中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (34): 5516-5522.doi: 10.12307/2023.882

• 组织工程骨材料 tissue-engineered bone • 上一篇    下一篇

同种异体移植物处置方法影响犬前交叉韧带重建术后腱骨愈合界面的骨重塑

尚小可1，马占军2，温  鹏1，王  浩3，马少伟3，胡建中4，李  箭5，郑  君1，李  棋5   

  1. 1西北民族大学第一附属医院(宁夏回族自治区人民医院)，宁夏回族自治区银川市  750000；2同心县人民医院，宁夏回族自治区吴忠市  751300；3宁夏医科大学第三临床医学院，宁夏回族自治区银川市  750000；4中南大学湘雅医院，湖南省长沙市  410000；5四川大学华西医院，四川省成都市  610041
  • 收稿日期:2022-11-24 接受日期:2022-12-26 出版日期:2023-12-08 发布日期:2023-04-22
  • 通讯作者: 李棋，博士，主任医师，四川大学华西医院骨科，四川省成都市 610041 郑君，主管护师，西北民族大学第一附属医院(宁夏回族自治区人民医院)，宁夏回族自治区银川市 750000
  • 作者简介:尚小可，男，1981年生，陕西省咸阳市人，汉族，博士，硕士生导师，副主任医师，主要从事运动医学疾病研究。
  • 基金资助:
    西北民族大学中央高校基本科研业务费项目(青年教师创新项目)(31920210045)，项目负责人：尚小可；宁夏自然科学基金项目(2020A0534)，项目负责人：尚小可

Disposal methods of allografts affect bone remodeling at the tendon-bone healing interface after canine anterior cruciate ligament reconstruction

Shang Xiaoke1, Ma Zhanjun2, Wen Peng1, Wang Hao3, Ma Shaowei3, Hu Jianzhong4, Li Jian5, Zheng Jun1, Li Qi5   

  1. 1The First Affiliated Hospital of Northwest Minzu University (People’s Hospital of Ningxia Hui Autonomous Region), Yinchuan 750000, Ningxia Hui Autonomous Region, China; 2Tongxin County People’s Hospital, Wuzhong 751300, Ningxia Hui Autonomous Region, China; 3The Third Clinical Medical College of Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China; 4Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China; 5West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2022-11-24 Accepted:2022-12-26 Online:2023-12-08 Published:2023-04-22
  • Contact: Li Qi, PhD, Chief physician, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China Zheng Jun, Nurse-in-charge, The First Affiliated Hospital of Northwest Minzu University (People’s Hospital of Ningxia Hui Autonomous Region), Yinchuan 750000, Ningxia Hui Autonomous Region, China
  • About author:Shang Xiaoke, PhD, Master’s supervisor, Associate chief physician, The First Affiliated Hospital of Northwest Minzu University (People’s Hospital of Ningxia Hui Autonomous Region), Yinchuan 750000, Ningxia Hui Autonomous Region, China
  • Supported by:
    Central University Basic Scientific Research Business Fee Project of Northwest Minzu University (Young Teachers Innovation Project), No. 31920210045 (to SXK); Ningxia Natural Science Foundation Project, No. 2020A0534 (to SXK)

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摘要：


文题释义：

同种异体移植物：是指前交叉韧带重建手术中所使用的在同种异体上获取且经过处理的肌腱移植物。
腱骨愈合：是指前交叉韧带重建手术中的移植肌腱与骨道壁之间的生长愈合及转化过程，其特征性结构为形成纤维软骨移行带。

背景：使用同种异体移植物进行前交叉韧带重建手术后的腱骨愈合过程复杂，愈合不良易导致隧道扩大。术前移植物的处理过程可能对腱骨愈合存在一定影响，但是具体情况并不清楚。
目的：探讨同种异体移植物术前处置方法对韧带重建术后腱骨愈合过程中骨重塑的影响。
方法：取32只雄性比格犬，建立双侧后膝前交叉韧带断裂模型后，采用抛硬币法随机分4组进行前交叉韧重建手术：A组以新鲜自体跟腱为移植物，B组以新鲜同种异体跟腱为移植物，C组以γ射线辐照后低温冷藏的同种异体跟腱为移植物，D组以冻干后经γ射线辐照的同种异体跟腱为移植物，每组8只。术后3，6个月取股骨-移植物-胫骨复合体，行Micro CT扫描和组织切片破骨细胞抗酒石酸酸性磷酸酶染色，扫描图像进一步行骨微观结构参数测量，并建立3D骨隧道模型测量隧道面积。

结果与结论：①Micro CT扫描：术后3个月，D组连接密度、骨小梁数量、骨小梁厚度、骨体积与总体积比值及结构模型指数均低于A、C组(P < 0.05)，骨小梁分离度高于A组(P < 0.05)；B组接密度、骨小梁数量及结构模型指数均低于A组(P < 0.05)，骨小梁分离度高于A组(P < 0.05)，骨体积与总体积比值低于A、C组(P < 0.05)。术后6个月，D组连接密度、骨小梁数量及骨体积与总体积比值均低于A组(P < 0.05)，骨小梁厚度及结构模型指数均低于A、C组(P < 0.05)，骨小梁分离度高于A组(P < 0.05)；B组连接密度、结构模型指数低于A组(P < 0.05)，骨小梁厚度低于A、C组(P < 0.05)，骨小梁分离度高于A组(P < 0.05)；②抗酒石酸酸性磷酸酶染色：与A组相比，B、D组破骨细胞染色更深且数量更多；C组破骨细胞在形态和数量上类似于A组，体积偏小且着色偏淡；③隧道面积：相同时间点下，D组股骨与胫骨隧道扩大程度最大；B组术后3个月的股骨隧道内口、术后3，6个月的股骨隧道内口与中部面积均大于A组(P < 0.05)，术后3，6个月的胫骨隧道内口面积大于A组(P < 0.05)；④结果显示：前交叉韧带重建术后腱骨愈合过程中骨隧道扩大现象普遍存在，移植物处置方法通过影响腱骨界面破骨细胞介导的骨吸收导致骨微观结构的改变，从而干预腱骨愈合过程中的骨重塑。

https://orcid.org/0000-0003-3583-979X(李棋)；https://orcid.org/0009-0007-8095-1293(郑君)

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料；口腔生物材料；纳米材料；缓释材料；材料相容性；组织工程

关键词: 前交叉韧带重建, 同种异体移植物, 跟腱, 处置方法, 腱骨愈合, 骨重塑

Abstract: BACKGROUND: The process of tendon-bone healing after anterior cruciate ligament reconstruction with allografts is complex, and tunnel enlargement may occur due to poor healing. The process of preoperative graft treatment may have some influence on tendon-bone healing, but the specific situation is not clear.
OBJECTIVE: To explore the effects of allograft disposal methods on bone remodeling during tendon-bone healing after anterior cruciate ligament reconstruction surgery. 
METHODS: Thirty-two male beagles were randomly divided into four groups (n=8 per group) for anterior cruciate ligament reconstruction by coin toss method after establishing bilateral posterior cruciate ligament rupture models. In group A, fresh autogenous Achilles tendon grafts were used. In group B, a fresh allograft Achilles tendon was used. In group C, an allograft Achilles tendon irradiated by gamma rays and refrigerated at low temperature was used. In group D, lyophilized allograft tendon after γ-ray irradiation was used. Micro CT scanning and osteoclast tartrate-resistant acid phosphatase staining were performed in the femor-graft-tibia complex at 3 and 6 months after anterior cruciate ligament reconstruction. Scanning images were selected to measure the bone microstructural parameters and a 3D bone tunnel model was established to measure the tunnel area.
RESULTS AND CONCLUSION: (1) Micro CT scan: 3 months after operation, the connection density, trabecular number, trabecular thickness, ratio of bone volume to total volume and structural model index in group D were lower than those in groups A and C (P < 0.05). The trabecular separation was higher in group D than that of group A (P < 0.05). The connection density, trabecular number and structural model index of group B were lower than those of group A (P < 0.05). The trabecular separation was higher in group B than that in group A (P < 0.05). The ratio of bone volume to total volume was lower in group B than that in groups A and C (P < 0.05). Six months after surgery, the connection density, trabecular number and the ratio of bone volume to total volume in group D were lower than those in group A (P < 0.05). Trabecular thickness and structural model index were lower in group D than those in groups A and C (P < 0.05). The trabecular separation was higher in group D than that in group A (P < 0.05). The connection density and structural model index of group B were lower than those of group A (P < 0.05). The trabecular thickness was lower in group B than that in groups A and C (P < 0.05). The trabecular separation was higher in group B than that in group A (P < 0.05). (2) Tartrate-resistant acid phosphatase staining: Compared with group A, osteoclasts in groups B and D were stained more deeply and more in number. The osteoclasts in group C were similar to those in group A in morphology and quantity, with small volume and light staining. (3) Tunnel area: At the same time point, the tunnel expansion of the femur and tibia in group D was the largest. The area of the inner opening of the tibial tunnel at 3 months after operation and the area of the inner opening and middle part of the femoral tunnel at 3 and 6 months after operation in group B were larger than that in group A (P < 0.05). The area of the inner opening of the tibial tunnel at 3 and 6 months after operation was larger than that of group A (P < 0.05). (4) Those findings suggest that bone tunnel enlargement is common during tendon-bone healing after anterior cruciate ligament reconstruction. The disposal methods may affect bone resorption and the changes in bone microstructure mediated by osteoclasts at the tendon-bone interface. Therefore, it affected bone remodeling during tendon-bone healing.

Key words: anterior cruciate ligament reconstruction, allograft, Achilles tendon, disposal method, tendon-bone healing, bone remodeling

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