猪小肠黏膜下层移植修复兔膝关节内侧副韧带缺损

Repairing rabbit knee medial collateral ligament defects with porcine small intestinal submucosa

目的:观察猪小肠黏膜下层修复兔膝关节内侧副韧带缺损的作用效果。方法:实验于2006-01/08在上海交通大学医学院附属第三人民医院动物房及中心实验室完成。选用新西兰大白兔24只,动物左右两膝分别作为猪小肠黏膜下层移植组及自体韧带移植组,分别制作兔膝关节内侧副韧带缺损模型。猪小肠黏膜下层移植组植入猪小肠黏膜下层,猪小肠黏膜下层作为细胞外基质,无免疫原性;自体韧带移植组植入对侧副韧带。分别于术后2,4,8和12周取白兔膝关节内侧副韧带,行大体形态观察及组织学和力学检查,两组间进行对比观察。结果:24只白兔均进入结果分析,无脱失。①内侧副韧带移植段大体形态观察结果:术后4周,猪小肠黏膜下层移植组有大量的肉芽增生,与周围粘连;自体韧带移植组肉芽组织与周围粘连相对少。术后8周,猪小肠黏膜下层移植组组织梭形增生;自体韧带移植组组织平行增生,直径略小于猪小肠黏膜下层移植组。术后12周,猪小肠黏膜下层移植组增生组织平行于自体韧带,大小一致;自体韧带移植组增生组织直径与猪小肠黏膜下层移植组相一致。②内侧副韧带移植段光镜检查结果:术后2周,猪小肠黏膜下层移植组少量炎性细胞浸润,成纤维细胞数目不多,血管增生明显;自体韧带移植组炎性细胞稀少。术后4周,猪小肠黏膜下层移植组有大量的成纤维细胞,胶原增多;自体韧带移植组成纤维细胞和胶原比猪小肠黏膜下层移植组多。术后8周,猪小肠黏膜下层移植组纤维细胞为主,纤维纵向排列;自体韧带移植组也以成纤维细胞为主。术后12周,两组均有大量的胶原,排列整齐,细胞和纤维密度相一致。③内侧副韧带力学检查结果:术后4周猪小肠黏膜下层移植组白兔内侧副韧带的最大拉伸负荷大于自体韧带移植组[(36.8±8.9,25.3±7.3)N(P<0.05)],术后2,8,12周,两组差异无显著性意义(P>0.05)。结论:猪小肠黏膜下层是一种良好的生物材料,可以用来移植修复膝关节内侧副韧带缺损和损伤,移植后期具有与自体韧带相似的替代修复作用。

AIM： To study the curative effect of repairing the rabbit knee medial collateral ligament defect with porcine small intestinal submucosa （SIS）. METHODS： The experiment was performed at the Central Laboratory and Animal Center, the Third People＇s Hospital of Shanghai Jiao Tong University Medical School from January to August in 2006. The left and right knees were divided into SIS graft group and autologous ligament graft group at random. The models of bilateral medial collateral ligaments were made in 24 New Zealand white rabbits. The experimental sides were grafted with SIS as non-immunogenic extracellular matrix and the control sides were grafted with contralateral ligament. The animals were sacrificed at 2, 4, 8 and 12 weeks after operation. The specimens were examined with the gross, histological and mechanical observation. RESULTS： All 24 white rabbits were involved in the result analysis without drop. （1）Gross observation： At 4 weeks postoperation, a large amount of adhesive granulation occurred in the experimental sides, whereas few adhesion was found in the control side. At 8 weeks, the hyperplastic tissue proliferated in fusiform shape in the experimental sides, and in parallel shape in the control sides, in which the diameter was shorter than that of experimental sides. At 12 weeks, there were identical proliferated tissue and diameter between SIS graft group and autologous ligament graft group.（2） Light microscope examination： At 2 weeks postoperation, a small quantity of inflammatory cell infiltration and fibroblast appeared in the experimental sides, with obvious vascular proliferation; while few inflammatory cells were found in the control sides. At 4 weeks, the number of fibroblast and collagen was increased in the experimental sides, which was lower than that of the control sides. At 8 weeks, both the two groups were mainly covered with fibroblast, which arranged lengthwise in SIS graft group. At 12 weeks, plenty of orderly collagen presented in the two groups, and the cell and fiber density were the similar. （3）Mechanics examination： The maximum expanding load of the medial collateral ligament was larger in experimental sides than in control sides [（36.8±8.9, 25.3±7.3） N, P 〈 0.05], and the difference between the two groups was insignificant at 2, 8, 12 weeks postoperation （P 〉 0.05）. （CONCLUSION： SIS is an excellent biomaterial that can repair the defect and injury of the medial collateral ligament, and identical with autologous ligament graft at the later period.