中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (14): 2221-2226.doi: 10.12307/2024.336

• 软骨组织构建 cartilage tissue construction • 上一篇    下一篇

内减张技术辅助前交叉韧带重建对滇南小耳猪关节软骨的保护作用

熊波涵1，卢晓君1，薛文强2，刘津瑞1，高娴玲2，余  鸿1，李雅娟1，刘昊龙1，李彦林1   

  1. 昆明医科大学第一附属医院，1运动医学科，2麻醉科，云南省昆明市  650032
  • 收稿日期:2023-04-15 接受日期:2023-05-25 出版日期:2024-05-18 发布日期:2023-07-28
  • 通讯作者: 李彦林，主任医师，教授，昆明医科大学第一附属医院运动医学科，云南省昆明市 650032
  • 作者简介:熊波涵，男，1998年生，四川省成都市人，汉族，昆明医科大学运动医学在读硕士，主要从事生物医学工程、内减张技术等研究。
  • 基金资助:
    云南省重大科技专项项目计划项目(202102AA100015)，项目负责人：李彦林；云南省骨关节疾病临床医学中心项目(ZX2019-03-04)，项目负责人：李彦林；云南省卫生和计划生育委员会医学领军人才培养计划(L-201601)，项目负责人：李彦林

Protective effect of anterior cruciate ligament reconstruction assisted by internal tension-reduction technique on the articular cartilage of southern Yunnan small-ear pigs

Xiong Bohan1, Lu Xiaojun1, Xue Wenqiang2, Liu Jinrui1, Gao Xianling2, Yu Hong1, Li Yajuan1, Liu Haolong1, Li Yanlin1   

  1. 1Department of Sports Medicine, 2Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
  • Received:2023-04-15 Accepted:2023-05-25 Online:2024-05-18 Published:2023-07-28
  • Contact: Li Yanlin, Chief physician, Professor, Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
  • About author:Xiong Bohan, Master candidate, Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
  • Supported by:
    Yunnan Province Major Science and Technology Special Project, No. 202102AA100015 (to LYL); Yunnan Province Clinical Medical Center Project for Bone and Joint Diseases, No. ZX2019-03-04 (to LYL); Medical Leading Talents Training Program of Yunnan Provincial Health and Family Planning Commission, No. L-201601 (to LYL)

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摘要：


文题释义：

内减张技术：指在运动医学及骨科领域前交叉韧带重建、肘关节尺侧副韧带修复、踝关节距腓前韧带修复等手术过程中，通过韧带增强装置如高强度缝线带配合挤压螺钉、钢板袢等进行手术重建，以达到分担膝关节内部部分负荷、保护重建的移植物，提高手术成功率的临床技术。
关节软骨：在关节中与骨相连的表面附有的软骨组织，又称透明软骨或纤维软骨。软骨具有较强的弹性和变形能力，能缓冲运动时的震动与冲击，同时也能在一定程度上增加关节活动度。关节软骨既无神经又无血管，它的营养主要由滑液和关节囊滑膜层周围的动脉分支供应。


背景：内减张技术可通过分担膝关节内部负荷有效减轻前交叉韧带重建移植物的松弛及微动，取得了较好的生物力学结果及临床疗效，但其是否能通过分担应力减轻前交叉韧带重建后的软骨退变尚不清楚。

目的：观察内减张技术对前交叉韧带重建滇南小耳猪关节软骨退变的作用。
方法：取10 头成年雌性滇南小耳猪，左后膝采用自体跟腱移植进行前交叉韧带重建(普通组)，右后膝采用内减张增强系统联合自体跟腱进行前交叉韧带重建(减张组)。术后1 年，取小耳猪膝关节软骨组织，分别进行苏木精-伊红染色、番红-固绿染色、国际骨关节炎研究协会评分及软骨Ⅱ型胶原、白细胞介素1β、肿瘤坏死因子α免疫组化染色分析。

结果与结论：①苏木精-伊红染色显示，减张组可见轻微骨关节炎病理改变，空骨陷窝数量少，无明显纤维化、细胞层断裂等病理改变；普通组软骨损伤程度较重，空骨陷窝数量增多，靠近骨质部分软骨细胞缺失，甚至形成形态裂隙。番红-固绿染色显示，减张组软骨组织厚度正常，软骨面平整，细胞排列呈整齐呈极性，细胞无肿胀及凋亡；普通组软骨组织厚度明显变薄，细胞排列紊乱，极性丧失，细胞数量减少，有明显软骨裂隙及软骨空泡形成，靠近中央骨质部分细胞缺失明显。减张组软骨组织国际骨关节炎研究协会评分低于普通组(P < 0.05)。②免疫组化染色显示，减张组软骨组织中Ⅱ型胶原蛋白表达高于普通组(P < 0.05)，白细胞介素1β、肿瘤坏死因子α蛋白表达低于普通组(P < 0.05)。③结果表明，内减张技术可延缓前交叉韧带重建滇南小耳猪关节软骨的退变。

https://orcid.org/0000-0002-1593-5654(熊波涵)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 前交叉韧带, 前交叉韧带重建, 动物模型, 骨关节炎, 内减张技术, 关节软骨

Abstract: BACKGROUND: Internal tension-reduction technique is to reconstruct the anterior cruciate ligament through high-strength suture system combined with tendon. It can effectively reduce graft relaxation and frets by sharing the internal load of the knee joint, and has achieved good biomechanical results and clinical efficacy. However, whether it can reduce cartilage degeneration after anterior cruciate ligament reconstruction through stress sharing reduction has not been studied.
OBJECTIVE: To investigate the effect of internal tension-reduction technique on articular cartilage degeneration in southern Yunnan small-ear pigs undergoing anterior cruciate ligament reconstruction.
METHODS: Ten adult female Yunnan small-ear pigs were selected, and the ipsilateral knee Achilles tendon was taken from the left knee joint for anterior cruciate ligament reconstruction (normal group, n=10), and the ipsilateral knee Achilles tendon from the right knee joint combined with internal tension-reduction and augmentation system for anterior cruciate ligament reconstruction (tension-reduction group, n=10). One year after surgery, the experimental pigs were sacrificed, and the left and right knee cartilage was taken for hematoxylin-eosin staining, Safranin O-fast green staining, Osteoarthritis Research Society International scoring, and immunohistochemistry staining of type II collagen, interleukin-1β, and tumor necrosis factor-alpha in the cartilage.
RESULTS AND CONCLUSION: Hematoxylin-eosin staining showed that in the tension-reduction group, there were mild pathologic changes of osteoarthritis, with a low number of empty bone lacunae and no obvious pathological changes such as fibrosis or cell layer breakage; in the normal group, more severe cartilage damage, with an increased number of empty bone lacunae, loss of chondrocytes near the bone and even the formation of fissures. Safranin O-fast green staining indicated that the tension-reduction group had normal cartilage tissue thickness, flat cartilage surface, a neat cell arrangement in a polar pattern, and no swelling or apoptosis, while in the normal group, the thickness of cartilage tissue was obviously thinner, the cell arrangement was disordered with no polarity, the number of cells was reduced, obvious cartilage fractures and cartilage vacuoles formed, and the absence of cells near the central bone was obvious. The Osteoarthritis Research Society International score was significantly lower in the tension-reduction group than in the normal group (P < 0.05).  Immunohistochemical findings showed that the protein expression of type II collagen in cartilage tissue of the tension-reducing group was higher than that of the normal group (P < 0.05), and the protein expression of interleukin 1β and tumor necrosis factor ɑ in cartilage tissue was lower than that of normal group (P < 0.05). To conclude, internal tension-reduction technique can delay the degeneration of articular cartilage in Yunnan small-eared pigs following anterior cruciate ligament reconstruction.

Key words: anterior cruciate ligament, anterior cruciate ligament reconstruction, animal model, osteoarthritis, internal reduction technique, articular cartilage

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