带血供阔筋膜重建兔腱骨连接的组织学和生物力学研究

Histological and biomechanical study of vascularized fascia lata for reconstruction of rabbit tendon-bone junction

目的探讨切取带血供阔筋膜重建兔髌骨-髌腱腱骨连接的组织学和生物力学效果。方法将54只新西兰兔随机分为3组,分别为空白对照组6只、无血供阔筋膜重建腱骨连接组24只和带血供阔筋膜重建腱骨连接组24只。除空白对照组外均建立左膝髌骨-髌腱缺损模型,无血供重建组切取游离阔筋膜折叠固定于髌骨残端与髌腱残端,带血供重建组切取带血管蒂阔筋膜折叠局部转移固定于髌骨残端与髌腱残端,保留阔筋膜血供。空白对照组直接处死,无血供组与带血供组于术后4周及8周处死,取髌骨-阔筋膜-髌腱复合体,进行组织学观察及生物力学测试。结果带血供组炎性细胞均少于同期无血供组,改良番红O-固绿软骨染色红染面积均增加(P<0.05)。韧带成熟度评分手术组均低于空白组,带血供组评分均优于同期无血供组(P<0.05);带血供组纤维软骨细胞密度、新生软骨面积、纤维软骨厚度均大于同期无血供组(P<0.05);带血供组最大载荷及刚度均大于同期无血供组,但差异无统计学意义(P>0.05)。结论带血供阔筋膜是修复腱骨连接缺损的有效方法,有利于腱骨重建血供恢复,促进腱骨愈合。

Objective To investigate the histological and biomechanical effects of cutting the fascia lata with blood supply to reconstruct the patella-patellar tendon bone connection in rabbits.Methods Fifty-four New Zealand rabbits were randomly divided into three groups,including 6 rabbits in the blank control group,24 rabbits in the non-vascularized fascia lata reconstruction tendon-bone connection group and 24 rabbits in the vascularized fascia lata reconstruction tendon-bone connection group.Except for the blank control group,the left knee patella-patellar tendon defect model was established.In the non-blood supply reconstruction group,the free fascia lata was cut,folded and fixed at the patellar stump and patellar tendon stump.In the blood supply reconstruction group,the vascularized fascia lata was cut,folded and fixed at the patellar stump and patellar tendon stump to preserve the blood supply of the fascia lata.The blank control group was killed directly,the non-blood supply group and the blood supply group were killed at 4 and 8 weeks after the operation,and the patella-fascia lata-patellar tendon complex was taken for histological observation and biomechanical test.Results The inflammatory cells in the blood supply group were less than those in the non-blood supply group at the same time,and the red staining area of the modified safranine O-solid green cartilage was increased(P<0.05).The ligament maturity score in the operation group was lower than that in the blank group,and the score in the blood supply group was better than that in the non-blood supply group(P<0.05).The density of fibrochondrocytes,the area of new cartilage and the thickness of fibrocartilage in the blood supply group were higher than those in the non-blood supply group(P<0.05).The maximum load and stiffness of the group with blood supply were greater than those of the group without blood supply at the same time,but the difference was not statistically significant(P>0.05).Conclusion The fascia lata with blood supply is an effective method to repair the defect of tendon bone connection,which is beneficial to the blood supply recovery of tendon bone reconstruction and promote the healing of tendon bone.