自体半腱肌腱重建距跟骨间韧带动物模型

目的:利用自体半腱肌腱移植建立距跟骨间韧带重建的动物模型。方法:将72只新西兰白兔随机分为重建组、切断组和对照组。分别于4周、8周、16周、32周取材,对3个实验组术前术后体重变化,重建韧带的影像学、组织学和生物力学结果以及术后距下关节的活动范围进行评估。结果:术后8周以后实验动物体重变化出现差别,韧带切断组较重建组体重多增加0.32 kg(P=0.04);影像学、组织学和生物力学均支持移植韧带成活,生物力学研究发现韧带牵拉时出现2个张力屈服点;术后3组距下关节冠状面(P<0.05)和水平面(P<0.001)活动度差异有统计学意义。结论:利用自体半腱肌腱移植重建距跟骨间韧带可有效恢复距下关节的解剖和功能。移植韧带经过坏死、塑形改建、成熟的过程与骨道形成末端结构愈合。对于研究距下关节稳定性、韧带断裂后关节的继发性改变、韧带移植重建的转归提供了良好的动物模型材料。     

辛伐他汀促进兔肩袖损伤修复术后腱-骨愈合的实验研究

目的:探讨辛伐他汀/甲基纤维素凝胶对兔肩袖损伤修复术后腱-骨愈合的影响。方法:将36只成年雄性新西兰大白兔随机分为实验组、实验对照组、空白对照组,每组各12只。建立兔肩袖损伤修复模型后,实验组在肱骨大结节骨槽上注射辛伐他汀/甲基纤维素凝胶并将冈上肌缝合回足印区;实验对照组仅注射甲基纤维素凝胶并缝合回足印区;空白对照组不给予任何干预措施缝合回足印区。术后连续3天肌注庆大霉素(3mg/kg),无须制动固定。所有兔子在术后2、4、8周处死,取冈上肌与近端肱骨的交界区行甲苯胺蓝染色、血管内皮生长因子(VEGF)免疫组化染色、Masson染色及生物力学检测。观察兔冈上肌腱-骨愈合情况。结果:(1)生物力学结果显示:三组术后腱-骨界面的最大载荷及刚度随着时间点的延长而不断增强,差异有统计学意义(P<0.05);术后2周,实验组腱-骨界面的最大载荷及刚度与实验对照组及空白对照组比较无差异(P>0.05);术后4周及8周,实验组腱-骨界面的最大载荷及刚度显著高于实验对照组及空白对照组(P<0.05)。(2)甲苯胺蓝染色结果显示:术后2周,实验组腱-骨界面的成纤维细胞较对照组多;4周及8周见较多新生软骨细胞及骨细胞且腱-骨结合较对照组致密。(3)免疫组化结果显示:术后2周,实验组VEGF阳性细胞表达明显高于实验对照组及空白对照组(P<0.05);术后4周及8周,三组腱-骨界面的VEGF表达趋于下降。(4)Masson染色结果显示:术后4周,实验组腱-骨界面胶原纤维的走形及生成情况均优于其余两组。结论:局部应用辛伐他汀/甲基纤维素凝胶能够促进兔肩袖损伤术后腱-骨愈合,增强腱骨界面的生物力学强度。     

自体外周血富白细胞-血小板纤维蛋白对兔关节外骨道内移植肌腱腱骨早期愈合的影响

目的:探讨兔关节外骨道内使用自体外周血富白细胞-血小板纤维蛋白(L-PRF)对移植肌腱早期腱骨愈合的影响。方法:30只健康新西兰大白兔平均分为实验组和空白对照组。将兔的半腱肌腱取出制成游离肌腱,植入同侧关节外胫骨近端的横向骨道内制成腱骨愈合模型。实验组加入自体血来源的L-PRF,对照组不加入L-PRF。分别于术后4、8、12周三个时间点处死实验动物取材,切片染色,行腱骨界面的组织形态学观察、Buark评级,并在高倍镜下行成纤维细胞计数并分析。结果:各个时间点实验组成纤维细胞数目均多于对照组,差异均具有统计学意义(P<0.05);在3个时间点中,与对照组相比,实验组腱骨连接更加紧密,腱骨间隙更小,胶原纤维排列更有序规则;标志腱骨早期愈合的Sharpey样纤维在4周时的实验组即可观察到,而对照组8周时才可观察到,并且随着时间延长,两组Sharpey样纤维均持续增多;两组标本的腱骨界面组织形态学Buark评级差异有统计学意义(P<0.05)。结论:自体血来源的L-PRF可促进关节外骨道内移植半腱肌腱腱骨的早期愈合。     

肌腱部分损伤修复方法的实验研究

目的　探讨肌腱横形和斜形严重部分损伤时合理修复肌腱的方法。　方法　 10 8根猪前蹄肌腱 ,横形或斜形损伤直径 90 % ,根据 3种中心缝合方法 (改良Kessler法、MGH法、改良MGH法 )与连续周边缝合方法组合分组 ,随机分为 12组 ,第 1～ 8组为横形损伤 ,第 9～ 12组为斜形损伤 ,第 1,9组为对照组 (不修复 ) ,每组 9根肌腱。用生物力学测定仪检测缝合肌腱的 2mm间隙形成负荷、最大抗张强度、最大功耗。　结果　当肌腱横断大部分损伤时 ,中心缝合或者周边缝合 ,均能在不同程度上明显提高肌腱的抗张强度 (P <0 .0 1) ,所有组中以改良MGH法 连续周边缝合的抗张强度最大 (P <0 .0 1)。　结论　肌腱横形或斜形严重部分损伤时的抗张力相当低 ,在拉伸过程中极易形成间隙 ,周边缝合和中心缝合能明显提高其修复强度     

不同去细胞方法对兔肌腱力学性能影响的实验研究

目的探讨不同去细胞方法对兔肌腱组织生物力学性能的影响,选出肌腱最佳的去细胞方法。方法应用6种去细胞方法1%TritonX-100、0.5%SDS、1%TnBP、1%TritonX-100+0.5%SDS、1%TnBP+0.5%SDS及1%TnBP+1%TritonX-100对兔半腱肌、趾屈肌腱行去细胞处理24h后行拉伸力学测试,比较其对兔肌腱生物力学性能的影响;对照组为新鲜肌腱。结果各去细胞肌腱组的破坏荷载与对照组比较均有一定的降低,1%TritonX-100、0.5%SDS1、%TnBP及1%TnBP+0.5%SDS组间无明显差异,1%TritonX-100+0.5%SDS去细胞组拉伸强度降低显著,但与对照组无明显差异(P>0.05)。去细胞肌腱的延伸率1%Tn-BP组与对照组有明显差异(P<0.01),余各组间无明显差异。结论拉伸实验表明各种去细胞处理均可最大程度保留肌腱的生物力学特性,单纯的TnBP组对肌腱的拉伸有一定的影响。     

富血小板血浆凝胶在同种异体肌腱重建前交叉韧带后腱-骨愈合中的作用

目的 观察富血小板血浆(platelet-rich plasma,PRP)凝胶对同种异体跟腱重建兔前交叉韧带(ACL)后腱一骨愈合的影响.方法 24只兔行双侧ACL重建;一侧膝关节移植物予自体PRP凝胶预处理(实验组),另一侧膝关节移植物不予处理(对照组).于术后2,6和12周行组织学、免疫组化和生物力学评价.结果 2周和6周时Burak评分实验组高于对照组.12周时对照组腱-骨界面为成熟瘢痕组织,而实验组显示该界面为成熟纤维软骨带.免疫组化显示实验组血管内皮生长因子(VEGF)的阳性表达在早期较对照组高,TGF-β1的表达持续高于对照组.生物力学分析显示2周及6周时实验组极限负荷[(15.3±2.9)N、(33.2±6.9)N]明显高于对照组((7.9±1.4)N、(23.7±4.9)N](P＜0.05).结论 PRP凝胶可促进同种异体移植肌腱早期腱-骨愈合.     

柠檬酸钙复合材料促进骨腱愈合的实验研究

目的：本实验为研发一种新型促进骨腱愈合材料———柠檬酸钙复合材料,并在合适动物实验模型中探究材料对骨腱愈合的作用。方法实验动物选用成年日本大白兔48只,将其随机分为6组,均采用双侧兔趾长伸肌腱模型,实验侧（右侧）注射注射型海藻酸钠-明胶-柠檬酸钙复合材料,对照侧（左侧）注射等量海藻酸钠－明胶液体。术后2、4、6、8、10、12周取材,行标本组织学染色观察,采用Image-Pro Plus 8.0图像分析软件测定肌腱周围每1mm2新生骨面积,进行生物力学测试。结果术后6周内,组织学示骨腱界面中,实验侧Sharpey纤维、纤维软骨、钙化软骨出现明显早于对照侧,骨腱间间隙明显减小;2、4、6、8、10周及12周,每1mm2中新生骨面积实验组均高于对照组;术后6周内,实验侧骨腱愈合抗牵拉强度明显高于对照侧。结论可注射型海藻酸钠-明胶-柠檬酸钙对骨腱愈合具有明显的促进作用,这种作用主要发生在早期。     

骨髓间充质干细胞促进前交叉韧带重建后腱-骨愈合的生物力学研究

目的 观察骨髓间充质干细胞(bone marrow-derived mesenchymal stem cells,bMSCs)移植对兔前交叉韧带(anterior cruciate ligament,ACL)重建后移植物与骨道愈合的影响.方法 选择24只新西兰大白兔,取自体同侧部分腓肠肌腱作为移植物,构建ACL重建模型,双后肢均纳入研究,一侧使用混合bMSCs的纤维蛋白胶包裹移植物(bMSCs组),对侧后肢单纯使用纤维蛋白胶包裹移植物(对照组).分别于术后2,4,6,8周取材检测腱-骨界面的断裂强度和刚度. 结果 bMSCs组和对照组腱-骨界面的断裂强度和刚度均随修复时间延长呈上升趋势,其中实验组腱-骨界面的断裂强度和刚度自第6周始明显高于对照组(P＜0.05). 结论 bMSCs移植可明显提高兔ACL重建后早期腱-骨界面的断裂强度和刚度,促进移植物与骨道早期愈合.     

改良kessler肌腱缝合法

肌腱断裂的缝接方法较多,效果均欠满意。原因是缝接后腱周围的粘连和再断裂,直接影响了肌腱修复术后的效果。解决粘连和缝接强度问题,是近十年来手术外科研究较多的课题之一。Backer 在1978年提出了肌腱的显微缝合法以来,已被显微外科和手外科医师采用。从1978年——1991年,本科用不同的方法共缝接67条肌腱,1982年以后,采用改良 Kessler 肌腱缝接法。现就随访到的采用不同方法缝接的28例59条复腱的效果作比较分析,其中以改良 Kessler 缝接法术后功能恢复最为满意。现报告如下:     

几丁聚糖影响肌腱愈合的实验研究及临床应用

目的　研究几丁聚糖对肌腱愈合的影响。　方法　以24只新西兰兔为实验动物，实验组于Ⅱ区将屈趾深肌腱切断并吻合后，腱鞘内注入几丁聚糖0.1ml，对照组不注入。术后3，4周后对其局部肌腱行大体标本观察、生物力学测试、光镜和透射电镜观察。临床Ⅱ区屈指肌腱断裂病人40例,Ⅰ组20例肌腱吻合后腱鞘内注入几丁聚糖0.2ml，Ⅱ组不注入，随访检查其握力，计算屈指肌腱总主动活动度(TAM)。　结果　（1）大体标本观察实验组肌腱较对照组愈合好，粘连轻。生物力学测试结果表明，两组比较差异具有显著性意义（P<0.05）。（2）组织学检查光镜和电镜示两组3，4周比较差异有显著性意义(P<0.05)。(3)临床应用中的握力及屈指TAMⅠ组握力为健侧的58%～96%，平均83.3%；Ⅱ组为49%～86%，平均72.6%。Ⅰ组TAM优9例，良7例，差1例；Ⅱ组优5例，良7例，可5例，差3例。两组比较差异有非常显著性意义（P<0.01)。　结论　几丁聚糖具有预防肌腱粘连的作用，且能促进肌腱愈合。     

腘绳肌腱与髌腱骨重建ACL不同固定方法的生物力学研究

目的　探讨不同材料与固定方法对髌腱骨 (B PT B)和绳肌腱重建ACL抗拉强度和稳定因素的影响。方法　采用猪膝关节 35个 ,模拟交叉韧带重建 ,实验分为 :骨 髌腱 骨两端界面螺钉固定法 (n=11) ,股骨端单纯肌腱结 (n =13)和肌腱结骨栓 (n =5 )嵌压固定法 ,胫骨端固定采用肌腱编织缝合后骨桥上打结固定法(n=7)、肌腱端编织缝线界面螺钉固定法 (n =6 )和不带缝线肌腱界面螺钉固定法 (n =5 ) ;猪正常膝关节 (n =6 )ACL作为实验对照组。生物力学实验包括最大载荷拔出、抗拉刚度和位移 ,数据进行统计学处理。结果　最大载荷 :绳肌腱结和绳肌腱结骨栓嵌压固定 >B PT B界面螺钉固定 ,前者可以满足正常生理强度需求 ;胫骨固定最大载荷 :绳肌腱编织缝线骨桥打结固定 >肌腱端编织缝合 >无缝线肌腱界面螺钉固定 ;抗拉刚度 :猪正常ACL >B PT B界面螺钉固定 >绳肌腱结和绳肌腱结骨栓固定 ;最大位移 :猪正常ACL 0 1) ,在其他参数上前者优于后者 ,差异均有统计学意义 (P<0 0 5 )。结论　股骨端绳肌腱结和     

Effect of repeated freezing–thawing on the Achilles tendon of rabbits

The increased use of allograft tissue in the reconstruction of anterior cruciate ligament has brought more focus to the effect of storage and treatment on allograft. The purpose of this study was to observe the effect of histology and biomechanics on Achilles tendon in rabbits through repeated freezing–thawing before allograft tendon transplantation. Rabbit Achilles tendons were harvested and processed according to the manufacture’s protocol of tissue bank, and freezing–thawing was repeated three times (group 1) and ten times (group 2). Those received only one cycle were used as controls. Then, tendons in each group were selected randomly to make for histological observations and biomechanics test. Histological observation showed that the following changes happened as the number of freezing–thawing increased: the arrangement of tendon bundles and collagen fibrils became disordered until ruptured, cells disrupted and apparent gaps appeared between tendon bundle because the formation of ice crystals. There were significant differences between the experimental and control groups in the values of maximum load, energy of maximum load and maximum stress, whereas no significant differences existed in other values such as stiffness, maximum strain, elastic modulus, and energy density. Therefore, repeated freezing–thawing had histological and biomechanical effect on Achilles tendon in rabbits before allograft tendon transplantation. This indicates that cautions should be taken in the repeated freezing–thawing preparation of allograft tendons in clinical application.     

Biomechanical evaluation of rotator cuff fixation methods

Initial fixation strength and failure mode for various rotator cuff reattachment techniques (variations of the McLaughlin technique) were evaluated. Repair methods included standard suture (control), reinforced suture [expanded polytetrafluoroethylene (PTFE) patch and polydioxanone (PDS) tape augmentation] and stapling (nonarthroscopic and arthroscopic soft-tissue staples). The average strength of intact rotator cuff tissue (supraspinatus tendon) was also determined. The different rotator cuff repairs, including at least one control, were performed on fresh-frozen human cadaver shoulder pairs. Repairs were tested to failure in pure tension with the shoulder fixed in 60 degrees of abduction. Load and displacement data were normalized to controls, grouped according to failure modes, and statistically analyzed. The two basic failure modes observed were 1) bone failure, or suture tearing through the bone (indicating weak bone stock) and 2) tendon failure, or suture tearing of the rotator cuff. Gross comparisons between intact and repaired tendons indicated that the intact tendon was two to three times stronger than the repaired tendon. Based on the mode of failure and lack of increased strength after repair, the use of staples for cuff attachment is discouraged. PDS tape suture reinforcement did not increase fixation strength. In contrast, PTFE patch suture augmentation demonstrated statistically higher initial failure loads than did the control and was of specific benefit for shoulders with weak bone stock.     

Suture plication, thermal shrinkage, and sclerosing agents: effects on rat patellar tendon length and biomechanical strength

BACKGROUND: Shortening or tightening of dense, collagenous tissues is often desirable in the treatment of laxity. PURPOSE: To compare the effect of stress-protection suture, radiofrequency thermal shrinkage combined with stress-protection suture, and a 5% sodium morrhuate sclerosing injection on the length and biomechanical strength of the rat patellar tendon. HYPOTHESIS: Sclerosing agents will increase tendon mechanical strength. Thermal shrinkage combined with stress-protection suture and stress-protection suture only will cause a short-term decrease in tendon strength. All 3 methods will produce equivalent shortening of the tendon. STUDY DESIGN: Controlled laboratory study. METHODS: Forty-six female retired breeder rats were split into 4 groups, each receiving 1 of the 3 aforementioned treatments plus a control group that received a saline injection. After 4 weeks' survival, the length and biomechanical properties of the patellar tendons were measured and compared to the contralateral untreated tendon. RESULTS: Rats treated with stress-protection suture had shorter tendons. Radiofrequency thermal shrinkage combined with stress-protection suture yielded tendons that were both shorter and stronger than were the untreated contralateral tendons. The sodium morrhuate-injected tendons were stronger whereas the saline-treated tendons were weaker than were their respective untreated contralateral tendons. CONCLUSION: Surgical stress-protection suture without radiofrequency shrinkage is most effective at shortening the length of the rat patellar tendon, whereas radiofrequency thermal shrinkage combined with stress-protection suture as well as sodium morrhuate are effective at increasing the strength of rat patellar tendons. CLINICAL RELEVANCE: Judicious use of thermal shrinkage in combination with stress protection may improve ligament strength and decrease laxity.     

A partially biodegradable material device for repair and reconstruction of injured tendons. Experimental studies

We assessed the applicability of a partially biodegradable synthetic material composed of polyglycolic acid (PGA) and dacron to repair or replace severely injured tendons. Adult rabbits underwent complete laceration and repair of one Achilles tendon. Group 1 (N = 8) had end to end tenorrhaphy with size 0 braided polyester suture, and Group 2 (N = 16) tendons were similarly repaired with the bicomposite designed PGA-dacron device. Group 3 (N = 16) received laceration and removal of 1 cm of tissue, and the defect was bridged with the same PGA-dacron material. No postoperative immobilization was applied. Evaluation, consisting of biomechanical testing or histologic inspection, was done at 4 and 8 weeks after tenorrhaphy. All tendons healed, and at 8 weeks the mean maximum load at failure of the repaired tendons was 32.2 +/- 3.4 kgf, 40.3 +/- 2.4 kgf, and 31.8 +/- 3.2kgf for Groups 1, 2, and 3, respectively. Values between groups were not significantly different, but all were significantly less (P less than or equal to 0.05) than the strength of the unoperated control tendons (55.8 +/- 7.2 kgf). The most noteworthy finding was the lengthening of the repaired tendons, due to scar elongation at the tenorrhaphy site, that occurred during healing as determined by a landmark placed a fixed distance proximal to the repair site. Group 1 tendons lengthened 22 mm, while Group 2 and 3 tendons increased by 12.5 mm. Histologically, fibrous tissue ingrowth into the residual dacron scaffold occurred, but it was inconsistent and inadequate in quality and quantity to be satisfactory as neotendon. The fibrous tissue did not mature or align in response to load. We concluded that the PGA-dacron material had adequate strength and physical properties to use both for primary tenorrhaphy and to bridge the tendon defect. However, in our experience this material lacks any significant advantage over other materials available or known to be under evaluation to support neotendon formation when an actual soft tissue defect exists.     

肌腱干/祖细胞和生长因子促进肌腱愈合的作用机制研究进展

肌腱损伤常需手术治疗,能够一定程度上恢复肌腱的结构与稳定性,但往往难以恢复到正常的强度,其主要原因是肌腱自然愈合能力有限,修复后的肌腱不能完全恢复功能。随着对肌腱愈合的研究不断加深,生物学技术为肌腱修复提供了新的方向。当前对肌腱修复的研究热点之一是使用生物辅助物来促进肌腱愈合,这些辅助物包括肌腱干/祖细胞(TSPCs)、生长因子等。笔者就TSPCs和生长因子促进肌腱愈合的作用机制研究进展作一综述,为肌腱损伤的生物学治疗和研究提供参考。     

四种屈肌腱缝合方法的生物力学研究

目的　比较 4种屈肌腱缝合方法的生物力学性能及操作难易程度 ,以供临床应用。　方法　选取 40只白种猪后足的屈趾深肌腱作为实验对象 ,随机分为 4组 ,切断肌腱后予以修复并记录操作时间。第 1组为Tang法 ,第 2组为Cruciate法 ,第 3组为Robertson法 ,第 4组为Silfverski old法。测定修复肌腱的 2mm裂隙抗张强度、断裂抗张强度及肌腱韧度 ,观察缝合断裂方式。　结果Tang法的 2mm裂隙抗张强度、断裂抗张强度及肌腱韧度最大 ,Cruciate法其次 ,Robertson法与Silfverskiold法相对较小。而在操作时间上 ,Tang和Cruciate最短。　结论　新近使用的Tang法和Cruciate法具有较好的生物力学性能 ,操作简便 ;Tang法的 2mm裂隙抗张强度较大 ,较Cruciate法更适应于术后早期主动功能锻炼。     

Arthroscopic reconstruction of a ruptured patellar tendon: a technical note

A traumatic patellar tendon rupture of a 35-year-old, otherwise healthy male was reconstructed with semi-tendinosus and gracillis tendons. Tendon grafts were harvested with an open-ended tendon stripper without dissecting them free from their tibial insertion. A transpatellar tunnel was drilled appropriate to the tendon size and a passing pin was used across the length of the patella. Graft bundles were passed in a standard fashion, traversing through the midst of the distal part of the patellar tendon via a beath pin with a loaded looped suture. The endo-button device was then flipped and fixed as an anchor. The patella was positioned at the original placement under arthroscopic visualization and the free ends of the hamstring tendons were attached to a post-fixation screw through the Krackow sutures. Tendon grafts were gathered on the tuberositas tibia and fixed with two additional staples. The patient could flex his knee up to 130 deg at the 3-month follow-up. It was demonstrated that arthroscopic reconstruction of a ruptured patellar tendon may be the optimal surgical choice to minimize trauma and begin early rehabilitation.