体外冲击波对兔ACL重建腱骨愈合影响的组织学观察

目的组织学观察体外冲击波（Extracorporeal Shock Waves,ESW）治疗对前交叉韧带（ACL）重建后腱骨愈合的影响。方法健康新西兰大白兔18只（2-3月龄雌雄不限）,随机分为2组,采用趾长伸肌腱建立ACL重建动物模型,ESW治疗组ACL重建术后24h给予冲击波治疗,对照组不给予冲击波处理,术后2、4、8周处死动物取标本行HE染色观察组织学改变,血管墨汁灌注观察愈合组织新生血管含量。结果 ESW组术后4周腱骨界面成纤维细胞和成软骨细胞增生活跃,胶原纤维合成明显增多、排列规则。术后8周腱骨界面由致密结缔组织连接,胶原纤维大量合成、呈垂直纵向规则排列,部分区域出现胶原纤维-纤维软骨组织-骨组织的移行带改变,形成类似韧带直接止点样结构。腱骨界面组织愈合较对照组迅速。术后4周和8周腱骨界面新生血管的含量ESW组明显高于对照组（P=0.028,P=0.008）。结论 ESW作用可诱导腱骨界面血管新生,改善腱骨界面血供,促进腱骨界面组织愈合。

Effect of extracorporeal shock-wave on tendon-bone healing after reconstruction of anterior cruciate ligament :A histological study in rabbits

Objective To observe the effect of extracorporeal shock wave（ESW） on tendon-bone healing after reconstruction of anterior cruciate ligament（ACL）. Methods Eighteen healthy F/M New Zealand white rabbits at the age of 2-3 months were randomly divided into ESW treatment group and control group. An animal model of ACL reconstruction was established using digital long extensor tendon. Rabbits in ESW group were treated with ESW 24 hours after ACL reconstruction while those in control group were not treated with ESW. Samples were collected when the animals were killed 2, 4 and 8 weeks after operation and stained with hematoxylin and eosin（HE） to observe changes in tendon-bone healing tissue. Intravascular ink injection was used to observe neo- vascularization in tendon-bone healing tissue. Results Active proliferation of fibroblasts and chondroblasts was observed on the tendon-bone interface and the number of collagen fibers was significantly increased and regularly arranged in ESW treatment group 4 weeks after operation. The healing tissue on bone-tendon interface was linked with dense connective tissue with a large number of collagen fibers which were regularly and longitudinally arranged. Collagen fibers, fibrocartilage and bone tissues with a direct ligamentous insertion-like structure could be found on tendon-bone interface in some transition zones 8 weeks after operation. The tissue on tendon-bone interface was healed quicker in ESW treatment group than in control group. The number of neo-vessels on tendon-bone interface was significantly greater in ESW treatment group than in control group 4 and 8 weeks after operation（P〈0.05）. Conclusion ESW can induce generation of neo-vessels, improve blood supply and promote tissue healing on the tendon-bone interface.