中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (4): 713-720.doi: 10.12307/2025.222

• 细胞外基质材料 extracellular matrix materials • 上一篇    下一篇

内减张技术辅助前交叉韧带重建促进滇南小耳猪跟腱移植物韧带化

熊波涵1,王国梁1,余  洋1,薛文强2,余  鸿1,刘津瑞1,阮朝晖1,李雅娟1,刘昊龙1,董开颜1,龙  丹1,陈  钊3   

  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;3西南医科大学公共卫生学院,四川省泸州市  646000
  • 收稿日期:2023-12-14 接受日期:2024-02-07 出版日期:2025-02-08 发布日期:2024-05-30
  • 通讯作者: 王国梁,运动医学博士,副主任医师,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:
    云南省技术创新人才项目(202105AD160018),项目负责人:王国梁;昆明医科大学硕士研究生教育创新基金资助项目(2023S061),项目负责人:熊波涵;昆明医科大学第一附属医院院内博士科研基金项目(2023BS022),项目负责人:余洋

Internal tension relieving technique assisted anterior cruciate ligament reconstruction to promote ligamentization of Achilles tendon grafts in small ear pigs in southern Yunnan province

Xiong Bohan1, Wang Guoliang1, Yu Yang1, Xue Wenqiang2, Yu Hong1, Liu Jinrui1, Ruan Zhaohui1, Li Yajuan1, Liu Haolong1, Dong Kaiyan1, Long Dan1, Chen Zhao3   

  1. 1Department of Sports Medicine, 2Department of Anesthesiology, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China; 3School of Public Health, Southwest Medical University, Luzhou 646000, Sichuan Province, China
  • Received:2023-12-14 Accepted:2024-02-07 Online:2025-02-08 Published:2024-05-30
  • Contact: Wang Guoliang, PhD, Associate chief physician, Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
  • About author:Xiong Bohan, Master candidate, Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
  • Supported by:
    Technology Innovation Talent Project of Yunnan Province, No. 202105AD160018 (to WGL); Master’s Education Innovation Fund Project of Kunming Medical University, No. 2023S061 (to XBH); PhD Research Fund Project within First Affiliated Hospital of Kunming Medical University, No. 2023BS022 (to YY)

摘要:

文题释义:
内减张增强系统(Internal bracing system):指在骨科和运动医学领域使用韧带增强装置通过分担移植物内部负荷提高手术疗效与成功率的医用耗材,诸如用ORthcordTM、 EthibondTM等高强度缝线联合固定袢、可调袢、界面螺钉等高强度固定装置修复重建髋膝踝的韧带损伤。
韧带化(ligamentizition):指手术重建受伤的韧带后,移植物经缺血坏死、血运重建、细胞增殖、组织成熟等时期过渡,成纤维细胞爬行替代原有坏死的肌腱细胞,最终形成细长坚韧的韧带纤维细胞,在形态学、组织学、生物力学等方面接近或达到原有韧带的过程。
背景:前期研究已经成功建立了内减张技术联合自体跟腱重建前交叉韧带的滇南小耳猪动物模型,并验证了模型的稳定性和可靠性,但内减张技术能否促进自体跟腱移植物的韧带化进程问题仍未被研究。
目的:从大体观、组织学、电镜检测多方面探讨普通重建与内减张重建前交叉韧带韧带化进程的差异。
方法:选取30只成年雌性滇南小耳猪,左后肢膝关节取同侧膝关节跟腱行前交叉韧带重建(普通组n=30),右后肢膝关节取同侧膝关节跟腱联合内减张增强系统行前交叉韧带重建(减张组n=30),以自体右前肢作为对照组,暴露前交叉韧带但不行离断及手术处理。在术后12,24,48周分别处死10只动物,取左右膝关节标本行大体形态学观察评估移植物形态,MAS评分评估各个时间点韧带优良率,苏木精-伊红染色评估韧带移植物血管化程度,观察胶原纤维及细胞核形态并进行细胞核形态学评分,扫描电镜与透射电镜评估超微结构重塑。
结果与结论:①在术后各个时间点减张组的韧带愈合形态更好,可以获得更高的MAS评分优良率(P < 0.05),并可以获得更高的韧带血管化评分(P < 0.05);②两组移植物胶原束及纤维束的排列均逐渐趋于有序,胶原间的横向纤维连接逐渐增多增粗,提示移植物的强度和塑形程度逐渐提升,术后各个时间点减张组韧带的重塑始终快于普通组;③术后各个时间点减张组胶原纤维的直径、分布密度、排列有序度均优于普通组,尤其在胶原纤维直径的比较上,组间及组内比较减张组均优于普通组(P < 0.05)。
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: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, 内减张技术, 韧带化, 超微结构, 血管化

Abstract:

BACKGROUND: We have successfully established an animal model of small ear pig in southern Yunnan province with internal tension relieving technique combined with autologous Achilles tendon for anterior cruciate ligament reconstruction, and verified the stability and reliability of the model. However, whether internal tension relieving technique can promote the ligamentalization process of autologous Achilles tendon graft has not been studied.

OBJECTIVE: To investigate the differences in the process of ligamentalization between conventional reconstruction and internal reduction reconstruction of the anterior cruciate ligament by gross view, histology and electron microscopy.

METHODS: Thirty adult female small ear pigs in southern Yunnan province were selected. Anterior cruciate ligament reconstruction was performed on the left knee joint with the ipsilateral knee Achilles tendon (n=30 in the normal group), and anterior cruciate ligament reconstruction was performed on the right knee joint with the ipsilateral knee Achilles tendon combined with the internal relaxation and enhancement system (n=30 in the relaxation group). The autogenous right forelimb was used as the control group; the anterior cruciate ligament was exposed but not severed or surgically treated. At 12, 24, and 48 weeks after surgery, 10 animals were sacrificed, respectively. The left and right knee joint specimens were taken for gross morphological observation to evaluate the graft morphology. MAS score was used to evaluate the excellent and good rate of the ligament at each time point. Hematoxylin-eosin staining was used to evaluate the degree of ligament graft vascularization. Collagen fibers and nuclear morphology were observed, and nuclear morphology was scored. Ultrastructural remodeling was evaluated by scanning electron microscopy and transmission electron microscopy.
RESULTS AND CONCLUSION: (1) The ligament healing shape of the relaxation group was better at various time points after surgery, and the excellent and good rate of MAS score was higher (P < 0.05). Moreover, the relaxation group could obtain higher ligament vascularization score (P < 0.05). (2) The arrangement of collagen bundles and fiber bundles in the two groups gradually tended to be orderly, and the transverse fiber connections between collagen gradually increased and thickened, suggesting that the strength and shape degree of the grafts were gradually improved, but the ligament remodeling in the relaxation group was always faster than that in the normal group at various time points after surgery. (3) The diameter, distribution density, and arrangement degree of collagen fibers in the relaxation group were better than those in the normal group at all time points, especially in the comparison of collagen fiber diameter between and within the relaxation group (P < 0.05). 

Key words: anterior cruciate ligament, internal tension relieving technique, ligamentization, ultrastructure, vascularization

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