von Lewinski Gabriela, Pressel Thomas, Hurschler Christof, Witte Frank
Orthopaedic Department, Hannover Medical School, Anna-von-Borries-Str. 1-7, D-30625 Hannover, Germany.
Am J Sports Med. 2006 Mar;34(3):397-406. doi: 10.1177/0363546505281801. Epub 2005 Dec 19.
Meniscal replacement has become more common in recent years. The meniscal transplant's ability to transfer load effectively depends on its ability to bear circumferential loading.
Intraoperative pretensioning on the meniscal transplant sutures has a positive influence on meniscal transplants' chondroprotective effect.
Controlled laboratory study.
Thirty-six sheep were divided into 6 groups (n = 6), subjected to a sham operation (group A), a meniscectomy (group B), or a meniscal autograft using tag sutures with different levels of pretensioning (group C, 0 N; group D, 20 N; group E, 40 N; group F, 60 N). Macroscopic (International Cartilage Repair Society score) and histologic evaluations (Mankin score) of the articular cartilage were performed after 6 months.
Higher suture pretension (40 N, 60 N) resulted in less cartilage degeneration than in meniscectomized (P =.047; P =.036) and nonpretensioned (P =.028; P =.015) knees, with International Cartilage Repair Society scores of 1.63 +/- 0.57 and 1.66 +/- 0.51 in groups E and F, respectively, and scores of 2.40 +/- 0.27 and 2.68 +/- 0.46 observed after meniscectomy and meniscal transplantation with no pretensioning, respectively. Group F had a significantly better Mankin score of 6.66 +/- 2.15 (P =.05) compared with group D. Regarding criterion cells, trends toward less degeneration compared with meniscectomized and nonpretensioned knees (P = .054 and P =.055) were found. The coefficient of variation of the Mankin scores was greater than that of the International Cartilage Repair Society score. Group A had significantly better cartilage than all other groups.
Adequate intraoperative pretensioning has a significant influence on the chondroprotective effect of meniscal transplants but did not prevent the development of articular cartilage degeneration.
The results suggest that intraoperative pretensioning could improve the chondroprotective effect of meniscal transplantation.
近年来，半月板置换术已变得更为常见。半月板移植有效传递负荷的能力取决于其承受圆周负荷的能力。
术中对半月板移植缝线进行预张紧对半月板移植的软骨保护作用有积极影响。
对照实验室研究。
将36只绵羊分为6组（每组n = 6），分别接受假手术（A组）、半月板切除术（B组）或使用不同预张紧水平标签缝线的半月板自体移植术（C组，0 N；D组，20 N；E组，40 N；F组，60 N）。6个月后对关节软骨进行宏观评估（国际软骨修复协会评分）和组织学评估（曼金评分）。
较高的缝线预张紧力（40 N、60 N）导致软骨退变程度低于半月板切除组（P = 0.047；P = 0.036）和未预张紧组（P = 0.028；P = 0.015），E组和F组的国际软骨修复协会评分分别为1.63±0.57和1.66±0.51，半月板切除术后和未预张紧的半月板移植术后的评分分别为2.40±0.27和2.68±0.46。与D组相比，F组的曼金评分显著更好，为6.66±2.15（P = 0.05）。关于标准细胞，与半月板切除组和未预张紧组相比，发现有退变减轻的趋势（P = 0.054和P = 0.055）。曼金评分的变异系数大于国际软骨修复协会评分的变异系数。A组的软骨明显优于所有其他组。
术中适当的预张紧对半月板移植的软骨保护作用有显著影响，但不能防止关节软骨退变的发生。
结果表明，术中预张紧可改善半月板移植的软骨保护作用。
Zotero 插件