两种康复训练方案对组织工程腱-骨界面早期愈合的影响

Effects of Two Rehabilitation Training Programs on Early Healing of Tissue Engineered Tendon Bone Interface

为了探讨前交叉韧带(Anterior Cruciate Ligament;ACL)重建术后两种康复训练方案对组织工程腱骨界面早期愈合的影响。文中对23只雄性新西兰大白兔双侧膝关节行自体腘绳肌肌腱移植重建ACL,且移植肌腱骨隧道界面均植入组织工程界面支架CPCXB。术后随机分为三组:对照组(CON;n=7),持续被动训练组(CPM;n=8)和CPM+跑台训练组(CPM+TD;n=8)。其中CON组笼内自由活动,CPM组及CPM+TD组术后第2天分别应用CPM装置及兔子跑台进行不同方案的康复训练,8周后取材分别行影像学、组织学及生物力学检测。研究结果发现:Micro CT结果发现术后各组腱骨界面间新生骨TMC量及BV/TV分数值比较差异均具有统计学差异,且新生骨Tb.Th及Tb.N值比较差异也均有统计学差异,但CPM+TD组TMC量、BV/TV分数值、Tb.Th及Tb.N值均明显低于CON组和CPM组(P<0.05),而各组之间Tb.Sp值比较差异则无统计学差异。V G染色结果显示虽然三组界面均有新生骨及软骨填充,但CPM+TD组界面间隙明显大于CON组及CPM组,且界面间形成的胶原纤维连接方向不一。术后8周CPM+TD组最大牵拉力明显低于CON组及CPM组(P<0.05),CPM组最大牵拉力则高于CON组(P>0.05)。结论说明术后过早主动运动介入的康复训练方案不利于腱骨组织工程界面的早期愈合,可能导致组织工程界面愈合不良,为不同康复训练方案在ACL重建后组织工程腱骨界面愈合中的应用提供了更多的实验依据。

The study aims to examine the effects of two motions on the early healing of tissue engineered tendon bone interface after ACL reconstruction.ACL reconstruction was performed on both keen joints of 23 male rabbits and CPCXB tissue engineered interface stands were separately transplanted into their tendon bone interfaces.Then the rabbits were randomly divided into 3 groups:control group(CON group;n=7),continuous passive motion group(CPM group;n=8)and CPM plus treadmill motion group(CPM+TD group;n=8).After 8 week motion of CPM motion or CPM plus treadmill motion,the rabbits were sacrificed for micro CT testing,histological analysis,and biomechanical testing.The micro CT examination showed that both new bone volume and new bone microarchitecture in the CPM+TD group were significantly inferior to those in the CON group and CPM group(P<0.05).What’s more,the micro CT results in the CPM group were better than those in the CON group(P>0.05).Histological observations also showed that although there were new cartilage and new bone in three groups,the gap of the interface in the CPM+TD group was significantly wider than that in the CON group and CPM group.And the collagen fibers formed between the interfaces were connected in different directions.Biomechanically,the ultimate load to failure of CPM+TD group was significantly lower than that of CON group and CPM group(P<0.05).Accelerated motions might have adverse effects on the early healing of the tissue engineered tendon bone interface after ACL reconstruction.This study provides experimental evidence for the application of different motions to the tissue engineered tendon bone interface healing after ACL reconstruction.