Kawakami Hideo, Shino Konsei, Hamada Masayuki, Nakata Ken, Nakagawa Shigeto, Nakamura Norimasa, Toritsuka Yukiyoshi, Yoshikawa Hideki, Ochi Takahiro
Department of Orthopedic Surgery, Osaka University Medical School, 2-2 Yamadaoka, 565-0871 Suita, Osaka, Japan.
Knee Surg Sports Traumatol Arthrosc. 2004 Sep;12(5):384-90. doi: 10.1007/s00167-003-0484-2. Epub 2004 Mar 24.
The purpose of this study was to clarify differences in tendon graft-to-bone tunnel healing between bone-attached tendon grafts with interference-screw fixation and bone-free tendon grafts with extra-articular suture fixation. In 42 Japanese White rabbits, anterior half replacement of the medial collateral ligament was performed using half of the ipsilateral patellar tendon. At the femoral attachment, the bone-plug-attached graft was fixed with an interference screw (group A). The bone-plug-free graft was fixed by the extra-articular suture fixation technique with sutures tied over a button (group B). Biomechanical and histological evaluations were performed at 2, 4 and 8 weeks postoperatively. In biomechanical evaluation, at 2 or 4 weeks 27 of 28 specimens (96%) were pulled out from the femoral tunnel, while one 4-week specimen and all four 8-week specimens failed at the graft's mid-substance. At 2 weeks, the maximum failure load was 25+/-10 N and 24+/-6 N for group A and group B respectively (mean+/-SD). At 4 weeks, the maximum failure load was 42+/-17 N and 35+/-15 N respectively. There were no significant differences in maximum pullout failure load between the groups at 2 or 4 weeks postoperatively. (P=0.887 at 2 weeks and P=0.339 at 4 weeks using ANOVA measurement). Histologically, the bone-attached grafts showed partial bone-to-bone union at the graft-bone tunnel interface at 4 weeks, and complete bony union at 8 weeks. The bone-free grafts exhibited newly formed Sharpey-like collagen fibers at 4 weeks, and strong connection by mature granulation tissue at 8 weeks. Graft-to-bone tunnel healing of bone-attached graft with screw fixation and bone-free graft with extra-articular suture fixation are comparable in terms of biomechanical evaluation during the early postoperative periods.
本研究的目的是阐明采用干涉螺钉固定的带骨肌腱移植物与采用关节外缝线固定的无骨肌腱移植物在肌腱移植物与骨隧道愈合方面的差异。在42只日本白兔中，使用同侧髌腱的一半进行内侧副韧带前半部分置换。在股骨附着处，带骨栓的移植物用干涉螺钉固定（A组）。无骨栓的移植物通过关节外缝线固定技术，将缝线系在纽扣上进行固定（B组）。术后2周、4周和8周进行生物力学和组织学评估。在生物力学评估中，术后2周或4周时，28个标本中有27个（96%）从股骨隧道中拔出，而1个4周的标本和所有4个8周的标本在移植物中部发生断裂。术后2周时，A组和B组的最大破坏载荷分别为25±10 N和24±6 N（平均值±标准差）。术后4周时，最大破坏载荷分别为42±17 N和35±15 N。术后2周或4周时，两组间最大拔出破坏载荷无显著差异（方差分析测量，2周时P = 0.887，4周时P = 0.339）。组织学上，带骨移植物在4周时在移植物-骨隧道界面显示部分骨-骨愈合，8周时完全骨愈合。无骨移植物在4周时出现新形成的类夏佩氏胶原纤维，8周时通过成熟肉芽组织形成牢固连接。在术后早期的生物力学评估方面，采用螺钉固定的带骨移植物和采用关节外缝线固定的无骨移植物在移植物与骨隧道的愈合情况相当。
