的细胞增生、再血管化和组织基质更新塑型。提示临床保留残迹ACL重建是一种合理促进移植物愈合的技术方法。[Objective]To explore the impact of preserved remnant on intra-articular graft healing under blockage of bone tunnels in anterior cruciate ligament（ACL） reconstruction.[Method]Thirty adult New Zealand rabbits were used in this experimental study.As cutting bilateral ACLs,2 mm remnants on both tibial and femoral ends were preserved on one side while the remnants were completely removed on the contralateral side at random.Subsequently,ACLs were reconstructed with achilles tendon graft under blockage of graft-bone interfaces with polyethylene membrane.The animals were divided into 3 subgroups,with 10 animals in each subgroups.Gross and histological evaluations were conducted respectively at 4,8,and 12 weeks postoperatively.[Result]The grafts in the preserved remnant group were not significantly relaxed with time,associated with progressive synovial coverage and new blood vessel formation on the graft,by contrast,the grafts in the removed remnant group were relaxed and thinned over time,combined with decreased synovial coverage and vessel formation.Gross scores were statistically higher in the preserved remnant group than in the removed remnant group at all time points（P 0.05）.Additionally,the intra-articular grafts in the preserved remnant group presented enhanced cellular proliferation,revascularization,remodeling of collagen,and synthesis of glycoprotein in the matrix compared to the removed remnant group.Histological scores were statistically higher in the preserved remnant group than in the removed remnant group at all time points（P 0.05）.[Conclusion]The preserved remnant improves cellular proliferation,revascularization,and turnover of the matrix within the intra-articular grafts in ACL reconstruction under blockage of the tendon-bone interfaces.It implies that preserved remnant is reasonable approach for enhancing graft healing of ACL reconstruction in clinical setting.

关 键 词：膝关节 前交叉韧带重建 残迹 移植 愈合 

分 类 号：R687.4[医药卫生—骨科学]