保留残端附着可改善前交叉韧带重建兔模型中的移植物愈合。
Preservation of remnant attachment improves graft healing in a rabbit model of anterior cruciate ligament reconstruction.
机构信息
Orthopaedic Center of PLA (People's Liberation Army), 88th Hospital of PLA, Tai'an, China.
出版信息
Arthroscopy. 2013 Aug;29(8):1362-71. doi: 10.1016/j.arthro.2013.05.010.
PURPOSE
To determine the effect of remnant preservation on the healing of anterior cruciate ligament (ACL) tendon graft after reconstruction in an animal model.
METHODS
Fifty-two New Zealand rabbits were divided into 6 groups. Revascularization and graft healing were studied in groups 1 through 4 (n = 8 each). The biomechanical properties of the graft complex were evaluated in group 5 (n = 12). The blood flow and biomechanical characteristics of the intact ACL were evaluated in group 6 (n = 8). Both knees of each rabbit were subjected to ACL reconstruction with 2-mm grafts of Achilles tendon splits. The right knees were reconstructed with remnant preservation, whereas the remnants in the left knees were debrided. The revascularization and remodeling of grafts were evaluated at 6, 12, 18, and 24 weeks after reconstruction. Tendon-to-bone integration was investigated histomorphologically. The tensile load strengths of graft complexes were also tested.
RESULTS
The blood flow in the graft was significantly higher in the remnant-preserved group than in the remnant-debrided group (P < .01). Specifically, the blood flow of the graft with remnant preservation was markedly enhanced at 6 weeks and 12 weeks after reconstruction (P < .05). The number of CD34-positive vessels in the graft was higher in the remnant-preservation group (P < .05). The ligamentization and remodeling of the graft were improved and the collagen type III content in the graft was higher in the remnant-preserved group (P < .05). Tendon-to-bone integration was improved by remnant preservation. At 24 weeks after reconstruction, the failure load of the graft complex was significantly higher in the remnant-preserved group (23.46 ± 7.40 N) than in the remnant-debrided group (18.63 ± 4.26 N) (P < .05).
CONCLUSIONS
The preservation of the remnant attachment in ACL reconstruction improved the revascularization and remodeling of the graft and enhanced the biomechanical properties of the integrated graft.
CLINICAL RELEVANCE
Preservation of the remnant attachment may benefit healing of the tendon graft in ACL reconstruction.
目的
在动物模型中确定残端保留对前交叉韧带（ACL）肌腱移植物重建后愈合的影响。
方法
将 52 只新西兰兔分为 6 组。第 1 至 4 组（每组 8 只）研究再血管化和移植物愈合。第 5 组（n=12）评估移植物复合物的生物力学特性。第 6 组（n=8）评估完整 ACL 的血流和生物力学特性。每只兔子的双侧膝关节均接受 ACL 重建，使用跟腱分裂的 2mm 移植物。右膝采用残端保留重建，而左膝残端清创。术后 6、12、18 和 24 周评估移植物的再血管化和重塑。组织形态学研究肌腱-骨整合。还测试了移植物复合物的拉伸载荷强度。
结果
残端保留组移植物中的血流明显高于残端清创组（P<0.01）。具体来说，残端保留组的移植物血流在重建后 6 周和 12 周时明显增强（P<0.05）。残端保留组移植物中的 CD34 阳性血管数量更高（P<0.05）。移植物的韧带化和重塑得到改善，残端保留组的移植物中 III 型胶原含量更高（P<0.05）。残端保留改善了肌腱-骨整合。重建后 24 周时，残端保留组（23.46±7.40N）的移植物复合物失效负荷明显高于残端清创组（18.63±4.26N）（P<0.05）。
结论
ACL 重建中残端附着的保留改善了移植物的再血管化和重塑，并增强了整合移植物的生物力学特性。
临床相关性
残端附着的保留可能有利于 ACL 重建中肌腱移植物的愈合。
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