中国组织工程研究

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (12): 1805-1812.doi: 10.3969/j.issn.2095-4344.2017.12.001

• 骨组织构建 bone tissue construction •    下一篇

急性损伤后开始训练时间对髌骨髌腱结合部愈合的影响

梁孝天1，王  博1，曾晓辉1，唐旖旎1，肖芳欣1，李海伟2，王  琳3   

  1. 1北京体育大学，北京市  100084；2山西师范大学体育学院，山西省临汾市  041000；3北京体育大学运动医学教研室，北京市  100084
  • 收稿日期:2017-03-10 出版日期:2017-04-28 发布日期:2017-05-16
  • 通讯作者: 王琳，博士，教授，北京体育大学运动医学教研室，北京市 100084
  • 作者简介:梁孝天，男，1989年生，广西壮族自治区桂林市人，汉族，2017年北京体育大学毕业，博士，主要从事运动损伤及预防机制方面的研究。
  • 基金资助:

    教育部科技发展项目，博士点基金课题(20111112110005)，课题名称：伤后开始训练时间对骨腱结合部急性损伤修复的影响及其作用机理研究。

Effect of different resting time on patella-patellar tendon healing after acute injury

Liang Xiao-tian1, Wang Bo1, Zeng Xiao-hui1, Tang Yi-ni1, Xiao Fang-xin1, Li Hai-wei2, Wang Lin3   

  1. 1Beijing Sport University, Beijing 100084, China; 2School of Physical Education, Shanxi Normal University, Linfen 041000, Shanxi Province, China; 3Department of Sports Medicine, Beijing Sport University, Beijing 10084, China
  • Received:2017-03-10 Online:2017-04-28 Published:2017-05-16
  • Contact: Wang Lin, M.D., Professor, Department of Sports Medicine, Beijing Sport University, Beijing 10084, China
  • About author:Liang Xiao-tian, M.D., Beijing Sport University, Beijing 100084, China
  • Supported by:

    the Scientific and Technologic Development Project of the Educational Ministry of China, No. 20111112110005

PDF

461

摘要：

文章快速阅读：

文题释义：
髌骨的作用：具有保护膝关节，避免股四头肌腱对股骨髁软骨面摩擦的功能，有传递股四头肌的力量，参与构成伸膝装置功能；有维持膝关节在半蹲位的稳定性，防止膝关节过度内收、外展和伸屈活动的功能，以及有车链作用，增加膝关节回转能力的功能。
髌腱断裂：通常是髌骨下缘撕脱，亦可见髌腱远端的胫骨结节撕脱。由于股四头肌的收缩，髌骨可以随股四头肌肌腱向上回缩3-6 cm。因此，对髌腱断裂，应该强调早期修复，晚期由于髌腱失张力后挛缩和瘢痕化，往往不得不施行重建手术。
摘要
背景：髌骨髌腱结合部损伤在运动训练中十分常见且复发率较高，及时合理的恢复训练对保持竞技状态有利，而不恰当的恢复训练则有可能加重损伤。
目的：从组织形态学、生长因子、胶原蛋白表达量及肌张力等角度，探讨伤后休息不同天数恢复训练对骨腱结合部愈合质量的影响。
方法：40只新西兰大白兔被随机分为：空白对照组，针刺后分别休息24，48，72，96，120 h开始恢复训练组。除空白对照组外，其余各组于髌腱止点处进行针刺损伤造模后采用已建立的循环载荷训练模型，进行4周低强度训练后处死取材，行组织学苏木精-伊红、番红及免疫组织化学染色；每次训练后利用Myoton-3肌肉功能分析仪采集肌张力，肌肉硬度数据；Metamorph图形处理软件对各组纤维软骨带厚度、细胞密度，血管内皮生长因子、胶原阳性染色细胞密度进行定量计算。
结果与结论：①与空白对照组相比，各伤后训练组在呈现出不同程度的组织形态改变，包括胶原排列紊乱，细胞密度降低，黏多糖蛋白增多，出现“涨潮”现象等；②针刺后24 h与针刺后120 h组纤维软骨带厚度比空白对照组显著增厚(P < 0.05)；③针刺后24 h组与针刺后48 h组的Ⅰ型胶原与Ⅲ型胶原比例显著低于空白对照组(P < 0.05)，72 h组最高；④针刺后48 h，针刺后72 h与针刺后96 h组的血管内皮生长因子表达量相较于空白对照组显著增高(P < 0.05)；⑤肌张力与胶原比例(r=-0.538；P < 0.01)及软骨细胞密度(r=-0.570；P < 0.01)呈负相关关系，而肌肉硬度则与血管内皮生长因子表达量呈正相关关系(r=0.613；P < 0.01)；⑥结果说明，急性损伤后不同开始恢复训练时间会对髌骨髌腱结合部的愈合造成明显的差异，伤后休息72 h开始训练是最为合理的选择；研究证实了肌张力及肌肉硬度会对细胞密度，胶原合成及生长因子表达存在相关性，此指标测量方便且无创，可应用在伤后训练及预防损伤复发等方面，指导运动员及普通人科学运动。

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
ORCID: 0000-0003-2938-4928(王玉)

关键词: 组织构建, 组织工程, 髌骨髌腱结合部, 伤后训练, 急性损伤, 愈合, 肌肉特性

Abstract:

BACKGROUND: Patella-patellar tendon junction (PPTJ) injuries are a common disease in athletes and vulnerable to re-injury. Post-injury training is a double-edged sword.
OBJECTIVE: To examine the effect of post-injury resting days on the quality of healing in PPTJ in view of histomorphology, expression levels of growth factor and collagen, and muscle tension.
METHODS: Forty New Zealand white rabbits were randomly divided into control, and five post-injury training groups representing different time to restart training after acute injury: the rabbits restarted training at 24 (PIT24), 48 (PIT48), 72 (PIT72), 96 (PIT96) and 120 (PIT120) hours, respectively. All post-injury training groups received acupuncture at the PPTJ and then underwent 4-week low-intensity training. Afterwards, all rabbits were killed to take specimens for hematoxylin-eosin, safranin O and immuohistochemical staining. The muscle tension and hardness were detected using Myoton-3. The thickness of fibrous cartilage zones, cell density, as well as the expression levels of vascular endothelial growth factor and collagen were measured on Metamorph software.
RESULTS AND CONCLUSION: Compared with the control group, in the PIT groups, the collagens arranged in disorder, and decreased cell density, increased mucopolysaccharide and “rising tide” phenomenon appeared. The fibrocartilage in the PIT24 and PIT120 groups was significantly thicker than that in the control group (P < 0.05). The ratio of collagen type I/III was significantly decreased in the PIT24 and PIT48 groups compared with the control group (P < 0.05), and the highest in the PIT72 group. The expression level of vascular endothelial growth factor in the PIT48, PIT72 and PIT96 groups was significantly higher than that in the control group (P < 0.05). The muscle tension was negatively correlated with the collagen ratio (r=-0.538; P < 0.01) and chondrocyte density (r=-0.570; P < 0.01), while muscle hardness was positively correlated with the expression level of vascular endothelial growth factor (r=0.613; P < 0.01). Our results suggest that different resting time makes significant differences in the PPTJ healing and the 72-hour resting is the best choice. Moreover, muscular properties are related to the cell density, collagen synthesis and growth factor expression, which can be used as a non-invasive indicator to guide post-injury training and prevent recurrence.

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

Key words: Patella, Sports Medicine, Wound Healing, Muscles

中图分类号: