保留残端与不保留残端重建前交叉韧带腱骨愈合情况比较

Tendon-bone healing after acute anterior cruciate ligament reconstruction with versus without remnant preservation

背景:保留残端重建能够促进腱骨愈合,但目前的研究仅停留组织学水平。从分子生物层面报道保残重建对促进腱骨愈合作用机制的研究国内外尚未见报道。目的:探讨保留残端重建前交叉韧带对腱骨愈合的机制。方法:72只新西兰兔随机分为不保残组、牵张保残组和残端鞘内重建组,各24只,分别采取不保残、牵张保残和残端鞘内重建方法进行急性期双膝前交叉韧带重建。结果与结论:1苏木精-伊红染色结果显示,牵张保残组和残端鞘内重建组兔腱骨愈合优于不保残组,残端鞘内重建组优于牵张保残组;2实时荧光定量PCR结果表明,牵张保残组和残端鞘内重建组兔移植腱周边骨组织中骨保护素m RNA表达水平及骨保护素/RANKL比值大于不保残组,且残端鞘内重建组兔移植腱周边骨组织中上述指标大于牵张保残组,而RANKL m RNA表达水平小于不保残组;3结果提示2种保留残端重建前交叉韧带方法都能够促进腱骨愈合,其中以残端鞘内重建最明显,作用机制可能与早期上调骨道中骨保护素m RNA,下调RANKL m RNA有关。

BACKGROUND：Reconstruction with remnant preservation can enhance tendon-bone healing. However, the study limits on the histological level, and there is a lack of research based on the modular biological level. OBJECTIVE：To investigate whether anterior cruciate ligament reconstruction with remnant preservation can enhance tendon-bone healing. METHODS：Seventy-two New Zealand rabbits were randomly al ocated to three groups （n=24 per group）, fol owed by cruciate ligament reconstruction without remnant （group A）, with remnant preservation （femoral tensioning and augmented suture） （group B） and with remnant preservation （graft passing remnant anterior cruciate ligament sheath） （group C）, respectively. RESULTS AND CONCLUSION：Hematoxylin-eosin staining showed that the tendon-bone healing in the groups B and C surpassed that in the group A, and group B was better than group C. Real-time PCR revealed that the expression level of osteoprotegrin mRNA and the osteoprotegrin/receptor activator of nuclear factor-κB ligand （RANKL） ratio were greater in the groups B and C than in the group A, and highest in the group C, while the expression levels of RANKL mRNA in the groups B and C were lower than that in the group A. In conclusion, these two kinds of anterior cruciate ligament reconstruction methods with remnant preservation can enhance tendon-bone healing, which have obtained most obvious achievements in the anterior cruciate ligament reconstruction in the graft passing anterior cruciate ligament remnant sheath that may be related to the up-regulation of osteoprotegrin mRNA and down-regulation of RANKL mRNA.