兔髌骨-髌腱复合体中骨-骨愈合和骨-腱愈合的比较研究  

BONE TO BONE REPAIR AND BONE TO TENDON HEALING IN PATELLA-PATELLAR TENDON COMPLEX——A COMPARATIVE STUDY IN RABBITS

作　　者：秦岭[1] 陈俊伟[1] 符立勤[1] 梁国穗[1] 

机构地区：[1]香港中文大学矫形外科及创伤学系肌肉与骨骼研究室

出　　处：《医用生物力学》2003年第2期65-70,共6页Journal of Medical Biomechanics

基　　金：香港中文大学医学院医学委员会研究基金 (2 2 0 4 0 1 .590 );部分AO/ASIF研究委员会基金(Ref.97-L1 5)

摘　　要：目的　比较髌骨 -髌腱复合体中骨 -骨连接和骨 -腱连接愈合。方法　 6 0只雌性成年兔。在一侧后肢的髌骨远端 1/ 3处横行截骨 ,在骨 -骨连接组中 ,将两髌骨骨折块重新连接 ;在骨-腱连接组中 ,切除远端 1/ 3髌骨。将髌腱与髌骨断端连接。分别于术后 8、12和 2 4周取材进行生物力学和组织学对比研究。结果　两组的拉断载荷没有显着性差异。但骨 -骨连接组第 8周和第2 4周的极限拉应力明显大于骨 -腱连接组 (P <0 .0 5 )。组织学研究表明骨 -骨愈合可通过愈合界面的软骨内化骨 ;在骨 -腱连接组中 ,大量瘢痕组织形成桥接愈合界面 ,并逐渐塑型重建 ,但没有形成典型的骨腱接点中的纤维软骨层。结论　髌骨 -髌腱复合体手术修复时 ,解剖学重建应该是首要考虑的问题 ,应尽可能采用骨折 (骨 -骨 )固定 。Objective To compare the healing quality of bone to bone and bone to tendon repair in a patella-patellar tendon complex. Methods A standard transverse osteotomy was performed at the distal one-third of patella of one hindlimb of 60 mature female rabbits. Both patellar fragments were reattached for bone to bone group while the patellar tendon was reattached to the remaining patella after removing the distal one-third of patella for bone to tendon group. Patella-patellar tendon complex was harvested at 8, 12 and 24 weeks post-operatively for biomechanical and histological evaluations. Results No significant differences in the failure loads were found between two groups. However, greater ultimate stress was found in bone to bone group as compared with bone to tendon group at week 8 and 24 (both P<0.05). Histology revealed that the bone to bone healing was via endochondral ossification at the healing interface. In bone to tendon group, extensive scar tissue was formed to overbridge the healing interface and remodeled with healing over time. The structural integration at the tendon and bony healing interface was poor and no typical intermitted fibrocartilage zone as seen in normal bone to tendon junction was formed. Conclusion The findings of this study may suggest that the anatomical reconstruction of patella-patellar tendon complex injury may be the primary concern in decision making for selecting either bone to bone or bone to tendon repair. However whenever possible, to initial fracture (bone-to-bone) fixation for ensuring better and predictable repair at the healing interface.

关 键 词：兔 髌骨-髌腱复合体 骨-骨愈合 骨-腱愈合 骨折愈合 生物力学试验 骸骨骨折 

分 类 号：R683.42[医药卫生—骨科学] R318.01[医药卫生—外科学]