关节滑液对兔前交叉韧带重建后腱骨愈合生物力学和组织学的影响*

背景：目前前交叉韧带重建后关节滑液对移植物强度以及腱骨愈合的影响尚无定论。目的：观察兔前交叉韧带重建后腱骨愈合过程中,关节滑液对移植肌腱生物力学及组织学的影响。方法：取新西兰大白兔下肢半腱肌腱,以同侧肢体半腱肌腱重建前交叉韧带模拟关节滑液影响模型,并同时取对侧肢体半腱肌行股骨髁上“U”形肌腱埋植避免关节滑液的影响。重建4周,取股骨-韧带-胫骨复合体,行生物力学测定和组织学观察。结果与结论：重建后4周,生物力学测定时发现“U”字形埋植肌腱断裂时平均载荷明显大于前交叉韧带重建后处于关节内的肌腱(P < 0.01)。组织学观察发现,骨隧道内坏死的腱组织已被纤维组织、新生骨组织替代,腱骨交界面形成Sharpey纤维连接和纤维软骨,优于关节内肌腱;“U”字形埋植肌腱腱骨交界面成骨细胞数目明显多于前交叉韧带重建肌腱(P < 0.01)。结果证实“U”字形埋植肌腱的生物力学及腱骨愈合均优于处于关节内肌腱,提示关节滑液对前交叉韧带重建后韧带的强度以及腱骨愈合有不利影响。

Effect of joint synovial fluid on biodynamics and histology of tendon-bone healing after reconstruction of anterior cruciate ligament in rabbits

BACKGROUND: At present, effect of joint synovial fluid on the strength of graft and tendon-bone healing after reconstruction of anterior cruciate ligament (ACL) is inconclusive.OBJECTIVE: To observe the effect of joint synovial fluid on biodynamics and histology of tendon-bone healing after reconstruction of ACL in the rabbits.METHODS: Semitendinosus tendons were taken from lower extremities of New Zealand white rabbits to reconstruct ACL simulation synovial fluid influence model with ipsilateral semitendinosus tendons, and contralateral semitendinosus tendons were used for implanting “U”-shaped on the femoral condyle to avoid the influence of the synovial fluid. Specimens were collected at 4 weeks after operation for biomechanical measurement and histological observation. RESULTS AND CONCLUSION: Biomechanical measurement at 4 weeks after reconstruction showed that the average load of “U” shaped implanted tendon breakage was significantly higher than that of the ACL reconstructed tendon (P < 0.01). Histological observation showed that necrotic tendon tissues in bone tunnel were replaced by new bone tissues and fibrous tissues. Sharpey’s fibers and fibrocartilages were appeared on the tendon-bone interface. The number of bone cells on the tendon bone interface of the “U” shaped implanted tendon was significantly higher than that of ACL reconstructed tendon (P < 0.01), superior to intra-articular group. It results showed that biomechanics and tendon bone healing of the “U” shaped implanted tendon were both superior to the ACL reconstructed tendon. It is indicated that joint synovial fluid of ACL reconstruction has an adverse effect on ligament strength and tendon bone healing.