人工骨材料磷酸钙及硫酸钙在腱-骨愈合中的作用

背景：有关促进腱-骨愈合的方法文献报道很多,主要方法就是给腱-骨间隙添加一些刺激物质,以此促进腱骨的愈合。磷酸钙盐作为生物活性材料具有骨传导性,已广泛应用于临床骨缺损的替代和填充。而硫酸钙作为人工材料,具有潜在的骨诱导活性。 目的：在自体腘绳肌肌腱移植重建膝关节前交叉韧带过程中,观察人工骨材料磷酸钙及硫酸钙促进腱-骨愈合的效应。 方法：选用36条雄性成熟比格犬,先行切断双侧膝关节前交叉韧带,取同侧后肢趾长屈肌腱作为移植物,采用悬吊式固定重建前交叉韧带。按随机数字表法分为3组,磷酸钙组于股骨腱骨隧道中注入磷酸钙,硫酸钙组注入硫酸钙,空白组韧带重建结束后不添加任何填充物。分别于重建后1,2,3,4,6个月取材行大体观察、组织学和生物力学观测。 结果与结论：前交叉韧带重建后1,2,3,4个月时,磷酸钙组及硫酸钙组腱骨界面纤维连接明显强于空白组,而磷酸钙组、硫酸钙组差异无显著性意义。6个月时,各组愈合程度相似。生物力学方面,重建后1个月时,磷酸钙组及硫酸钙组腱骨界面的抗拉脱强度均高于空白组(P < 0.05),而磷酸钙组、硫酸钙组差异无显著性意义(P > 0.05)。提示磷酸钙及硫酸钙均能促进腱-骨愈合,两者之间无明显差异。

Effect of calcium acid phosphate and calcium sulfate on tendon-bone healing

BACKGROUND: The reports are related to the promotion of tendon-bone healing are many, the main method is to give tendon-bone gap some excitor substance, so as to promote tendon-bone healing. Calcium acid phosphate as bioactive material has bone conductibility, and has been commonly used in substitution and padding of clinical bone defect. However, calcium sulfate as artificial material has potential osteoinductivity. OBJECTIVE:To observe the effect of calcium acid phosphate and calcium sulfate on tendon-bone healing during the process of anterior cruciate ligament of knee joint constructed with autologous hamstring tendon transplantation. METHODS:A total of 36 male Beagle dogs were selected, and treated with cut off bilateral anterior cruciate ligament, the tendon of flexor digitorum longus was obtained. Suspended fixation method was used to reconstruct anterior cruciate ligament; which were randomly divided into 3 groups: calcium acid phosphate group, calcium sulfate group and blank group. Calcium acid phosphate was injected into femoral tendon bone tunnel in calcium acid phosphate group. Calcium sulfate was injected into calcium sulfate group. No additional treatment was applied to blank group after ligament reconstruction. Dogs were undergoing general observation, histological examination and biomechanical test at 1, 2, 3, 4, 6 months after reconstruction. RESULTS AND CONCLUSION:Tendon-bone interface fibronectin in calcium acid phosphate group and calcium sulfate group was significantly better than that in blank group at 1, 2, 3, 4 months after reconstruction of anterior cruciate ligament. There was no significant difference between calcium acid phosphate group and calcium sulfate group. The healing degree in each group was similar after 6 months. In biomechanics, the pull-off strength of tendon-bone interface in calcium acid phosphate group and calcium sulfate group was higher than that in blank group (P < 0.05). However, there was no significance between calcium acid phosphate group and calcium sulfate group (P > 0.05). It is indicated that calcium acid phosphate and calcium sulfate can promote tendon-bone healing, and there was no significant difference between two groups.