内减张技术辅助前交叉韧带重建促进滇南小耳猪跟腱移植物韧带化  

Internal tension relieving technique assisted anterior cruciate ligament reconstruction to promote ligamentization of Achilles tendon grafts in small ear pigs in southern Yunnan province

作　　者：熊波涵 王国梁[1] 余洋[1] 薛文强 余鸿 刘津瑞 阮朝晖 李雅娟 刘昊龙 董开颜 龙丹 陈钊 Xiong Bohan;Wang Guoliang;Yu Yang;Xue Wenqiang;Yu Hong;Liu Jinrui;Ruan Zhaohui;Li Yajuan;Liu Haolong;Dong Kaiyan;Long Dan;Chen Zhao(Department of Sports Medicine,First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan Province,China;Department of Anesthesiology,First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan Province,China;School of Public Health,Southwest Medical University,Luzhou 646000,Sichuan Province,China)

机构地区：[1]昆明医科大学第一附属医院运动医学科,云南省昆明市650032 [2]昆明医科大学第一附属医院麻醉科,云南省昆明市650032 [3]西南医科大学公共卫生学院,四川省泸州市646000

出　　处：《中国组织工程研究》2025年第4期713-720,共8页Chinese Journal of Tissue Engineering Research

基　　金：云南省技术创新人才项目(202105AD160018),项目负责人:王国梁;昆明医科大学硕士研究生教育创新基金资助项目(2023S061),项目负责人:熊波涵;昆明医科大学第一附属医院院内博士科研基金项目(2023BS022),项目负责人:余洋。

摘　　要：背景:前期研究已经成功建立了内减张技术联合自体跟腱重建前交叉韧带的滇南小耳猪动物模型,并验证了模型的稳定性和可靠性,但内减张技术能否促进自体跟腱移植物的韧带化进程问题仍未被研究。目的:从大体观、组织学、电镜检测多方面探讨普通重建与内减张重建前交叉韧带韧带化进程的差异。方法:选取30只成年雌性滇南小耳猪,左后肢膝关节取同侧膝关节跟腱行前交叉韧带重建(普通组n=30),右后肢膝关节取同侧膝关节跟腱联合内减张增强系统行前交叉韧带重建(减张组n=30),以自体右前肢作为对照组,暴露前交叉韧带但不行离断及手术处理。在术后12,24,48周分别处死10只动物,取左右膝关节标本行大体形态学观察评估移植物形态,MAS评分评估各个时间点韧带优良率,苏木精-伊红染色评估韧带移植物血管化程度,观察胶原纤维及细胞核形态并进行细胞核形态学评分,扫描电镜与透射电镜评估超微结构重塑。结果与结论:①在术后各个时间点减张组的韧带愈合形态更好,可以获得更高的MAS评分优良率(P<0.05),并可以获得更高的韧带血管化评分(P<0.05);②两组移植物胶原束及纤维束的排列均逐渐趋于有序,胶原间的横向纤维连接逐渐增多增粗,提示移植物的强度和塑形程度逐渐提升,术后各个时间点减张组韧带的重塑始终快于普通组;③术后各个时间点减张组胶原纤维的直径、分布密度、排列有序度均优于普通组,尤其在胶原纤维直径的比较上,组间及组内比较减张组均优于普通组(P<0.05)。BACKGROUND:We have successfully established an animal model of small ear pig in southern Yunnan province with internal tension relieving technique combined with autologous Achilles tendon for anterior cruciate ligament reconstruction,and verified the stability and reliability of the model.However,whether internal tension relieving technique can promote the ligamentalization process of autologous Achilles tendon graft has not been studied.OBJECTIVE:To investigate the differences in the process of ligamentalization between conventional reconstruction and internal reduction reconstruction of the anterior cruciate ligament by gross view,histology and electron microscopy.METHODS:Thirty adult female small ear pigs in southern Yunnan province were selected.Anterior cruciate ligament reconstruction was performed on the left knee joint with the ipsilateral knee Achilles tendon(n=30 in the normal group),and anterior cruciate ligament reconstruction was performed on the right knee joint with the ipsilateral knee Achilles tendon combined with the internal relaxation and enhancement system(n=30 in the relaxation group).The autogenous right forelimb was used as the control group;the anterior cruciate ligament was exposed but not severed or surgically treated.At 12,24,and 48 weeks after surgery,10 animals were sacrificed,respectively.The left and right knee joint specimens were taken for gross morphological observation to evaluate the graft morphology.MAS score was used to evaluate the excellent and good rate of the ligament at each time point.Hematoxylin-eosin staining was used to evaluate the degree of ligament graft vascularization.Collagen fibers and nuclear morphology were observed,and nuclear morphology was scored.Ultrastructural remodeling was evaluated by scanning electron microscopy and transmission electron microscopy.RESULTS AND CONCLUSION:(1)The ligament healing shape of the relaxation group was better at various time points after surgery,and the excellent and good rate of MAS score was higher(P<0.05).Moreover,the r

关 键 词：前交叉韧带 内减张技术 韧带化 超微结构 血管化 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.4