Endress Ryan, Woon Colin Y L, Farnebo Simon J, Behn Anthony, Bronstein Joel, Pham Hung, Yan Xinrui, Gambhir Sanjiv S, Chang James
Division of Plastic and Reconstructive Surgery, Stanford University Medical Center and Section of Plastic Surgery, Stanford, CA, USA.
J Hand Surg Am. 2012 Aug;37(8):1529-37. doi: 10.1016/j.jhsa.2012.05.020.
In patients with chronic scapholunate (SL) dissociation or dynamic instability, ligament repair is often not possible, and surgical reconstruction is indicated. The ideal graft ligament would recreate both anatomical and biomechanical properties of the dorsal scapholunate ligament (dorsal SLIL). The finger proximal interphalangeal joint (PIP joint) collateral ligament could possibly be a substitute ligament.
We harvested human PIP joint collateral ligaments and SL ligaments from 15 cadaveric limbs. We recorded ligament length, width, and thickness, and measured the biomechanical properties (ultimate load, stiffness, and displacement to failure) of native dorsal SLIL, untreated collateral ligaments, decellularized collateral ligaments, and SL repairs with bone-collateral ligament-bone composite collateral ligament grafts. As proof of concept, we then reseeded decellularized bone-collateral ligament-bone composite grafts with green fluorescent protein-labeled adipo-derived mesenchymal stem cells and evaluated them histologically.
There was no difference in ultimate load, stiffness, and displacement to failure among native dorsal SLIL, untreated and decellularized collateral ligaments, and SL repairs with tissue-engineered collateral ligament grafts. With pair-matched untreated and decellularized scaffolds, there was no difference in ultimate load or stiffness. However, decellularized ligaments revealed lower displacement to failure compared with untreated ligaments. There was no difference in displacement between decellularized ligaments and native dorsal SLIL. We successfully decellularized grafts with recently described techniques, and they could be similarly reseeded.
Proximal interphalangeal joint collateral ligament-based bone-collateral ligament-bone composite allografts had biomechanical properties similar to those of native dorsal SLIL. Decellularization did not adversely affect material properties.
These tissue-engineered grafts may offer surgeons another option for reconstruction of chronic SL instability.
在慢性舟月骨分离或动态不稳定的患者中，韧带修复往往无法进行，因此需要进行手术重建。理想的移植韧带应重建舟月骨背侧韧带（舟月骨背侧间韧带，dorsal SLIL）的解剖和生物力学特性。手指近端指间关节（PIP关节）侧副韧带可能是一种替代韧带。
我们从15具尸体肢体上获取了人类PIP关节侧副韧带和舟月骨韧带。我们记录了韧带的长度、宽度和厚度，并测量了天然舟月骨背侧间韧带、未处理的侧副韧带、脱细胞侧副韧带以及采用骨 - 侧副韧带 - 骨复合侧副韧带移植物进行舟月骨修复的生物力学特性（极限载荷、刚度和破坏位移）。作为概念验证，我们随后用绿色荧光蛋白标记的脂肪来源间充质干细胞对脱细胞骨 - 侧副韧带 - 骨复合移植物进行再接种，并进行组织学评估。
天然舟月骨背侧间韧带、未处理和脱细胞的侧副韧带以及采用组织工程化侧副韧带移植物进行舟月骨修复之间，在极限载荷、刚度和破坏位移方面没有差异。对于配对的未处理和脱细胞支架，极限载荷或刚度没有差异。然而，与未处理的韧带相比，脱细胞韧带的破坏位移较低。脱细胞韧带与天然舟月骨背侧间韧带之间的位移没有差异。我们用最近描述的技术成功地使移植物脱细胞，并且它们可以同样地进行再接种。
基于近端指间关节侧副韧带的骨 - 侧副韧带 - 骨复合异体移植物具有与天然舟月骨背侧间韧带相似的生物力学特性。脱细胞处理不会对材料特性产生不利影响。
这些组织工程化移植物可能为外科医生提供另一种重建慢性舟月骨不稳定的选择。
