羟基磷灰石修饰的多孔螺钉对腱骨愈合的研究  

Tendon-bone healing with hydroxyapatite modified porous screw

作　　者：王亚飞[1] 任铖真 王志远 李鹏举 孔富岗 田科[1] Wang Yafei;Ren Chengzhen;Wang Zhiyuan;Li Pengju;Kong Fugang;Tian Ke(Department of Orthopedic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Joint Surgery,Xi’an Honghui Hospital,Xi’an 710054,China;Knee and Ankle Department of Sports Medicine,Xi’an Honghui Hospital,Xi’an 710054,China;Department of Orthopedic Surgery,Xihua County People’s Hospital,Zhoukou 466699,China)

机构地区：[1]郑州大学第一附属医院骨科,郑州450052 [2]西安市红会医院关节外科,西安710054 [3]西安市红会医院运动医学膝踝科,西安710054 [4]西华县人民医院骨科,周口466699

出　　处：《中华实验外科杂志》2023年第1期119-122,共4页Chinese Journal of Experimental Surgery

基　　金：2022年河南省高等学校重点科研项目(22A320014);2020年河南省科技攻关项目(202102310214);2017年陕西省重点研发计划(S2017-ZDYF-YBXM-SF-0764)。

摘　　要：目的观察羟基磷灰石(HA)修饰的3D打印左旋聚乳酸(PLLA)多孔螺钉用于兔前交叉韧带(ACL)重建术后肌腱-骨愈合情况。方法通过3D打印机制备具有良好正交孔隙结构的PLLA多孔螺钉。通过静电层层自组装技术将HA附着在多孔螺钉上。将30只12周龄新西兰雄性大白兔(由郑州大学动物实验中心提供),根据简单随机分组法分为PLLA组和PLLA-HA组,PLLA组仅使用多孔螺钉固定移植肌腱,PLLA-HA组使用HA修饰的多孔螺钉固定移植肌腱。分别于术后6周和12周将每组动物随机各处死5只,进行组织学检测。每组中余下5只进行Micro-CT和生物力学检测。组间比较采用两独立样本t检验。结果组织学显示,术后6周肌腱-骨界面处有胶原蛋白及网状纤维生成,两组间无明显骨整合,但PLLA-HA组有软骨细胞形成。术后12周,两组肌腱-骨界面胶原纤维增多。PLLA组在肌腱-骨界面处可见骨小梁生成,PLLA-HA组可见较成熟的骨小梁,且与移植肌腱出现骨整合。术后12周Micro-CT示,在PLLA-HA组中,反映骨性结构的骨体积分数[BV/TV=(36.46±3.45)%],骨小梁分离率[Tb.Sp=(0.35±0.04)mm]等指标均优于PLLA组[BV/TV=(25.59±3.22)%,t=-5.147,P<0.05;Tb.Sp=(0.64±0.19)mm,t=3.304,P<0.05],组间比较差异均有统计学意义(P<0.05)。术后12周测得PLLA-HA组极限抗拉负荷[(83.74±12.43)N],刚度[(14.16±3.53)N/mm],较PLLA组差异有统计学意义[极限抗拉负荷为(54.70±12.58)N,t=-3.671,P<0.05;刚度为(10.42±0.71)N/mm,t=-2.230,P<0.05]。结论HA修饰的3D打印PLLA多孔螺钉可以通过增加骨的诱导性促进骨的生长,加快肌腱在骨隧道内的骨整合。Objective To observe the tendon-bone healing of rabbit anterior cruciate ligament(ACL)reconstruction with hydroxyapatite(HA)modified 3D printed poly L-lactic acid(PLLA)porous screw.Methods The PLLA porous screws were prepared with good orthogonal pore structure by 3D printing mechanism,then HA was attached to the porous screw by electrostatic layer-by-layer self-assembly technique.A total of 3012-week-old male New Zealand white rabbits were divided into PLLA group and PllA-HA group by the simple random grouping method.Only the grafted tendon was fixed with porous screws in the PLLA group,and the grafted tendons were fixed with the porous screws modified by HA in the PLLA-HA group.A total of 5 animals in each group were randomly killed at 6th and 12th week after operation,and histological examination was performed.The remaining 5 rabbits in each group were examined by Micro-CT and biomechanics.Two independent samples t-test was used for comparison between groups.Results Histology showed that collagen and reticular fibers were produced at the tendon-bone interface at 6th week after operation,and there was no obvious osseointegration in both groups,but chondrocytes were formed in the PLLA-HA group.At 12th week after operation,the collagen fibers increased at the tendon-bone interface in both groups.Trabecular formation could be seen at the tendon-bone interface in PLLA group,and more mature trabecular bone could be seen in PLLA-HA group,and osseointegration with transplanted tendon could be seen.At 12th week postoperatively,Micro-CT showed that the bone volume fraction[BV/TV=(36.46±3.45)%]and trabecular separation rate of bone structure[Tb.Sp=(0.35±0.04)mm]in PLLA-HA group were better than those in PLLA group[BV/TV=(25.59±3.22)%,t=-5.147,P<0.05;Tb.Sp=(0.64±0.19)mm,t=3.304,P<0.05].At 12th week postoperatively,the failure load[(83.74±12.43)N]and stiffness[(14.16±3.53)N/mm]of PLLA-HA group were significantly different from those of PLLA group[failure load:(54.70±12.58)N,t=-3.671,P<0.05;stiffness:(10.42±0.71)N/m

关 键 词：3D打印 左旋聚乳酸 羟基磷灰石 前交叉韧带 肌腱-骨愈合 

分 类 号：R687.4[医药卫生—骨科学]