保留残端纤维与剩余束支重建前交叉韧带的再血管化研究

Effects of retention stump fiber and residue bundle on the graft revascularization in autologous anterior cruciate ligament reconstruction

目的研究保留残端纤维、剩余束支对自体肌腱重建前交叉韧带后移植物再血管化的影响,旨在为临床上提高肌腱移植物成活质量提供一种新方法。方法取成年新西兰大白兔,建立膝关节前交叉韧带(ACL)完全断裂模型。研究分ACL离断后清理残端纤维(清理残端组)、保留残端纤维(保留残端组)、部分剪断ACL纤维束,保留剩余束支残端纤维(单束重建组)。观察术后2、4、8周大白兔肌腱移植物生长情况,移植物血管形成情况。结果术后各组均可见明显滑膜增生,术后8周单束重建组滑膜内血管面积均大于清理残端组和保留残端组,保留残端组滑膜内血管面积大于清理残端组;术后2、4周单束重建组的纤维母细胞形成数均多于清理残端组和保留残端组,但尚不能认为保留残端组的纤维母细胞形成数与清理残端组有差异。结论保留残端、剩余束支重建前交叉韧带较清理残端组术后早期移植物再血管化显著增加,促进良好的腱-骨愈合。

Objective To study the effect of retention stump fiber and residue bundle before autologous anterior cruciate ligament （ACL） reconstruction on the graft revascularization for improving grafted tendon, so as to provide a new method for clinical practice. Methods New Zealand the function of the adult rabbits were bought for developing self-control model of complete-ruptured bilateral knee joint ACL. Experimental rabbits were divided into ACL stump from the rear to clean fiber （stump debridement group）, retained stump fiber （stump residual group）, or ACL augmentation partial tear model （stump left group）. Growth and vaseularization of graft formation of New Zealand white rabbits were evaluated at two, four, eight weeks after sur gery. Results All samples in each group showed obvious synovial hyperplasia, the revascularization of the graft in stump left group was superior to stump residual group and stump debridement group at eight weeks, the revascularization of the graft in stump residual group was superior to stump debridement group; fibroblast cell counts in graft of stump residual group were more than stump debridement group and residual group at two and four weeks, but fibroblast cell counts stump residual group still did not differ from stump debridement group. Conclusion Compared to ACL reconstruction with stump debridement, early graft revaseularization in ACL reconstruction with retention stump and residue bundle was significantly increased postoperatively, then promoting process of tendon - bone healing.