手术与非手术治疗急性肘关节尺侧副韧带损伤的组织学及生物力学研究

Operative vs. non-operative treatments of acute injury of the ulnar collateral ligament of elbow joint： histologic and biomechanical observations

目的 探讨手术修复与不修复急性肘关节尺侧副韧带损伤后韧带愈合的组织学及生物力学特性。方法 新西兰白兔56只，随机分为两组，其中28只切断右肘尺侧副韧带后随即缝合，为缝合组；另28只切断尺侧副韧带后不缝合，为不缝合组。分别于术后3、6、9、12周四个阶段取材，进行组织学观察及生物力学检测。结果12周时缝合组和不缝合组的韧带断端间均被平行的胶原纤维桥接，并与原韧带纤维相连，但前者翻转交错明显，纤维间隙较后者小。除术后3周外各时间点检测韧带缝合组位移均明显小于切断不缝合组，差异有统计学意义（P〈0．05），而最大负荷及功耗则明显高于韧带不缝合组，差异有统计学意义（P〈0．05）。结论 肘关节尺侧副韧带损伤后手术和非手术修复韧带均能愈合，但手术修复后的韧带愈合质量明显比未修复高。

Objective To investigate the histologic and biomechanical properties of the healing and healed ulnar collateral ligaments （UCL） of elbow joint which have been repaired operatively and non-operatively for acute injury. Methods Fifty-six New Zealand rabbits were equally randomized into one study group and one control group, The UCLs of the right elbow joint in the study group were severed and sutured, while those in the control group were dissected but not sutured. They were killed at time intervals of 3, 6, 9 and 12 weeks for histological and biomechanical observations of the specimens of healing and healed UCLs. Results At 12 weeks postoperatively, the severed ligaments in both groups were bridged by parallel collagen fibrils and connected with the original ligament fiber. But, turnover was evident and fiber interspace was smaller in the suture group than in the non-suture group. At 6 weeks postoperatively, the ligament displacement was significantly less in the suture group than in the non-suture group（P 〈 0. 05）, while the failure load and maximum work of ligaments were greater in the suture group than in the non-suture group （ P 〈 0. 05 ）. Conclusion Although both operative and non-operative treatments of acute injury of the UCL of elbow joint can lead to healing of the ligaments, operative treatment can result in a better repair of the injured UCL with better histological and biomechanical outcome.