兔自体骨膜包裹同种异体肌腱移植对腱-骨愈合的影响

目的 探讨兔同种异体肌腱表面包裹自体骨膜植入骨隧道对移植肌腱与骨隧道之间界面愈合的影响. 方法 健康4～5月龄新西兰白兔20只,体重2.5～3.0 kg,随机取一侧后肢作为实验组,另一侧后肢作为对照组.以同种异体肌腱在兔胫骨干骺端建立腱-骨固定模型,实验组骨隧道肌腱表面包裹自体骨膜,骨膜生发层朝向骨隧道;对照组骨隧道肌腱表面不包裹自体骨膜.分别于术后4、8周取标本作腱.骨界面的组织学检查(n=2),并进行最大拔出负荷的生物力学测试(n=8). 结果 术后4、8周标本大体观察,实验组骨隧道口周围新生骨较多;对照组新生骨少或不明显.组织学观察:术后4周实验组骨膜生发层内有大量间充质细胞增生,出现明显的膜内成骨,沿新生骨小梁周围可见大量骨母细胞呈栅形排列,新生骨小梁与骨膜延续:对照组腱-骨界面间无明显新生骨形成,有疏松结缔组织填充,腱-骨间连接较疏松.术后8周实验组新生骨和肌腱与骨隧道连接紧密,无间隙,新生骨量多,新生骨排列比较规则、整齐,腱-骨界面可见潮线形成,类似于正常腱-骨附着结构,骨膜内成纤维细胞增殖活跃,骨膜与肌腱间有较多纤维连接;对照组腱-骨界面局部有新生骨形成,排列紊乱,腱-骨间可见较多胶原纤维连接.术后4、8周,实验组最大拉出或拉断强度分别为(35.03±1.21)N/cm和(42.36±1.31)N/cm,对照组分别为(26.14 ±6.13)N/cm和(31.63±6.87)N/cm,两组比较差异均有统计学意义(P<0.05). 结论 兔自体骨膜包裹同种异体肌腱移植可缩短腱-骨间成骨时间,提高愈合强度,加速腱-骨间愈合.     

用自体骨膜包裹肌腱 - 松质骨匀浆复合体为月骨替代物的实验研究

目的：观察自体肌膜包绕肌腱－松质骨匀浆复合体植入动物关节腔后组织形态学改变,为替代月骨治疗月骨无菌性坏死提供实验依据。方法：选新西兰白兔45只,按手术先后顺序随机分为骨膜组、复合体组和对照组3组,每组15只兔。将上述三种植入分别植入兔膝关节腔内。术后3,6,12,16及24周取标本观察组织形态变化并测量CT值。结果：对照组呈玻璃样变性,形成片状瘢痕。骨膜组织复合体组均有软骨和骨形成,但后组尤为明显,标本CT值经统计学方差分析组间差别有非常显著性意义（P＜0．01）。结论：骨膜包绕肌腱－松质骨匀浆复合体在骨膜、松质骨匀浆诱导下可形成大量肌和软骨,具有较好支撑作用,可用作月骨替供物。     

自体腘绳肌肌腱重建交叉韧带腱-骨愈合研究进展

采用自体腘绳肌肌腱重建交叉韧带正得到越来越广泛的临床应用,如何促进肌腱与骨隧道及早、可靠的愈合,是近年研究的重点.该文就腘绳肌肌腱重建交叉韧带后腱-骨愈合的组织学及促进腱-骨愈合的生物学因素的研究进展作一综述.     

自体骨膜,软骨膜包绕肌腱团块为月骨替代物的实验研究

目的　观察自体骨膜、软骨膜包绕肌腱团块作为植入物在关节腔中生长变化的情况 ,为替代月骨治疗月骨无菌性坏死提供形态学依据。方法　日本大耳兔 45只 ,按手术先后随机分为 3组 :(1)软骨膜包绕组 ;(2 )骨膜包绕组 ;(3)单纯肌腱球组为对照组。每组 15只兔。将三种植入物分别置入兔膝关节髌上囊处。术后 3、6、12、16及 2 4周取标本进行大体、组织学检查并测量其中心厚度。结果　单纯肌腱球发生玻璃样变性 ,形成片状的胶原化瘢痕组织。软骨膜包绕、骨膜包绕肌腱球 ,在关节腔中能够良好地生长。膜与腱之间靠肉芽组织牢固愈着 ,表面光滑。具有软骨及骨的硬度 ,并有一定的抗压能力。结论　单纯肌腱球不能替代月骨起到支撑作用。骨膜、软骨膜包绕肌腱球可作为月骨的替代     

关节滑液对重建韧带腱-骨愈合的影响

[目的]观察关节滑液对关节内韧带重建术后腱-骨愈合的影响。[方法]6个月龄健康雌性新西兰大白兔40只,体重2.5～3.5kg/只,随机分为4组。采用自体带血供半腱肌转移建立胫骨隧道-肌腱界面模型。右侧胫骨隧道不与关节腔相通,无关节滑液浸入;左侧胫骨隧道与关节腔相通,有关节滑液浸入。1组于术后8周取材行生物力学测试,其余3组分别于术后2、4、8周取材,行HE、Masson染色,观察组织形态学改变及界面组织愈合情况。[结果]术后2周,无关节滑液组和有关节滑液组腱骨界面无显著差异,被肉芽组织填充。术后4周,无关节滑液组成纤维细胞和成软骨细胞增生明显,胶原纤维合成明显增多,明显优于有关节滑液组。术后8周,有关节滑液组腱骨界面由结缔组织连接,但连接仍不够紧密,胶原纤维大量合成,不规则排列。无关节滑液组腱骨界面连接紧密,胶原纤维致密,排列规则。界面组织细胞计数比较结果显示各时间组和各组内时间段无关节滑液组与有关节滑液组比较均有显著差异(P0.05)。生物力学测试无关节滑液组抗拉力强度显著高于有关节滑液组(P0.05)。[结论]关节滑液对重建韧带腱骨愈合有负面影响,不利于重建韧带的腱骨愈合,提示阻止关节滑液进入骨隧道可能对改进前交叉韧带重建的临床效果有益。     

磷酸钙水泥对自体腘绳肌腱重建前交叉韧带后腱-骨愈合影响的生物力学研究

目的探讨骨形态发生蛋白结合型磷酸钙水泥(rhBMP-2-CPC)对自体腘绳肌腱重建前交叉韧带(ACL)后腱-骨愈合的影响。方法取54只成年新西兰大白兔,建立48只双膝关节ACL完全断裂的自身对照模型,24只用rhBMP-2-CPC充填移植腱-骨隧道界面(实验组),24只未用rhBMP-2-CPC(对照组),6只为生物力学试验的正常组。术后第2、4、8和12周取材进行生物力学检测。结果2、4、8和12周实验组肌腱移植物较对照组抗拉伸的最大载荷明显要大,差异有统计学意义(P<0.05)。结论实验组肌腱移植物的生物力学特性优于对照组;BMP-CPC能促进肌腱移植物在骨隧道内的早期腱-骨愈合。     

骨膜促进骨-肌腱结点愈合的研究

[目的]探讨骨膜对骨-肌腱结合部位愈合的影响,通过实验证明骨膜促进骨-肌腱结合部位细胞增生,进而促进该部位愈合.[方法]48只18周龄新西兰大白兔随机分为2组,实验组将骨膜游离并植入兔髌骨部分切除模型中骨-肌腱结点中,对照组只进行手术,不植入骨膜.在术后4、8、12周处死动物取标本进行大体和组织学观察.[结果]大体观察可见实验组骨-肌腱结合部位愈合较早.组织学检查显示实验组术后4、8周骨-肌腱结合部组织愈合明显,以从松质骨再生和骨-肌腱愈合接点纤维软骨带的再生为特征,较对照组迅速,提示早期实验组恢复较对照组迅速.[结论]骨膜可以促进骨-肌腱结合部位细胞增生,增加细胞基质合成,促进新生骨和纤维软骨移行带形成,促进其愈合.     

自体半腱肌复合骨形态发生蛋白和同种异体骨重建前交叉韧带后腱-骨愈合的生物力学研究

目的研究骨形态发生蛋白(BMP)复合同种异体骨(DPB)对自体半腱肌肌腱重建前交叉韧带后腱-骨愈合的影响。方法取64只成年新西兰大白兔,分成4组,建立左侧膝前交叉韧带(ACL)完全断裂模型。重建ACL时,于股骨隧道内分别植入BMP结合DPB、BMP、DPB。结果术后3、6、12及24周BMP结合DPB腱-骨愈合及移植物抗拉强度大于其他各治疗组,P<0.05。结论缓释载体DPB能延长BMP作用时间,提高移植物生物力学特性,拮抗骨吸收因子的负面效应,促进腱-骨愈合。     

自体骨膜包裹肌腱-松质骨匀浆作为月骨替代物的对比研究

目的探讨自体骨膜包裹肌腱-松质骨匀浆植入关节腔后的骨化机制,以及作为月骨替代物治疗月骨无菌性坏死的可行性. 方法新西兰白兔45只,随机分为A(骨膜组)、B(复合体组)、C(对照组)3组,每组15只.分别于兔膝关节腔内植入骨膜包绕肌腱、骨膜包绕肌腱-松质骨匀浆及单纯肌腱球.术后3、6和9周取材,测量定量CT骨密度值,组织切片采用HE染色和免疫组织化学ABC法,在光镜下观察骨形成蛋白(bone morphogenetic protein,BMP)分布. 结果术后免疫组织化学染色显示,BMP A组3周为阴性, 9周呈阳性,主要分布于新生软骨细胞;B组3周为阳性, 9周呈强阳性, 主要分布于新生骨细胞和软骨细胞;C组始终为阴性.各组各时间点定量CT骨密度值经统计学分析,除3周时A、C组间差异无统计学意义(P＞0.05)外,其余各组间差异均有统计学意义(P＜0.01). 结论自体骨膜包裹肌腱-松质骨匀浆在骨膜及松质骨匀浆中BMP的诱导作用下可形成大量骨和软骨,有较强支撑作用,为其用作月骨替代物提供实验依据.     

利用带血管骨膜重建腱-骨、腱-假体止点的实验研究

目的 研究利用带血管骨膜原位重建关节周围骨缺损部位腱-骨止点及在金属内植物表面重建腱-骨止点的可行性.方法 建立实验兔双侧桡骨肱二头肌腱-骨止点缺损模型,采用4种方法修复.A组:将肌腱断端置于缺损处中央,取带尺动脉的尺骨后外侧骨膜瓣,包裹缺损部及肌腱断端并缝合固定.A1组:将肌腱止点断端缝合于骨缺损处骨组织断端,不用游...     

Periosteal augmentation of a tendon graft improves tendon healing in the bone tunnel

Secure fixation of tendon or ligament to bone has been a challenging problem. The periosteum is an osteogenic organ that regulates bone growth and remodeling at the outer surface of cortical bone and also is known to play an important role in forming a tendon insertion site to bone. Therefore, we hypothesized that a freshly harvested periosteum can be used as a stimulative scaffold to biologically reinforce the attachment of tendon graft to bone. Using a rabbit hallucis longus tendon and calcaneus process model, we found that a periosteal augmentation of a tendon graft could enhance the structural integrity of the tendon-bone interface, when the periosteum is placed between the tendon and bone interface with the cambium layer facing toward the bone. Clinically, the use of an autogenous periosteum patch would be an optimal choice for biologic augmentation of the tendon graft in the bone tunnel, because the tissue is readily available for harvest from the patient's body.     

兔骨髓间质干细胞修复肌腱缺损效果观察

目的　观察兔骨髓间质干细胞(MSCs)修复肌腱缺损的效果。　方法　分离培养家兔MSCs,检测CD44mRNA进行鉴定。6只家兔分为实验组和对照组,每组3只。在兔跟腱处造成3cm长的缺损,实验组家兔以自体MSCs为种子细胞、以胶原聚羟基乙酸(PGA)为生物支架构建肌腱并移植于跟腱缺损处,对照组家兔仅以PGA生物支架修复跟腱缺损。于术后4、8、12周对移植部位进行大体和组织学观察。　结果　MSCs培养11d时CD44mRNA显示阳性。实验组术后8周肉眼可见移植处形成腱样组织, 12周时组织学观察可见形态一致、顺应力学方向排列于胶原中的腱样细胞,类似正常肌腱组织。对照组所形成的新生组织较实验组细小且与周围组织粘连, 12周时组织学观察见细胞排列紊乱,胶原纤维呈松散网丝状。　结论　应用组织工程技术以自体MSCs修复肌腱缺损具有可行性。     

Evaluations of guided bone regeneration in canine radius segmental defects using autologous periosteum combined with fascia lata under stable external fixation

BackgroundAlthough bone defect is one of the most common orthopaedic diseases, treatment remains a challenge and an issue of debate. Guided bone regeneration (GBR) is primarily accompanied by barrier membranes; however, optional membranes show some inherent flaws in clinical application. The purpose of this study was to observe the healing velocity and quality of repairing canine radius segmental defect using transferred autologous periosteum combined with fascia lata, which can provide better biological safety than other materials.ResultsBone union was seen in most individuals from the autologous periosteum combined with fascia lata group, within an average of 14.2 weeks. Histopathologic and SEM examinations both showed the different osteogenesis state between groups. Necropsy confirmed US findings with regard to distance of bone defects and location.ConclusionThese findings suggest that autologous periosteum combined with fascia lata is as effective as a GBR membrane, even in long tubular bone defects. With reliable biological safety, the autologous periosteum combined with fascia lata is expected to achieve increasing application in orthopaedic trauma patients.

Level of evidence

Not applicable, animal study.     

Enveloping the tendon graft with periosteum to enhance tendon-bone healing in a bone tunnel: A biomechanical and histologic study in rabbits

Purpose: Fixing and incorporating the tendon graft within the bone tunnel is a major concern when using grafts for ligament reconstruction. The periosteum contains multipotent stem cells and has the potential to form osteogenic and chondrogenic tissues. This study uses histologic and biomechanical analyses to examine the effect of periosteum on tendon-bone healing within a bone tunnel. Type of Study: Experimental study in an animal model. Methods: In this study, 36 adult New Zealand White rabbits were used. The long digitorum extensor tendon was transplanted into a bone tunnel of the proximal tibia. The periosteum from the proximal tibia was sutured on the surface of the tendon portion. The tendon was pulled through a drill-hole in the proximal tibia and attached to the medial aspect of the tibia. Histologic examination of the tendon-bone interface and biomechanical test for maximal pullout load were evaluated at 4, 8, and 12 weeks after operation. Results: Histologic analysis of the tendon-bone interface showed a fibrous layer formed between the tendon and the bone by the periosteum. This layer became progressively integrated with the tendon and bone surface during the healing process. At 4 weeks, the cancellous bone lining in the bone tunnel was interdigitated with the fibrous interface tissue. At 8 weeks, progressive new bone grew into the interface fibrous layer. At 12 weeks, collagen fibers anchored to the bone and organization with fibrocartilage formation developed between the tendon and bone. Biomechanical testing revealed higher maximal pullout strength in the periosteum-enveloped group at all time points, with a statistically significant difference at 8 and 12 weeks. The periosteum-treated group had a higher interface strength-to-length ratio and significant increase at 8 weeks and 12 weeks. Conclusions: The histologic and biomechanical studies demonstrated that, if periosteum was sutured on the tendon that was transplanted within a bone tunnel, it resulted in a superior healing process and better healed strength. When doing ligament reconstruction with a tendon graft, the periosteum can be sutured to the graft to enhance tendon-bone healing.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 3 (March), 2003: pp 290–296     

四种自体植入物作月骨替代物的对比实验研究

目的 对比研究四种自体植入物置入动物关节腔后的组织形态学变化,为治疗Kienbock病提供可行的月骨替代物。方法 选新西兰白兔60只,按手术前后随机分为A组(骨膜组)、B组(复合体组)、C组(BMP-松质骨粒复合体组)和D组(对照组),每组15只。将四种植入物分别植入兔关节腔内,术后3、6、12、16和24周时取材,组织学观察骨形成并测量骨密度值(bone mineral density,BMD)。结果 A组、B组均有骨和软骨形成,后者尤为明显;C组仅有骨形成;D组呈玻璃样变性,无骨形成。标本的 BMD值经统计学方差分析,A组、B组和D组间有非常明显的差别(P<0.01),B组与C组间无明显差别(P>0.05)。结论 BMP-松质骨粒复合体组骨形成较强;复合体组在骨膜、松质骨匀浆中多种骨形成诱导因子作用下可形成大量骨和软骨,两种自体植入物可用作月骨替代物。     

去除外骨膜对引导性骨再生模型成骨过程的影响

目的研究去除外骨膜对引导性骨再生成骨过程的影响。方法对２４只新西兰兔双侧桡骨制作１０ｍｍ骨缺损,一侧保留外骨膜并用硅胶管连接,另一侧于缺损两端各去除外骨膜１０ｍｍ,其余手术方法相同,动物分别于术后３天和１、２、３、４、６、１０、１２周处死,标本行Ｘ线、非脱钙骨切片组织学检查。结果（１）去除外骨膜后对于膜管内、膜管外成骨过程均无影响;（２）外骨膜生发层中的成骨细胞与哈弗系统中央管内及骨表面的成骨细胞相互联系;（３）外骨膜的两层结构分别来自于不同的组织：纤维层组织来自于外周的软组织,生发层中的成骨细胞来自于骨表面及哈弗系统。结论去除外骨膜对引导性骨再生模型的成骨过程无影响