鱼鳔膜的制备及其理化特性的研究

目的采用交联技术制备鱼鳔膜材料,检测其理化性能及细胞毒性。方法取鱼鳔经脱细胞处理后随机分为两组,交联组采用碳二亚胺[1-ethyl-3-(3-dimethylaminopropyl)carbodiimide,EDC]/N-羟基琥珀酰亚胺(N-hydroxysuccinimide,NHS)法交联处理后,行表面制孔及冻干处理;未交联组仅行表面制孔及冻干处理。观测两组材料理化性能,包括扫描电镜观察微观结构,电子万能材料试验机测试力学性能(拉伸强度及断裂伸长率),接触角测量仪检测材料亲水性,乙醇浸润法测定材料孔隙率,体外降解性能及热稳定性检测,以及红外光谱分析支架成分。取小鼠成纤维细胞L929与两组材料浸提液培养,细胞检测试剂盒8(cell counting kit 8,CCK-8)测定细胞毒性。结果扫描电镜观测两组支架均具有多孔结构,且表面粗糙。与未交联组相比,交联组材料拉伸强度明显增高、断裂伸长率降低、孔隙率增大,差异有统计学意义(P0.05);接触角差异无统计学意义(P0.05)。两组材料降解趋势一致,最初7 d内降解较快,之后趋于平缓;各时间点交联组降解率低于未交联组,差异均有统计学意义(P0.05)。差示扫描量热法检测显示,交联组材料变性温度为(75.2±1.3)℃,高于未交联组的(68.5±0.4)℃,差异有统计学意义(t=4.586,P=0.002)。红外光谱分析,与未交联组相比,交联组生成了酰胺键中新的C=O键和N-H键,并且未引入其他新的基团。CCK-8法检测示,交联组及未交联组A值与阳性对照组比较,差异均无统计学意义(P0.05)。结论经EDC/NHS法交联处理获得的鱼鳔膜材料具有优良的理化性能,无细胞毒性,有望作为硬膜修复材料。     

Concurrent arthroscopic bicruciate ligament reconstruction using Achilles tendon-bone allografts: experience with 15 cases

Objective： To evaluate the clinical outcome of arthroscopically assisted combined anterior and posterior cruciate ligament （ACL/PCL） reconstructions using Achilles tendon-bone allografts.
Methods： Associated meniscus injuries were treated according to established methods prior to ligament reconstructions during arthroscopic surgery. Thirty Achilles tendon-bone allografts were used to reconstruct torn ACL and PCL in 15 knees. At postoperative follow-up, all knees were graded using the modified IKDC and the Lysholm scoring systems just as done preoperatively. Results were analyzed compared with the contralateral healthy knees.
Results： Eleven men and 4 women with a minimum of 3-year follow-up （mean 38 months） were included in the study. Preoperatively, the group ratings by the modified IKDC standards were all severely abnormal. Twelvebicruciate reconstructions were performed in subacute or chronic stage （〉3-8 weeks）, 3 for acute ligamentous deficiencies （≤ 3 weeks）. The noticeable early complication was transitory local fever combined with joint effusion in one case. At postoperative follow-up, 9 knees were normal, 5 nearly normal and 1 abnormal. On Lysholm score the difference was statistically significant （ttest, P〈0.001） before and after operation. Conclusions： Achilles tendon-bone allograft offers an alternative for simultaneous arthroscopic ACL/PCL reconstructions. However, further investigation is needed to eradicate its potential immunogenicity for better use.     

枝化状聚乙二醇对牛跟腱Ⅰ型胶原结构与构象稳定性的影响

目的 观察枝化状聚乙二醇对牛跟腱Ⅰ型胶原结构与构象稳定性的影响.方法 以牛跟腱Ⅰ型胶原为原料,以枝化状聚乙二醇为交联剂,在有效交联的前提下,通过测定羟脯氨酸含量观察聚乙二醇交联对胶原酶解稳定性的影响,采用示差扫描量热法(DSC)观察胶原热变性温度,采用圆二色光谱法(CD)观察聚乙二醇对胶原三螺旋构象稳定性的影响.结果 枝化状聚乙二醇交联组24 h降解率为26.79%,而对照组则达97.39%,两者比较差异有统计学意义(P＜0.05).交联组热变性温度为(79.1±1.2)℃,与对照组(68.6±1.9)℃比较,差异有统计学意义(P＜0.05);CD谱测定特征性吸收峰差异无统计学意义(P＞0.05).结论 枝化状聚乙二醇可显著提高其热变形温度和抗酶性分解能力,而对其三螺旋结构与构象无明显不利影响,是较理想的生物高分子交联剂,可有望用于胶原分子的交联改性.

Abstract：

Objective The triple helix of collagen is the basis of its biological function, such as cell adhesion and tissue remodeling. Crosslinking of collagen with chemical agent will improve the biomechanical properties. However, the effects of differernt crosslinking agents on the structure and conformation stability of type Ⅰ collagen are rarely investigated. Methods The branched polyethylene glycol ( PEG)derivative ( MW 12 kD) was used as crosslinking agent, and allowed to react with bovine achilles' s tendon type Ⅰ collagen modified by succinimidylacetylthioacetate (SATA). The ability of resistance of crosslinked collagen to enzymatic degradation was investigated by measuring the release of hydroxyproline, and differential scanning calorimeter ( DSC ) was taken to determine the thermal denaturation temperature. The effect of PEG on the riple helix of collagen was studied by circular dichroism ( CD) . Results The resistance ability of PEG crosslinked collagen was strongly enhanced when compared with that of control group ( P ＜0. 05 ) , and the thermal denaturation temperature was also significantly rised. CD demonstrated that PEG crosslinking did not result in the destruction of the triple helix conformation of type Ⅰ collagen. Conclusion Branched PEG derivative used in this study is a promising polymer crosslinking agent that may be utilized in the modification of type Ⅰ collagen.     

Bridge tendon graft in no man‘s land:an experimental study in chickens

Objective:To investigate the morphological characteristics of the bridge tendon grafting in no man‘s land to reconstruct the tendon defect and the effect of passive mobilization on it.Methods:A 2 cm defect was made in bilateral flexor digitorum profundus tendons of the middle chicken toes,and was then transplanted to the opposite site to serve as a segmental autograft tendon.Postoperatively,passive mobilization of the left and right middle toes began at 5 and 21 d separately.Specimens were studied by light,scanning and transmission electron microscopy at 5,10,21 and 35d.Results:Early repair of the tendon-graft of the left middle toes was made by proliferation and ingrowth of the epitenon cells intermingled with newly-formed collagen fibers.a gliding surface formed at 10 and 21 d.The tendon graft itself played an active role in the repair.In contrast,adhesions obliterated the surface and occupied the space between the tendon graft and surrounding tissues in the right middle toes.Conclusions:It indicates that the use of the segmental bridge tendon graft in no man‘s land coupled with early passive motion stimulates an intrisic repair process in both the tendon stump and the autogenous tendon graft and results in a functional healing.     

谷氨酰胺抑制人外周血单个核细胞细胞因子表达的机制

Objective To investigate the mechanism that glutamine (Gin) downregulates the cytokine expression in lipopolysaccharide (LPS)-stimulated human peripheral blood mononuclear cells (PMBCs). Methods PMBCs were extracted from healthy volunteer by density gradient centrifugation, the cells were divided into two parts. The first part of PMBCs was pretreated with Gin of the concentration of 0, 8,15 mmol/L for 0.5 h and 2.0 h respectively, then stimulated by LPS for 4. 0 h. Cells and supematants were collected. The second part of PBMCs was divided into group A, B and C. Group A and B were preteated with HSP70 blocker (Quereetin) for 1.0 h, then were stimulated by LPS for 4. 0 h. Cells and supematants were also collected. The release of TNF-α and IL-10 was analyzed via enzyme-linked immunosorbent assay (ELISA) and HSP70 via Western Blot. In this experiment, the effect of Quercetin on TNF-α,IL-10 and HSP70 expression in human PBMCs was assessed. Results Gin led to an increase in HSP70 expression, and decreased TNF-α, IL-10 release at 4. 0 h after LPS stimulation when 8 mmol/L glutamine pretreated for 0.5 h and 2. 0 h, 15 mmol/L glutamine pretreated for 0.5 h (P < 0.05). The expression level of HSP70 was significantly decreased, however, the expression of TNF-α and IL-10 was enhanced in Quercetin group (P <0.05). Conclusion The effect of glutamine attenuating cytokine release in PBMCs is related to the enhancement of HSP70 expression.     

急诊移植带趾伸肌腱趾背皮瓣修复复杂指背缺损

目的 探讨急诊游离移植带1/2趾伸肌腱趾背皮瓣修复复杂指背缺损创面,重建伸指功能的临床疗效.方法 2001年2月至2010年3月,为6例患者急诊行游离移植带1/2趾长伸肌腱的趾背复合组织瓣,修复指背皮肤、肌腱缺损,重建伸指功能,并进行了长期随访观察.结果 6例游离移植趾背复合组织瓣修复指背皮肤、肌腱缺损缺损重建伸指功能,术后皮瓣完全成活,创面一期愈合,经5～10年随访,皮瓣色泽接近正常,质地和外形优良,供受区外形和功能患者满意.结论 急诊游离趾背复合组织瓣修复指背缺损,重建伸指功能,经长期随访疗效观察显示,是一种较好的治疗方法.

Abstract：

Objective To report emergency reconstruction of the complex dorsal digital defect using the composite flap with extensor tendon graft from the second toe. Methods From February 2001 to March 2010, 6 fingers in 6 patients with complex dorsal digital defects were repaired using the composite flap. The defect of the extensor tendon was also repaired with the extensor tendon graft harvested from the second toe. Results All the flaps survived completely with primary healing. The patients were followed up for 5 to 10 years. The flaps had a good match in skin color and texture. Both the esthetic and functional results were satisfactory either in recipient or in donor sites. Conclusions The emergency reconstruction of the complex dorsal digital defect using the composite flap with extensor tendon graft is an effective way to repair the skin defect and extensor tendon defect simultaneously with good long-term results.     

血小板源性生长因子BB对体外培养肌腱细胞增殖的影响

Objective To study the effect of platelet-derived growth factor-BB (PDGF-BB) in dif-ferent concentrations on proliferation of tendon cells cultured in vitro. Methods Rat tendon cells were cultured and identified in vitro. The rat tendon cells were cultured in PDGF-BB nutrient solution in different concentrations. They were then divided into 1, 5, 10, 20, 50, 100, 150, 200, 250 ng/mL PDGF-BB groups (cultured with 0.1 mL 0.5% PBS with addition of 1, 5, 10, 20, 50, 100, 150, 200, 250 ng/mL PDGF-BB respectively). Tendon cells in control group were cultured with 0.1 mL 0.5% FBS. Proliferation of tendon cells was detected by MTT test. The absorbance values of tendon cells in control group and 20 ng/mL PDGF-BB group before culture and after cultured for 12, 24, 36, 48, 60, 72 hs were determined. Results The isolated cells were identified to be rat tendon cells as they were Type Ⅰ collagen staining posi-tive and Type Ⅲ collagen staining negative. Compared with that of control group, the absorbance values of other groups were all increased, except for that of 250 ng/mL PDGF-BB group (P<0.05 or P<0.01). Besides, the absorbance value rose gradually with the increase of the concentration of PDGF-BB on, and then diminished gradually with the increase of the concentration of PDGF-BB from 20 ng/mL on. Tendon cells in 20 ng/ml PDGF-BB group began to increase in number when cultured for 12 hs, and it reached the highest level (0.53±0.04) at 48 h, which were obviously higher than those of control group at 24-72 h (P<0.01). The absorbance value of tendon cells in 20 ng/mL PDGF-BB group was significantly higher than that of control group at 24, 36, 48, 60, 72 h after culture (P<0.01 ). Conclusions PDGF-BB can promote the proliferation of tendon cells in a definite range of concentration and time.     

Analysis of differentially expressed genes in fetal skin of scarless and scar-forming periods of gestational rats

Objective: To study the differences of gene expression between earlier gestational skin and later gestational skin of rats with the aids of single primer amplification (SPA) and high-density oligonucleotide DNA array to understand the molecular mechanism of scarless healing. Methods: Total RNAs were isolated from fetal rat skin of the scarless (E15) and scar-forming (E18) periods of gestation (term =21.5 days). The RNAs from earlier gestational skin (EGS) and later gestational skin (LGS) were both reversely transcribed to cDNAs, then labeled with the incorporation of fluorescent dCTP for preparing the hybridization probes by SPA method. The mixed probes were then hybridized to the oligonucleotide DNA arrays which contained 5 705 probes representing 5 705 rat genes. After highly stringent washing, these DNA arrays were scanned for fluorescent signals to display the differentially expressed genes between the 2 groups of skin. Results: Among 5 705 rat genes, there were 53 genes (0.93%) with differentially expressed levels between EGS and LGS groups, 27 genes, including fibroblast growth factor 2 ( FGF2 ) and follistatin were up-regulated (0.47%) and 26 genes were down-regulated (0.46%) in fetal skin during scarless period versus scar-forming period. Higher expressions of FGF2 and follistatin in EGS than those in LGS were also revealed by RT-PCR method. Conclusions: High-density oligonucleotide DNA array provided a powerful tool for investigating differential gene expression in earlier and later gestational fetal skins. This technology validates that the mechanism of fetal scarless healing is very complicate and the change of many gene expressions is associated with fetal scarless healing.     

Closed reduction and intramedullary nailing versus open reduction and locking plate fixation in treatment of middle and upper humeral fractures北大核心CSCD

Objective To compare closed reduction and intramedullary nailing versus open reduction and locking plate fixation in the treatment of middle and upper humeral fractures. Methods A retrospective case-control study was conducted to analyze the clinical data of 62 patients with middle and upper humeral fracture who had been treated at Department of Orthopaedics, The First People's Hospital of Jinmen and at Department of Orthopedics, General Hospital of PLA Central Theater from October 2017 to February 2021. There were 35 males and 27 females, aged from 27 to 86 years. The left side was affected in 24 cases and the right side in 38 cases. All fractures were fresh. According to the AO classification, 16 cases were type A, 32 type B, and 14 type C. Of the patients, 29 were treated with closed reduction and intramedullary nailing (intramedullary nail group) and 33 with open reduction and locking plate fixation (locking plate group). The length of incision, operation time, intraoperative blood loss, hospital stay, fracture healing and complications were recorded and compared between the 2 groups. The pain degree was evaluated by visual analogue scale (VAS) at one week and one month after operation, and the functional recovery of the shoulder was evaluated by Constant-Murley score at one month and 12 months after operation. Results There was no significant difference in the preoperative general data between the 2 groups, showing comparability (P>0.05). The intramedullary nail group was followed up for 12 to 29 months and the locking plate group for 15 to 50 months. In the intramedullary nail group, the length of incision [(4.1±0.7) cm], operation time [(58.3±7.7) min], intraoperative blood loss [(52.7±6.5) mL], and hospital stay [(7.3±1.5) d] were significantly less than those in the locking plate group [(21.7±2.3) cm, (95.8±11.7) min, (237.4±14.9) ml, and (12.3±1.7) d] (P<0.05). The fracture healing time in the intramedullary nail group was (5.0±1.9) months, significantly longer than that in the locking plate group [(3.5±1.7) months] (P<0.05). The VAS scores at one week and one month after operation in the intramedullary nail group [(2.8±0.3) points and (1.2±0.5) points] were significantly lower than those in the locking plate group [(4.3±0.4) points and (1.6±0.5) points], and the Constant-Murley score at one month after operation in the intramedullary nail group [(63.5±7.4) points] was significantly higher than that in the locking plate group [(54.3±6.9) points] (P<0.05). However, at 12 months after operation, there was no significant difference in the Constant-Murley score between the 2 groups (P>0.05). In both groups, the VAS score at one month after operation was significantly lower than that at one week after operation while the Constant-Murley score at 12 months after operation was significantly higher than that at one week after operation (P<0.05). In the intramedullary nail group, intraoperative distal refracture happened in one case; in the locking plate group, incision infection occurred in one case and postoperative radial nerve injury in another. There was no significant difference in the incidence of complications between the 2 groups [3.4% (1/29) versus 6.1% (2/33)] (P>0.05). Conclusion In the treatment of middle and upper humeral fractures, compared with open reduction and locking plate fixation, closed reduction and intramedullary nailing shows advantages of a smaller surgical incision, shorter operation time, less intraoperative blood loss, shorter hospital stay and faster functional recovery. © The Author(s) 2022.     

天狼猩红染色法在肌腱胶原形态分析中的应用

目的 探讨天狼猩红染色法在肌腱胶原形态分析中的应用价值.方法 将30只10个月龄雄性Leghorn鸡随机分为A、B、C 组,每组10只.将每只鸡的左足第Ⅲ趾造成挤压撕脱伤模型,用改良Kessler缝合法缝接.A组、B组、C组分别于术后2周、4周、8周取材,对标本进行磷钨酸苏木素染色、天狼猩红染色、免疫组织化学染色等观察.结果 A组腱缝合段内的胶原纤维数量少,排列稀疏,以纤细的Ⅲ型胶原为主;B组腱缝合段内的胶原纤维数量较多,排列紊乱,Ⅰ、Ⅲ型胶原交错排列;C组腱缝合段内的胶原纤维数量多,以粗大的Ⅰ型胶原为主,成纤维细胞数量少,腱细胞成熟.结论 天狼猩红染色法在胶原纤维的染色中可在同一张切片中同时显示Ⅰ型和Ⅲ型胶原,是研究肌腱损伤修复中胶原纤维形态变化的重要染色方法.肌腱在愈合早期以纤细的Ⅲ型胶原为主,愈合晚期则以粗大的Ⅰ型胶原为主.

Abstract：

Objective To observe the applied value of Sirius red staining in the study on tendon repair. Methods Thirty ten-month old fowls were randomly divided into groups A, B and C (10 each group). The flexor tendon was cut off in the third toe then suture it.A group,B group,C group,respectively after 2 weeks,4 weeks,8weeks drawn and did the specimens biomechanical test,sirius red staining,immunohistochemical staining,the specimens were evaluated by means of macroscopic observation.Results A group within the section of tendon suture a small number of collagen fibers,arranged in sparse,thin collagen type Ⅲ to the main;B group within the section of tendon suture collagen fibers are more disordered,Ⅰ,Ⅲ collagen staggered;C group tendon suture paragraph quantity of collagen fibers,with thick main type Ⅰ collagen;a small number of fibroblasts,tendon cell maturation.Conclusion Sirius red staining of collagen fibers can be dyed simultaneously in the same slide show type Ⅰ and Ⅲ collagen,is to study the tendon collagen fibers in the repair of major staining.Tendon healing in the early to slim type Ⅲ collagen-based,healing late stage Ⅰ collagen-based thick.     

富血小板血浆复合物促进兔前交叉韧带重建后腱骨愈合的组织学研究

目的探讨富血小板血浆(PRP)复合小牛脱蛋白松质骨(DPB)对兔前交叉韧带(ACL)重建术后腱骨愈合的影响。 方法取36只成年新西兰大白兔,随机分为3组：PRP+ DPB组,PRP组,空白对照组,每组12只。建立右侧膝关节ACL完全断裂模型,行白体半腱肌重建ACL。于PRP+ DPB组和PRP组骨隧道内分别植入PRP凝胶结合DPB和PRP凝胶,空白对照组骨隧道内单纯植入肌腱。术后6、12、18周行大体观察、组织学、免疫组化评价腱骨愈合情况。 结果大体观察术后各个时间点,与其他2组比较,PRP+ DPB组移植肌腱与骨隧道壁纤维组织连接更为致密。HE染色显示PRP+DPB组在各时间点腱骨界面的胶原纤维连接及纤维组织分级结果均优于其他2组。PRP+ DPB组、PRP组及空白对照组标本术后6周时TGF-β1表达量平均分别为119.5±9.3、93.0±7.3、73.3±5.4,12周时平均分别为76.8±5.7、48.0±6.7、26.8±4.7;术后6周时VEGF的表达量平均分别为117.5±8.4、90.5±8.2、69.8±5.8,12周时平均分别为76.6±5.7、48.0±6.7、26.8±4.7,以上指标3组之间两两比较差异均有统计学意义(P＜0.05),PRP+DPB组优于其他2组。术后18周时3组标本TGF-β1及VEGF的表达量差异均无统计学意义(P＞0.05)。 结论在兔膝关节ACL重建模型中,PRP复合DPB能促进术后的腱骨愈合。     

Histological findings of tendon-bone healing following anterior cruciate ligament reconstruction with hamstring grafts

BACKGROUND: The purpose of the study was the histological examination of tendon-bone healing of hamstring grafts after anterior cruciate ligament (ACL) reconstruction. METHODS: During five arthroscopies done 6-14 months after ACL reconstructions, biopsies of the wall of the former drilled femoral canal were obtained. Four patients were primarily operated on using a suspending device (Endobutton, Acufex Microsurgical, Mansfield, MA, USA, and Transfix, Arthrex, Naples, FL, USA) for femoral fixation, one patient was reconstructed with a biodegradable interference screw directly inserted between the tendon and the wall of the canal. Biopsies were obtained using a tube harvester during re-arthroscopy. Three grafts were stable, two grafts were unstable, and revision of the ACL was performed. RESULTS: Histologically, in the four cases of reconstruction with a button or a rectangular pin, biopsies resembled granulation tissue without insertion of fibers between the tendon tissue and the bony wall. A wide area of woven bone was noted adjacent to the pre-existing lamellar bone. In contrast, the tendon-bone junction in the knee reconstructed with a biodegradable interference screw resembled a zone of metaplastic fibrous cartilage between the tendon graft and the lamellar bone. Collagen fibers connecting the tendon-bone interface occurred under polarized light microscopy. CONCLUSION: We conclude that the use of hamstring grafts for ACL reconstruction can lead to different histological pattern of tendon-bone healing. Micromotion of the hamstring graft inside the drilled canal can be play a role in tendon-bone healing.     

Acceleration of tendon-bone healing in anterior cruciate ligament reconstruction using an enamel matrix derivative in a rat model

We examined whether enamel matrix derivative (EMD) could improve healing of the tendon-bone interface following reconstruction of the anterior cruciate ligament (ACL) using a hamstring tendon in a rat model. ACL reconstruction was performed in both knees of 30 Sprague-Dawley rats using the flexor digitorum tendon. The effect of commercially available EMD (EMDOGAIN), a preparation of matrix proteins from developing porcine teeth, was evaluated. In the left knee joint the space around the tendon-bone interface was filled with 40 μl of EMD mixed with propylene glycol alginate (PGA). In the right knee joint PGA alone was used. The ligament reconstructions were evaluated histologically and biomechanically at four, eight and 12 weeks (n = 5 at each time point). At eight weeks, EMD had induced a significant increase in collagen fibres connecting to bone at the tendon-bone interface (p = 0.047), whereas the control group had few fibres and the tendon-bone interface was composed of cellular and vascular fibrous tissues. At both eight and 12 weeks, the mean load to failure in the treated specimens was higher than in the controls (p = 0.009). EMD improved histological tendon-bone healing at eight weeks and biomechanical healing at both eight and 12 weeks. EMD might therefore have a human application to enhance tendon-bone repair in ACL reconstruction.     

生物骨传导性骨水泥促进前交叉韧带重建术腱骨愈合的研究进展(英文)

近10年来,应用软组织移植物行前交叉韧带重建术越来越普遍。手术的远期疗效主要取决于肌腱移植物能否在骨隧道内达到坚强的腱-骨愈合。但是,目前面临的问题是肌腱移植物在骨隧道内获得腱-骨愈合所需要的时间相当长。研究发现,在腱-骨界面局部应用生物骨传导性的骨水泥能有效地促进肌腱移植物的骨愈合。这类骨水泥主要是磷酸钙。本文就生物骨传导性骨水泥促进前交叉韧带重建术腱-骨愈合的研究进展作一综述。     

自体骨-髌腱-骨和腘绳肌腱单束重建前交叉韧带的愈合形态学和前向稳定性对比

目的探讨采用自体骨-髌腱-骨（bone-patellar tendon-bone,B-PT-B）和自体腘绳肌腱（hamstring tendon,HT）进行前交叉韧带（anterior cruciate ligament,ACL）单束重建后的移植物愈合形态和前向稳定性是否存在差异。方法 1996年7月~2005年5月,我所对134例急性ACL断裂施行膝关节镜下ACL单束重建,移植物分别为自体B-PT-B和HT,其中51例为去除金属内固定而二次入院手术（术后6~46个月,平均13.8月）,根据移植物种类将51例分为2组：B-PT-B组（n=14）和HT组（n=37）,比较关节镜下移植物愈合形态,采用膝关节韧带位移测量仪（KT-2000）分别在屈膝30°和90°时测量前向松弛度。结果 B-PT-B组和HT组重建韧带形态学表现如下：韧带完整分别占85.7%（12/14）和86.5%（32/37）,断裂〈1/2分别占14.3%（2/14）和13.5%（5/37）,2组无统计学差异（χ2=0.000,P=1.000）;滑膜完整分别占57.1%（8/14）和64.9%（24/37）,部分滑膜覆盖分别占28.6%（4/14）和27.0%（10/37）,无滑膜覆盖分别占14.3%（2/14）和8.1%（3/37）,2组无统计学差异（χ2=0.501,P=0.779）;滑膜内有血管形成分别占57.1%（8/14）和64.9%（24/37）,2组无统计学差异（χ2=0.259,P=0.611）;有＂独眼征＂（cyclops）形成分别占14.3%（2/14）和10.8%（4/37）,2组无统计学差异（χ2=0.000,P=1.000）。2组前向松弛度在屈膝30°时分别为（2.2±0.5）、（1.8±1.4）mm（t=1.039,P=0.304）,90°时分别为（1.2±0.6）、（1.1±0.7）mm（t=0.472,P=0.639）。结论急性期采用自体B-PT-B和HT单束重建ACL,在韧带愈合形态学表现和重建的前向稳定性方面均无显著性差异。     

Anterior cruciate ligament reconstruction: Which graft is best?

For the last 4 decades, since the initial use of the patellar tendon for anterior cruciate ligament (ACL) reconstruction, there has been controversy regarding the ideal graft choice for this procedure. Beside bone-patellar tendon-bone autografts, several other graft choices have become popular, including hamstring tendon and a variety of allografts. Within the past 5 years, several randomized and nonrandomized studies have compared the graft choices in ACL reconstruction. However, the question still remains: Is there an ideal graft for ACL reconstruction? The purpose of this review is to assess the most recent data, identifying if there truly is an ideal graft choice.     

膝关节持续被动活动对兔重建前交叉韧带腱骨愈合的影响

目的 通过兔半腱肌腱腱后固定方法重建前交叉韧带(ACL)实验动物模型,研究持续被动活动(CPM)对移植物隧道内腱骨界面的组织学转归影响.方法 对12只雄性新西兰大白兔右侧后肢膝关节行自体双股半腱肌腱移植重建ACL.术后随机分为两组:CPM组(n=6)术后第2天开始早期CPM康复6周;自由活动组(n=6)笼养.分别于术后第6、12、24周取材,采用HE和甲苯胺蓝染色观察腱骨愈合过程.结果 前侧腱骨界面纤维组织较多且较后侧腱骨界面宽;后侧腱骨界面的成骨细胞和类软骨细胞较多,新骨沉积较多.在骨道内口(关节腔入口),破骨细胞较多.与自由活动组比较,CPM组界面组织改建塑形更成熟、胶原排列更有序,潮线结构出现较早,类软骨细胞、成骨细胞和类似潮线的结构较多.结论 腱骨界面前侧张力较大,纤维较多;腱骨界面后侧压力较大,软骨较多.半腱肌腱重建ACL术后早期CPM加快移植物止点潮线结构恢复,增强移植物与骨组织之间整合.     

保留残迹对前交叉韧带移植物腱骨愈合影响的实验研究

目的探讨保留残迹重建前交叉韧带对移植物腱骨愈合的影响。方法 32只新西兰兔一期行双侧前交叉韧带重建术,一侧保留残端纤维,对侧切除残端纤维。重建术后6、12、18及24周时,采用HE染色、甲苯胺蓝染色观测,分析移植物腱骨愈合变化情况。结果重建术后各观察时间点上,保留残迹组移植物腱骨界面组织构建更接近正常,术后24周时保留残迹组腱骨界面软骨细胞含量明显高于切除残迹组[（56.5±2.4）vs（45.7±2.7）,P〈0.05]。结论保留残迹重建前交叉韧带有助于移植物腱骨愈合。     

金葡素促进兔前交叉韧带重建后腱骨愈合的实验研究

目的 :探讨兔膝关节前交叉韧带(ACL)重建后,金黄色葡萄球菌滤液制剂(金葡素)对移植肌腱与骨隧道愈合的作用。方法:将3月龄新西兰大白兔24只(体重平均2.56 kg,雌雄不限)随机分为实验组和空白对照组,每组12只。采用兔自体趾长伸肌腱建立膝前交叉韧带重建后的腱骨愈合模型。实验组分别于术中及术后第2天向胫骨端腱骨界面处缓慢均匀注射金葡素0.1 ml,对照组以相同时间和方法注射等量0.9%Na Cl注射液。术后双膝不予制动,以青霉素注射液80万U/d连续肌肉注射3 d。分别于术后4、8和12周各处死动物8只,完整获取腱骨愈合标本并分别进行组织学分析,肉眼观察判断ACL重建大体情况,苏木精-伊红染色进行Yamakado腱骨界面组织形态分型评价,苦味酸-天狼猩红染色观察腱骨界面胶原纤维情况,血管内皮生长因子免疫组化染色定量评价腱骨界面再血管化情况,甲苯胺蓝染色定量评价腱骨界面新骨生成情况。结果:大体观察显示全部动物术后伤口Ⅰ期愈合,关节功能恢复良好,未见感染、死亡及金葡素注射不良反应。腱骨界面形态学分型结果显示术后各时间点实验组腱骨界面愈合质量均优于对照组(P0.05))。苦味酸-天狼猩红染色显示实验组胶原纤维术后4周生成少,8周大量生成,12周Sharpey纤维有序排列,集结成束,各时间点胶原纤维生成情况均优于对照组。基于血管内皮生长因子免疫组化染色和甲苯胺蓝染色的定量分析显示实验组术后4、8和12周腱骨界面新生血管面积和新骨生成面积均高于对照组(P0.05)。结论:金葡素能够在葡萄球菌肠毒素C等多种明确成分的协同作用下,通过局部启动无菌性炎症反应,加快腱骨界面血管生成和血液供应,激活骨细胞和纤维细胞大量增殖,有效促进兔ACL重建后腱骨愈合,有望成为促进ACL重建后腱骨愈合的新的临床方法。     

Optimization of surface modifications of extrasynovial tendon to improve its gliding ability in a canine model in vitro.

Previous studies have shown that the carboxyl groups in hyaluronic acid (HA) could be activated by 1-ethy 1-3-[3-dimethylaminopropyl] carbodiimide hydrochloride (EDC)/N-hydroxysuccinimide (NHS) to form intermediate O-acylisoureas, which can chemically bind to exposed amino groups on the tendon surface, leading to improved gliding ability. However, the optimal ratio and concentrations of the components in this chemical mixture were not investigated. The purpose of this study was to optimize the constituents of this tissue engineering approach to tendon surface modification, to reduce friction and improve durability. Peroneus longus (PL) tendons (n=40) were harvested from adult mongrel dogs along with the A2 pulley obtained from the ipsilateral hind paw. After the gliding resistance of the normal PL tendon was measured, the tendons were treated under varying concentrations of HA (0.5, 1, and 2%) and EDC/NHS (0.05, 0.25, and 1%) mixed with a 10% gelatin. Tendon friction was measured for 1000 cycles of simulated flexion/extension motion. Following testing, the residual HA on the tendon surface was evaluated by immunohistochemisty. The gliding resistance of the untreated PL tendons had a mean value of 0.087+/-0.021 N. After surface treatment, there was no significant difference in friction due to HA concentration alone, but the concentration of EDC/NHS and the interaction between HA concentration and EDC/NHS concentration had a significant effect on friction. Regardless of HA concentration, the friction after 1000 cycles was significantly decreased in preparations which included a 1% concentration of EDC/NHS. The tendons with lower gliding resistance presented a smoother surface on light microscopy and maintained more residual HA on the tendon surface. By varying the relative concentrations of HA, EDC, and NHS it is possible to optimize the effect of surface treatment on friction and durability in a canine extrasynovial tendon in vitro.