生物材料介入对ACL重建术后持续被动康复训练过程中腱-骨愈合的影响

Effect of Biomaterials on the Tendon-Bone Interface Healing in Continuous Passive Motion Training after ACL Reconstruction

为了达到延缓或阻止持续被动康复训练对移植肌腱-骨隧道界面愈合的负性影响,将杂合生物材料(ICPCB)应用于前交叉韧带重建术后的腱-骨界面.将三组实验兔,对照组(n=7),ICPC治疗组(n=7)及ICPCB治疗组(n=7),均行前交叉韧带(ACL)重建术,术后进行8周持续被动康复训练.结束后行影像学,组织学及生物力学测试.显微CT结果显示,治疗组腱-骨界面新生骨矿化量及微结构指标均明显优于对照组(P<0.05),其中ICPCB组矿化组织量(TMC),相对骨体积(BV/TV)、骨小梁数量(Tb.N)及骨小梁分离度(Tb.Sp)却明显优于ICPC组(P<0.05).组织学结果发现ICPCB组界面间新生骨量均明显多于对照组及ICPC组,但残余材料量却明显少于ICPC组.同时两组治疗组界面最大牵拉力均明显高于对照组(P<0.05).ICPC或ICPCB均能够阻止ACL术后激进康复训练过程中的负性作用,进一步促进腱-骨界面的愈合.但杂合生物材料ICPCB促进愈合的效果明显优于单纯ICPC.

The study is to explore the effect of injected calcium phosphate cement （ICPC） and ICPC combined with recombined xenograft bone granules-ICPCB on the tendon-bone interface healing after the anterior cruciate ligament （ACL） reconstruction with continuous passive motion training （CPM）. Twenty-one rabbits were randomly divided into three groups, the control group （n= 7）, the ICPC treated group （n=7） and the ICPCB treated group （n= 7）. After ACL reconstruction surgery,all the rabbits received eight-weeks CPM training. Then the rabbits were tested iconographically, histologically and biomechanically,observing their tendon-bone healing. The micro-CT testing showed that both the new bone volume and the new bone microarchitecture in the ICPC and ICPCB groups were superior to those of the control group within CPM motion. And the micro-CT results in the ICPCB group were much better than those in the ICPC group （P〈0.05）. The histological observations also showed there were more new cartilage and new bone in the interface in the ICPCB group （P〈0. 05）. Biomechanically, the maximum pulling load of ICPC and ICPCB groups was higher than that of the control group （P〈0.05）. Both ICPC and ICPCB composite may persistently promote the tendon-bone interface healing with accelerated motions. ICPCB achieves a better effect because of the higher porosity and bone morphological proteins.