富血小板血浆凝胶在同种异体肌腱重建前交叉韧带后腱-骨愈合中的作用

Role of platelet-rich plasma in tendon-bone healing after anterior cruciate ligament reconstruction with tendon allograft

目的 观察富血小板血浆（platelet-rich plasma,PRP）凝胶对同种异体跟腱重建兔前交叉韧带（ACL）后腱一骨愈合的影响.方法 24只兔行双侧ACL重建;一侧膝关节移植物予自体PRP凝胶预处理（实验组）,另一侧膝关节移植物不予处理（对照组）.于术后2,6和12周行组织学、免疫组化和生物力学评价.结果 2周和6周时Burak评分实验组高于对照组.12周时对照组腱-骨界面为成熟瘢痕组织,而实验组显示该界面为成熟纤维软骨带.免疫组化显示实验组血管内皮生长因子（VEGF）的阳性表达在早期较对照组高,TGF-β1的表达持续高于对照组.生物力学分析显示2周及6周时实验组极限负荷[（15.3±2.9）N、（33.2±6.9）N]明显高于对照组（（7.9±1.4）N、（23.7±4.9）N]（P＜0.05）.结论 PRP凝胶可促进同种异体移植肌腱早期腱-骨愈合.

Objective To observe the effect of platelet-rich plasma（PRP）gel on tendon-bone healing following tendon allograft reconstruction of anterior cruciate ligament（ACL）.Methods Bilateral ACL reconstructions using Achilles tendon allografts were performed in 24 New Zealand white rabbits matured skeletally.One knee joint was pretreated with the allograft PRP gel（served as experimental group）,while the contralateral knee joint was free from treatment with PRP（served as control group）.The reconstructions were assessed histologically,immunohistochemically and biomechanically at 2,6 and 12 weeks.Results At 2 and 6 weeks,Burak scores of experimental group were higher than control group.At 12 weeks,the grafts showed a mature zone of fibrocartilage in experimental group but mature scar tissues on the tendon-bone surface.Immunohistochemistry demonstrated early higher expression of VEGF in experimental group than control group and continually higher expression of TGF-β1 in experimental than control group.In contrast,the grafts of the controls group revealed the development of mature scar tissue resembling Sharpey fibers spanning the tendon-bone interface.At 2 and 6 weeks,the biomechanical analysis revealed the limit load of（15.3±2.9）N and（33.2±6.9）N respectively in experimental group,which were significantly higher than（7.9±1.4）N and（23.7±4.9）N in control group （P 〈 0.05）.Conclusion Application of PRP is the potential means to enhance the earlier healing of the allograft tendon-bone.