Roeddecker K, Muennich U, Nagelschmidt M
IInd Department of Surgery, University of Cologne, Germany.
J Surg Res. 1994 Jan;56(1):20-7. doi: 10.1006/jsre.1994.1004.
Insight into the functional role of menisci has stimulated investigators to repair meniscal tears even in regions of poor vascularity. Data on scar strength resulting from different forms of therapy can be obtained applying biomechanical methods to animal models. With our new tear load propagation test, tissue strength in the scar as well as in the scar periphery was determined in rabbit medial menisci. Standardized longitudinal lesions localized in the microvascular zone II near the posterior horn were left untreated, fixed by suture, or sealed with fibrin glue. In two consecutive trials healing was determined after 6 weeks and after 12 weeks. After 6 weeks the mean scar strength was 19% (no therapy), 26% (suture), and 42.5% (fibrin glue) of the value measured in the equivalent region of the intact contralateral controls. In the peri-scar tissue in the line of the scar a section of secondary tissue weakness was discovered, which was shorter after treatment with fibrin glue. Although the scar strength was the same at Week 12, the area of tissue weakness was reduced. These biomechanical data point to the necessity of long-term studies to evaluate ultimate scar strength. They may explain the development of a bucket handle tear by extension of an initial lesion across an adjoining zone of secondary tissue weakness. The good results obtained with fibrin glue should encourage clinicians to use this therapy in clinical studies on meniscus repair in the inner zones of low healing capacity.
对半月板功能作用的深入了解促使研究人员即使在血管分布较差的区域也尝试修复半月板撕裂。通过对动物模型应用生物力学方法，可以获得不同治疗方式所产生的瘢痕强度数据。利用我们新的撕裂负荷传播试验，测定了兔内侧半月板瘢痕处及瘢痕周边的组织强度。将标准化的纵向损伤定位在后角附近的微血管Ⅱ区，不进行治疗、通过缝合固定或用纤维蛋白胶封闭。在连续两次试验中，分别在6周和12周后测定愈合情况。6周后，平均瘢痕强度分别为完整对侧对照等效区域测量值的19%（未治疗）、26%（缝合）和42.5%（纤维蛋白胶）。在瘢痕线上的瘢痕周围组织中发现了一段继发性组织薄弱区，用纤维蛋白胶治疗后该区域较短。尽管12周时瘢痕强度相同，但组织薄弱区面积减小。这些生物力学数据表明有必要进行长期研究以评估最终瘢痕强度。它们可能解释了最初的损伤通过相邻的继发性组织薄弱区扩展而导致桶柄状撕裂的发生。纤维蛋白胶取得的良好结果应鼓励临床医生在低愈合能力内侧区域半月板修复的临床研究中使用这种治疗方法。
