保留与不保留残端重建前交叉韧带后本体感觉恢复的比较

Proprioception recovery after anterior cruciate ligament reconstruction with and without remnant preservation

背景:保留残端重建前交叉韧带能否提高膝关节本体感觉目前仍存在较大争议,如果能通过实验对保留残端重建前交叉韧带移植腱中本体感受器、神经生长、电生理情况进行直接检测,将能更加客观的评价保留残端对本体感觉恢复的作用。目的:建立残端鞘内重建、牵张保残重建和不保残重建前交叉韧带动物实验模型,比较3种重建手术术后膝关节本体感觉是否存在差异。方法:96只新西兰兔随机分为空白对照组、不保残组、牵张保残组和残端鞘内保残组,每组24只。除空白对照组外,其他3组兔进行双膝前交叉韧带重建。术后3,6,12周各组行膝关节电生理检测;实时荧光定量PCR检测移植腱神经营养因子3 mRNA的表达;苏木精-伊红染色、免疫组织化学染色观察重建组移植腱本体感受器数量。结果与结论:①术后3,6,12周,重建的3组兔移植物神经营养因子3mR NA表达、本体感受器数量、腘绳肌肌电图差异均无显著性意义(P> 0.05);②结果说明,保留残端重建前交叉韧带与不保留残端重建前交叉韧带膝关节本体感觉再生情况无明显差异。

BACKGROUND:Whether remnant preservation can improve proprioception of knee joint remains a controversy.Direct detection of proprioceptor,nerve growth and electrophysiological changes in the grafting tendon of remnant preservation in anterior cruciate ligament reconstruction can objectively evaluate the effect of remnant preservation on proprioception recovery.OBJECTIVE:To establish the animal models of anterior cruciate ligament reconstruction with remnant preservation(femoral tensioning and augmented suture),with remnant preservation(graft passing remnant anterior cruciate ligament sheath)and without remnant,and to compare the differences in postoperative knee proprioception among methods.METHODS:Ninety-six New Zealand rabbits were randomly divided into control group,anterior cruciate ligament reconstruction groups with remnant preservation(femoral tensioning and augmented suture),with remnant preservation(graft passing remnant anterior cruciate ligament sheath)and without remnant(n=24/group).At 3,6 and 12 weeks after surgery,electrophysiological examination of knee joint was performed.The mRNA expression of neurotrophic factor 3 was detected by real-time fluorescent quantitative PCR.The number of proprioceptor in graft tendon in the anterior cruciate ligament reconstruction groups was detected by hematoxylin-eosin staining and immunohistochemistry.RESULTS AND CONCLUSION:(1)At postoperative 3,6 and 12 weeks,there were no significant differences in mRNA expression of neurotrophic factor 3,number of proprioceptor and electromyography hamstring among anterior cruciate ligament reconstruction groups(P >0.05).(2)To conclude,there is no significant difference in the proprioception recovery of knee joint between anterior cruciate ligament reconstruction with and without remnant preservation.