不同辐照剂量下兔同种异体半月板移植的大体和组织学研究  

Effect of Gamma Irradiation on the Transplanted Meniscal Allograft in Rabbit Model

作　　者：张晋[1] 陈星佐[2] 宋关阳[1] 李岳[1] 李旭[1] 王雪松[1] 冯华[1] 

机构地区：[1]北京积水潭医院运动损伤科,北京100035 [2]中日友好医院骨科

出　　处：《中国运动医学杂志》2016年第1期11-17,共7页Chinese Journal of Sports Medicine

基　　金：国家自然科学基金(编号81404814)

摘　　要：目的:许多研究认为gamma射线对同种异体移植物生物力学强度的破坏存在剂量依赖性,不过,尚无研究证实这种强度的减低与半月板移植术(MAT)后高的失效率有关。本研究目的为明确应用gamma射线辐照的半月板行MAT术后,移植半月板及关节软骨在形态学与组织学上的变化。方法:60只新西兰大耳白兔均于右侧膝关节行内侧半月板切除术。取下的全部60例半月板分为3组,每组20例,分别接受0 Mrad、1.5 Mrad及2.5 Mrad gamma射线辐照。在每组20例半月板中,随机选取5例半月板行电子显微镜扫描(SEM),剩余的15例半月板作为MAT术供体(3组共45例)。共45只实验兔接受了MAT术,分别为0 Mrad组,1.5 Mrad组及2.5 Mrad组,每组15只。余下的15只不接受MAT术(Meni组),其左膝关节作为阴性对照组(n=15)。所有实验兔于术后24周处死。采用国际软骨修复协会(ICRS)评分评价内侧间室软骨大体形态学改变,应用Masson三色染色并通过Mankin评分评价内侧间室软骨组织学改变。结果:SEM分析结果显示半月板纤维随着gamma射线辐照剂量的增加而破坏程度加剧。在术后24周,移植半月板的形态学评估显示行MAT术的3组间差异无统计学意义,仅在2.5 Mrad组中2例移植半月板存在体部放射状裂。ICRS评分及Mankin评分对照组最低,Meni组最高(P<0.05)。接受MAT术的3组中,2.5 Mrad组的ICRS评分及Mankin评分均高于0 Mrad组及1.5 Mrad组,差异存在统计学意义。而1.5Mrad组与0 Mrad组ICRS评分及Mankin评分相近,差异无统计学意义。结论 :对于新西兰大耳白兔,尽管在gamma射线辐照后半月板纤维存在一定程度的破坏,但只要gamma射线辐照剂量不高于1.5 Mrad,则不会增加MAT术的失败率。Purpose The aim of this study was to investigate the effects of gamma irradiation on the joint meniscus and cartilage after meniscal allograft transplantation（MAT）. Methods Sixty New Zealand white rabbits underwent total right knees medial meniscectomy. Every 20 of the excised menisci were sterilized and respectively received 0 Mrad of gamma irradiation（0 Mrad group）,1.5 Mrad of gamma irradiation（1.5 Mrad group）and 2.5 Mrad of gamma irradiation（2.5 Mrad group）. 5 menisci in each group were randomly chosen for electron microscopic scanning（Meni group）,and the remaining 45 were used as allografts for MAT. The left knees of the rabbits were served as control group. All rabbits were sacrificed 24 weeks after the surgery. Their cartilage of the medial compartment was evaluated macroscopically using the International Cartilage Repair Society（ICRS）score and the histology of the cartilage using the Mankin score based on the Masson trichrome staining. Results The damage of meniscal collagen fibers deteriorated gradually with the increasing dose of gamma irradiation. There was no significant differences in overall macroscopic scores of the transplanted meniscal tissue among the 3 MAT groups 24 weeks after the surgery,with the only exception of the 2 in 2.5Mrad group（partial radial tears in caudomedial part of the meniscus）. The lowest ICRS scores and the Mankin scores appeared in the control group and the highest in Meni group（P〈 0.05）. The ICRS scores and Mankin scores in 2.5 Mrad group were significantly higher than in 0 Mrad group and the 1.5 Mrad group（P 〈0.05）,while those between 1.5 Mrad group and 0 Mrad group were insignificant. Conclusions The failure rate of MAT surgery increased insignificantly if the gamma irradiation dose was less than 1.5 Mrad for New Zealand white rabbits.

关 键 词：Gamma射线辐照 组织学 形态学 半月板移植术 

分 类 号：R873[医药卫生—运动医学]