去细胞与冷冻干燥人体肌腱特性的对比研究

An in- vitro comparison of the properties of acellular and freeze- dried human tendons

[目的]观察化学萃取去细胞技术与冷冻干燥处理技术对人体肌腱性能的影响,并体外比较去细胞与冷冻干燥人体肌腱的特性,为进一步体内移植对比实验提供依据。[方法]实验分三组,从健康尸体获取新鲜肌腱20根,留10根作为对照组,用1%TnBP+0.25%Triton X-100化学萃取法制备去细胞人体肌腱10根作为实验组1,购买冷冻干燥异体肌腱10根作为实验组2。各标本留取组织行组织学、扫描电镜、生物力学和羟脯氨酸含量检测并相互比较。[结果]HE染色结果显示去细胞肌腱未见腱细胞残留,胶原纤维完整,走形自然。冷冻干燥异体肌腱细胞数量较新鲜肌腱少,纤维间留有大而不规则空隙;扫描电镜见去细胞肌腱胶原纤维完整,近平行排列,和新鲜肌腱相似,冷冻干燥肌腱纤维似"胶粘合"在一起;各组力学性能在最大载荷(N)、抗张强度(MPa)、断裂延伸率(%)、断裂功耗(J)等指标相比差异无统计学意义(P>0.05)。羟脯氨酸含量结果 (ug/mg):新鲜对照组为(0.292 882±0.010 098 8),去细胞组为(0.291 567±0.003 256 1),冷冻干燥组为(0.288 802±0.007 123 4),组间差异无统计学意义(P>0.05)。[结论]去细胞与冷冻干燥人体肌腱的体外差异主要表现在组织形态学上,力学性能和羟脯氨酸含量并无明显差异,本实验为体内移植研究提供了实验依据。

[Objective] To evaluate the clinical outcome of total hip arthroplasty(THA) in the treatment of bony ankylosis of the hip in patients with ankylosing spondylitis(AS).[Methods] A retrospective analysis was performed in 18 patients(29hips) with AS,who had undergone THA in the period April 2004- March 2011.Of these,11 patients had undergone bilateral THA.The mean age of the patients was 36.83 years(range,28 ~ 58 years).The mean disease duration was 12.11 years(range,5-23 years) and the mean hip flexion deformity was 23.17°(range,10° ~55°).All patients in this study had received a biological prosthesis.The clinical results were evaluated by using the Harris hip scoring system.The patients' health statuses were evaluated by using the ShortForm 12-item Survey(SF- 12).[Results] The average follow- up duration in this study was 3.39 years.All functions of the hip joint improved after THA.The mean value of the scores based on the Harris hip scoring system improved from the preoperative score of 32.97 to 82.24 at follow- up(P<0.01,by paired t- test),with 26cases rated as excellent and 28 as good(excellent or good results rate of 72.41%).The serious flexion deformities of the involved hips had been corrected completely.The total hip motion improved from 0° preoperatively to 145.79° at follow- up and was statistically significant(P<0.01,by paired t- test).The average range of motion improved from 0° preoperatively to83.69°at follow- up and was statistically significant(P<0.01,by paired t- test).At the final follow- up,a total relief from pain was noted in 18 hips(62.07%) and occasional mild pain in5 hips(17.24%).Only 2 patients continued to need a crutch for walking.The other patients were able to function and care for themselves appropriately.The prostheses were found to be at the correct location in the radiographs with no sign of aseptic loosening and dislocation of the prostheses on the cup or the stem side.Three patients(3 hips) presented with heterotopic ossification.Based on the Brooker grading system,2.hips were classified as Grade I and 1 as Grade II.The mean value of the scores based on the ShortForm- 12 scores physical component summary showed an average improvement from 29.10 preoperatively to 50.07 at follow- up(P<0.01,by paired t- test).The mental component summary showed an average improvement from 40.49 preoperatively to 50.38 at follow- up(P<0.01,by paired t-test).[Conclusion] THA is an effective method of treating bony deformity of the hip in patients with ankylosing spondylitis and can be used to improve the patients' quality of life.