自体浓缩骨髓移植促进腱骨愈合

背景：前交叉韧带断裂后应用自体腘绳肌腱移植进行重建应用较多,腱-骨愈合的时间较长,限制了患者交叉韧带重建后早期的功能活动。目的：用浓缩自体骨髓植于前交叉韧带重建腱-骨界面,观察其界面愈合情况。方法：32只新西兰大白兔行双侧膝关节半腱肌肌腱前交叉韧带重建,随机选取一侧膝关节作为实验组,胫骨侧腱骨界面植入自体浓缩骨髓,对侧不植入作为对照组。结果与结论：组织学显示,前交叉韧带重建后2周对照组移植肌腱与骨隧道的界面由肉芽组织填充,连接组织松散,有成骨活动;实验组移植肌腱与骨隧道界面肉芽组织连接亦不紧密,骨隧道侧成骨活动较活跃。前交叉韧带重建后12周对照组腱骨结合部组织界面变模糊,可见胶原纤维-纤维软骨-钙化的软骨组织-骨组织的移行带改变;实验组显示明显的胶原纤维-纤维软骨-钙化的软骨组织-骨组织的移行带改变,潮线清晰。前交叉韧带重建后4,8,12周,实验组最大抗拉脱强度数值显著大于对照组（P〈0.05）。提示自体浓缩骨髓可以增强腱骨界面的抗拉伸强度,有利于腱-骨界的组织愈合。

Condensed autologous bone marrow transplantation facilitates the tendon-bone healing

BACKGROUND： There are a lot of applications of hamstring tendons autografts in the reconstruction of anterior cruciate ligament, which needs a long term for the tendon-bone healing and restricts the early functional activities of patients.OBJECTIVE： To evaluate the effect of condensed autologous bone marrow transplantation on the tendon-bone interface in the reconstruction of anterior cruciate ligament.METHODS： One knee joint was chosen as the experimental group and the other side as the control group in 32 New Zealand rabbits experiencing the reconstruction of anterior cruciate liagment. The tibial tendon-bone interface was injected with condensed autologous bone marrow in the experimental side and the other side was not injected as the control.RESULTS AND CONCLUSION： The histological anatomy showed the tendon-bone interface was filled with granulation tissues that were loose, and there were some activities of bone formation in the control group at 2 weeks after operation; the tendon-bone interface was filled with granulation tissues that were not compact, but there were active activities of bone formation in the experimental group at 2 weeks after operations. The bound between the tendon and bone was becoming obscure, and there were collagen fiber-fibrocartilage-calcified fibrocartilage-bone transitional zones at the interface in the control group at 12 weeks after operation. In the experimental group, there were conspicuous collagen fiber-fibrocartilage-calcified fibrocartilage-bone transitional zones and clear tidal line at the interface. The maximal pull-out loads in the experimental group were higher than those in the control group at 4, 8 and 12 weeks after operation （P 〈 0.05）. These findings indicate that condensed autologous bone marrow transplantation can enhance the tensile strength of tendon-bone interface, and can do good to tendon-bone healing in a bone tunnel.