自体肌腱重建前交叉韧带腱骨愈合早期的组织学观察与相关生物力学变化的研究

发布时间：2018-06-25 21:31

本文选题：前交叉韧带重建 + 腱骨愈合　；参考：《苏州大学》2013年硕士论文

【摘要】：1目的结合组织学与生物力学研究来观察腱骨愈合腱骨界面的生长情况，以确定建议肌腱内固定取出的最短时间，及更好的来指导临床康复锻炼。为进一步临床研究提供实验依据。 2材料与方法 2.1实验动物与前交叉韧带重建模型选用健康成熟的雄性比格犬36条，体重12.5±1.48kg，将36条比格犬36个膝关节分别取同侧趾长屈肌腱进行单束双股重建。 2.2随机分组随机分为2组，每组18条比格犬，，分别组织学切片组为18条比格犬(18个膝关节)，和同期生物力学组18条比格犬(18个膝关节）。 2.3标本处理术后第2、4、6、8、10、12周随机抽取一小组（6条比格犬，6个膝关节）按顺序处死，取膝关节对象（包括股骨端与前交叉韧带），分别随机取3个膝关节做生物力学拉脱试验，和将另3个膝关节标本固定、脱钙、取腱骨界面切片、染色。 3结果 3.1组织学观察组在愈合早期，即第2周内，腱骨界面细胞重构和多血管形成，伴有在骨隧道壁上大量成骨细胞，软骨样细胞和成纤维细胞的增生。骨生长因子，如BMPs，大量表达和在骨隧道壁附近可见少量新形成的骨小梁。术后大约4周时，纤维血管界面组织密集，并排列有序，随后逐渐减少，伴有II型胶原的沉积的软骨样细胞从骨向肌腱生长。由于肌腱周围的新骨形成，骨隧道壁增厚。但在此期间，胶原纤维机化不充分，腱骨的连续性只能偶尔可见。随后，6周时，胶原纤维生长成熟，腱骨的连续性进行重建。术后8周，垂直排列的Sharpey样纤维在腱骨界面中心可见。这些Sharpey样纤维由III型胶原组成，并连接骨与移植的肌腱，被认为是腱骨整合最早的征象。早期的生物力学结果也被认为是胶原纤维的连续性与腱骨整合的共同作用所产生。而这种早期的腱骨愈合方式几乎取决于骨隧道中的生物学或生物力学环境。而在8至12周后，腱骨愈合进程进入慢性炎症反应期，此时腱骨愈合已逐步趋于稳定。 3.2生物力学研究组术后第2、4、6、8周，肌腱都能从骨隧道里拉脱出来，且随着时间的延长，肌腱拉脱的力量也在增长，在第10—12周时，肌腱逐渐开始不能被拉脱出来，而是肌腱中间断裂。 4结论自体肌腱重建前交叉韧带愈合早期，腱骨界面经历了急性炎症期、缺血坏死期、胶原纤维重构期和慢性炎症期后趋于稳定。在此期间腱骨愈合界面强度较弱，直到第八周时，才较为牢固，在此期间活动度的锻炼不宜过激，力量和运动功能的康复训练也应该在8周以后，以免发生肌腱松弛和微动，建议内固定取出的时间至少也应大于12周。
[Abstract]:Objective to observe the growth of tendon bone interface in combination with histological and biomechanical studies in order to determine the shortest time for tendon internal fixation and better guide clinical rehabilitation. Materials and methods 2.1 36 healthy and mature male Beagle dogs were used to reconstruct the anterior cruciate ligament (ACL) model in the experimental animals and the anterior cruciate ligament (ACL) reconstruction model. The body weight was 12.5 卤1.48 kg. The knee joints of 36 Beagle dogs were harvested from the same side of flexor digitorum longus tendon for single bundle and double strand reconstruction. 2.2 each group was randomly divided into two groups, 18 Beagle dogs in each group. The histological section group was divided into 18 Beagle dogs (18 knees) and the biomechanics group (18 knees) respectively. Three knee joints (including femur and anterior cruciate ligament) were randomly selected for biomechanical pullout test, and the other three knee joint specimens were fixed, decalcified, and tendon bone interface sections were taken. 3Results in the 3.1 histological observation group, in the early healing stage, that is, the 2nd week, the tendon bone interface cells were reconstructed and many blood vessels were formed, accompanied by a large number of osteoblasts in the bone tunnel wall. Proliferation of chondroid cells and fibroblasts. Bone growth factors, such as BMPs, are highly expressed and a small number of newly formed trabeculae are observed near the bone tunnel wall. At about 4 weeks after operation, the fibrous vascular interface was densely organized and arranged, then gradually decreased, and the chondroid cells with type II collagen deposition grew from bone to tendon. The bone tunnel wall is thickened by the formation of new bone around the tendon. During this period, however, collagen fibers are not sufficiently organized and the continuity of tendons can only be seen occasionally. At the end of 6 weeks, the collagen fibers matured and the tendon bone was reconstructed. Sharpey-like fibers perpendicular to the center of the tendon bone interface were observed 8 weeks after operation. These Sharpey-like fibers are composed of type III collagen and connect the bone to the transplanted tendon, which is considered to be the earliest sign of tendon bone integration. Early biomechanical results are also thought to be the result of collagenous fiber continuity and tendon bone integration. This early healing of tendons almost depends on the biological or biomechanical environment in the bone tunnel. However, after 8 to 12 weeks, the healing process of tendons entered a chronic inflammatory reaction period, and the healing of tendons gradually stabilized. 3.2 in the biomechanical study group, the tendons could be pulled out of the bone tunnel at the 2nd and 6th week after operation. As time went on, the strength of tendon pullout also increased. At the 10-12 weeks, the tendon gradually began to be not pulled out, but the intertendinous rupture. 4 conclusion autogenous tendon reconstruction of the anterior cruciate ligament is early in healing. The interface of tendon and bone was stable after acute inflammation, ischemic necrosis, collagen remodeling and chronic inflammation. During this period, the strength of the healing interface of tendon bone is weaker, but it is not more firm until the eighth week. During this period, the exercise of movement should not be excessive, and the rehabilitation training of strength and motor function should be done after 8 weeks, so as to avoid tendon relaxation and fretting. The recommended time for internal fixation should also be at least 12 weeks.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R318.01

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