保留与不保留残端重建前交叉韧带后移植物腱骨愈合的比较  

Tendon-bone healing in anterior cruciate ligament reconstruction with and without remnantpreservation

作　　者：马子越 巨啸晨[1] 张磊 孙荣鑫[1] Ma Ziyue;Ju Xiaochen;Zhang Lei;Sun Rongxin(First Department of Joint Surgery,Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,Xinjiang Uygur Autonomous Region,China;First Department of Surgery,Armed Police Corps Hospital,Urumqi 830061,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学第六附属医院关节外一科,新疆维吾尔自治区乌鲁木齐市830002 [2]武警兵团总队医院外一科,新疆维吾尔自治区乌鲁木齐市830061

出　　处：《中国组织工程研究》2021年第4期582-587,共6页Chinese Journal of Tissue Engineering Research

基　　金：新疆维吾尔自治区高校科研计划科学研究重点项目(XJEDU2016I027),项目负责人:孙荣鑫。

摘　　要：背景:保残重建前交叉韧带是否可以促进移植物腱骨愈合目前尚有争议,设计实验通过组织学和影像学评估保留残端是否具有促进腱骨愈合的生物学优势。目的:探讨前交叉韧带重建术中保留或不保留韧带残端对移植物腱骨愈合的影响。方法:选取新西兰兔40只随机分为不保残重建组与保残重建组,每组20只。选取跟腱作为移植物,分别将所有标本兔的双侧前交叉韧带切断,不保残重建组完全切除前交叉韧带残端,保残重建组由股骨止点处切断,保留胫骨残端,按照正常兔前交叉韧带解剖结构,选取胫骨与股骨骨道进行重建。并于术后6,12周应用免疫组织化学染色检测移植物血管内皮生长因子、缺氧诱导因子1α的表达强度,CD34免疫组化染色标记移植物微血管密度,MRI、CT观察移植腱信号强度并测量骨隧道宽度。结果与结论:①术后6周,保残重建组中血管内皮生长因子与缺氧诱导因子1α阳性细胞百分比明显高于不保残重建组(P<0.05),微血管密度也明显高于不保残重建组(P<0.05);术后12周,两组中血管内皮生长因子与缺氧诱导因子1α阳性细胞百分比与同手术方式6周组对比均下降(P<0.05),微血管密度较同手术方式6周组均显著升高(P<0.05),但组间比较差异无统计学意义(P>0.05);②术后6周,保残重建组骨隧道扩大程度明显低于不保残重建组,移植腱信号强度低于不保残重建组(P<0.05);12周两组骨隧道扩大程度均减小,移植腱信号强度均减低,组内比较差异显著(P<0.05),组间比较差异无统计学意义(P>0.05);③在该实验条件下,在韧带重建早期,保残重建在移植物再血管化、减少骨隧道扩大等方面明显优于不保残组,展现了一定的生物学优势。BACKGROUND:Whether remnant preservation can improve tendon-bone healing remains a controversy.Experiments were designed to evaluate whether remnant preservation has the biological advantage of promoting tendon-bone healing by histology and imaging.OBJECTIVE:To investigate the effect of preservation of ligament stump on tendon-bone healing in anterior cruciate ligament reconstruction.METHODS:Forty New Zealand rabbits were randomly divided into two groups:anterior cruciate ligament reconstruction group without remnant preservation(group A)and anterior cruciate ligament reconstruction group with remnant preservation(group B),with 20 rabbits in each group.Achilles tendon was selected as the graft,and the bilateral anterior cruciate ligaments of all the rabbits were cut off.In group A,the anterior cruciate ligament stump was completely removed.In group B,the tibia stump was cut off from the femoral stop,and the tibia stump was retained.According to the position of the anterior cruciate ligament of the normal rabbits,the tibia and the femoral canal were selected for reconstruction.At 6 and 12 weeks after surgery,the expression of vascular endothelial growth factor and hypoxia inducible factor-1αwas detected by immunohistochemistry.Graft microvessel density was detected by CD34 immunohistochemical staining.The signal intensity of tendon and the width of bone tunnel were observed by MRI and CT.RESULTS AND CONCLUSION:(1)The percentage of hypoxia inducible factor-1αand vascular endothelial growth factor positive cells in group B was significantly higher than that in group A at 6 weeks after operation(P<0.05).The microvessel density in group B was significantly higher than that in group A(P<0.05).At 12 weeks after operation,the percentage of hypoxia inducible factor-1αand vascular endothelial growth factor positive cells in the two groups decreased 12 weeks after operation compared with that in the same 6-week group(P<0.05).The microvessel density in the two groups increased 12 weeks after operation compared with that in

关 键 词：前交叉韧带 保留残端 腱骨愈合 因子 跟腱 微血管密度 骨隧道 实验 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]