Wong Margaret Wan Nar, Qin Ling, Lee Kwong Man, Tai Ka On, Chong Wai Sing, Leung Kwok Sui, Chan Kai Ming
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Clin Orthop Relat Res. 2003 Aug(413):291-302. doi: 10.1097/01.blo.0000076802.53006.5b.
Bone-tendon junction healing in a bone trough was investigated in a goat partial patellectomy model. Histologic evaluation and biomechanical tests were done at 6, 12, and 24 weeks. Irregular fibrous tissue seen at the healing bone-tendon junction at 6 weeks gradually assumed longitudinal alignment and remodeled toward a direct bone-tendon junction. Type III collagen deposition was diffuse at 6 weeks, but became localized to the healing interface at 12 weeks. Thickness of newly formed bone increased progressively with time. Bridging collagen fibers were formed at the junction, with fibrochondrocytic cells and a basophilic tidemark detected at 24 weeks. The trabecular line remained discontinuous and there was no safranin O uptake. Most specimens failed at the junctions under tensile loads. The ultimate failure stress increased from 4.78 +/- 0.50 N/mm2 at 6 weeks to 7.99 +/- 0.33 N/mm2 at 24 weeks (mean +/- standard error of the mean), only reaching 15% of normal. Cartilage from the articular cut surface extended into the healing interface, later forming an area of fibrocartilage with densely packed collagen fibers aligned along the direction of force, containing proteoglycans. Cartilage may enhance restoration of a transition zone in bone-tendon junction healing. The sequence of events outlined formed a basis to guide clinical practice regarding bone-tendon junction reattachment.
在山羊部分髌骨切除术模型中研究了骨槽内骨-肌腱连接的愈合情况。在6周、12周和24周时进行了组织学评估和生物力学测试。6周时在愈合的骨-肌腱连接处可见不规则纤维组织,逐渐呈现纵向排列并向直接的骨-肌腱连接重塑。Ⅲ型胶原沉积在6周时弥漫性分布,但在12周时局限于愈合界面。新形成骨的厚度随时间逐渐增加。在连接处形成了桥接胶原纤维,在24周时检测到纤维软骨细胞和嗜碱性潮线。小梁线仍不连续,且无番红O摄取。大多数标本在拉伸载荷下在连接处失效。极限破坏应力从6周时的4.78±0.50 N/mm²增加到24周时的7.99±0.33 N/mm²(平均值±平均标准误差),仅达到正常水平的15%。关节切割面的软骨延伸至愈合界面,随后形成一个纤维软骨区域,其中密集排列的胶原纤维沿力的方向排列,含有蛋白聚糖。软骨可能会增强骨-肌腱连接愈合中过渡区的恢复。所述事件序列为指导骨-肌腱连接重新附着的临床实践奠定了基础。