本文選題：前交叉韌帶　切入點：自體肌腱　出處：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：觀察自體骨膜包裹肌腱重建兔前交叉韌帶（anterior cruciateligament，ACL）對腱骨愈合的影響，探討自體骨膜促進(jìn)腱骨愈合的能力與機制，為自體骨膜包裹肌腱在前交叉韌帶損傷重建治療領(lǐng)域的應(yīng)用提供實驗資料。 方法：選取96只3-4月齡新西蘭大白兔，雌雄不限，體重2.5~3.5Kg，由河北醫(yī)科大學(xué)實驗動物中心提供。將實驗用兔隨機分為兩組，每組48只，分別命名為A組、B組，，其中A組為實驗組，B組為對照組。兩組試驗用兔飼養(yǎng)條件完全相同,術(shù)前麻醉用1%戊巴比妥鈉溶液于耳緣靜脈注射，劑量約為2ml/Kg，全麻后備皮消毒手術(shù)側(cè)膝關(guān)節(jié)及遠(yuǎn)端部位，對兩組新西蘭大白兔分別進(jìn)行直視下同側(cè)自體跟腱移植重建前交叉韌帶術(shù),其中右膝關(guān)節(jié)做為手術(shù)側(cè)。A組在進(jìn)行自體跟腱移植重建前交叉韌帶時取手術(shù)側(cè)脛骨上端內(nèi)側(cè)骨膜，大小約1.5cm*0.5cm,用以包裹修整好的肌腱脛骨端，生發(fā)層朝向骨隧道，用可吸收縫線縫合固定，將骨膜包裹的肌腱植入脛骨隧道內(nèi)，生發(fā)層與骨隧道緊密接觸；B組肌腱無骨膜包裹，只進(jìn)行自體跟腱移植前交叉韌帶重建。術(shù)中給予慶大霉素4萬單位預(yù)防感染,術(shù)后繼續(xù)抗炎治療3日,支具固定手術(shù)側(cè)膝關(guān)節(jié)，常規(guī)換藥,14天拆除縫線,分別于術(shù)后第2周、第4周、第6周、第8周麻醉后處死實驗用兔,解剖手術(shù)側(cè)膝關(guān)節(jié),將實驗用兔手術(shù)側(cè)膝關(guān)節(jié)包含重建韌帶隧道部分完整解剖并離斷，剔除周圍軟組織，將脛骨隧道部位標(biāo)本分為兩段，其中一段置于4%甲醛溶液中固定,另一段置于2%戊二醛溶液中固定。將所需標(biāo)本置于含30%甲酸溶液及10%甲醛溶液配置的脫鈣液中進(jìn)行脫鈣48h后沖水48h。將4%甲醛溶液中固定的標(biāo)本分別進(jìn)行HE染色及甲苯胺藍(lán)（toluidineblue,TB）染色后進(jìn)行光鏡制片，將2%戊二醛溶液中固定的標(biāo)本進(jìn)行電鏡(transmission electron microscope,TEM)制片，制片完成后分別用光鏡和電鏡觀察兩組重建前交叉韌帶腱骨愈合的情況。 結(jié)果： 1實驗動物術(shù)后均未出現(xiàn)感染、傷口不愈合等并發(fā)癥。 2新西蘭白兔自體跟腱移植重建前交叉韌帶后lachman試驗陰性，側(cè)方應(yīng)力試驗陰性，符合交叉韌帶重建后的臨床要求。 3大體觀察：實驗組自體跟腱移植重建前交叉韌帶術(shù)后2周時隧道腱骨結(jié)不緊密，腱骨之間有疏松的結(jié)締組織存在，外力作用下可導(dǎo)致腱骨分離；術(shù)后4周時隧道腱骨緊密程度好于2周時，腱骨之間有稍致密的結(jié)締組織存在，外力作用下導(dǎo)致腱骨分離難于2周時；術(shù)后6周時隧道腱骨緊密程度好于4周時，腱骨之間有致密的結(jié)締組織存在，外力作用下導(dǎo)致腱骨分離難于4周時；術(shù)后8周時隧道腱骨緊密程度好于6周時，腱骨之間有較致密的結(jié)締組織存在，外力作用下不易導(dǎo)致腱骨分離。對照組自體跟腱移植重建前交叉韌帶術(shù)后第2周、第4周、第6周、第8周時隧道腱骨結(jié)合程度均弱于同時期的實驗組，腱骨之間的結(jié)締組織均少于同期實驗組，外力作用下較實驗組更容易導(dǎo)致腱骨分離。 4顯微鏡下觀察：實驗組第2周時腱骨結(jié)合部有大量細(xì)胞浸潤，主要為炎性細(xì)胞，其次為成纖維細(xì)胞，并出現(xiàn)少量纖維軟骨細(xì)胞，HE染色未見明顯著色；術(shù)后第4周、第6周及第8周可見損傷裂口處新生組織填充逐漸增多，并與周圍肌腱及骨隧道組織形成緊密連接，新生組織中纖維軟骨細(xì)胞逐漸增多，細(xì)胞外基質(zhì)成分逐漸增多并出現(xiàn)纖維成分及新生毛細(xì)血管形成；甲苯胺藍(lán)染色范圍逐漸擴(kuò)大，表明新生組織中軟骨成分逐漸增多。對照組腱骨結(jié)合部2周，少量細(xì)胞浸潤，肌腱與骨隧道未緊密結(jié)合，亦無纖維軟骨細(xì)胞出現(xiàn)；術(shù)后4周、6周及8周可見腱骨結(jié)合部出現(xiàn)少量新生組織，但與周圍組織連接不緊密，其中的纖維軟骨細(xì)胞數(shù)量明顯少于實驗組，僅有少量新生毛細(xì)血管形成，細(xì)胞基質(zhì)成分較少，甲苯胺藍(lán)染色見著色不明顯(FIG1.1-4.8)。統(tǒng)計學(xué)分析結(jié)果顯HE染色及甲苯胺藍(lán)（TB）染色術(shù)后第2周、第4周、第6周同時期實驗組和對照組組間比較無明顯差異，術(shù)后第8周實驗組和對照組組間比較有統(tǒng)計學(xué)意義（P＜0.05）。術(shù)后第2周至第8周實驗組組內(nèi)比較有統(tǒng)計學(xué)意義，術(shù)后第2周至第8周對照組組內(nèi)比較有統(tǒng)計學(xué)意義（P＜0.05）。電鏡觀察組術(shù)后第6周及第8周組間比較有統(tǒng)計學(xué)意義（P＜0.05）。(Table-7) 結(jié)論： 骨膜包裹自體跟腱移植重建兔前交叉韌能夠促進(jìn)腱骨結(jié)合部炎性反應(yīng)發(fā)生和細(xì)胞聚集，促進(jìn)炎性細(xì)胞，成纖維細(xì)胞、骨細(xì)胞及軟骨細(xì)胞的再生；促進(jìn)新生毛細(xì)血管的形成及軟骨分化；對腱骨結(jié)合部愈合修復(fù)具有積極的促進(jìn)作用。
[Abstract]:Objective: To observe the effect of autologous periosteum wrapped tendon reconstruction of anterior cruciate ligament in rabbits (anterior cruciateligament, ACL) on tendon bone healing, to explore the ability and mechanism of autologous periosteum promote tendon bone healing and provide experimental data for the application of autologous periosteum wrapped tendon reconstruction for the treatment in the field of anterior cruciate ligament injury.
Methods: a total of 96 3-4 month old New Zealand white rabbits, male or female, weight 2.5~3.5Kg, provided by the experimental animal center of Hebei Medical University. The experimental rabbits were randomly divided into two groups, 48 rats in each group, which were named as A group, B group, A group for the experimental group, group B as control group. Two groups test with rabbit under the same feeding conditions, anesthesia by ear vein injection of 1% pentobarbital sodium before operation, the dose is about 2ml/Kg, the skin is disinfected after general anesthesia in surgical knee joint and distal part of two groups of New Zealand white rabbits were reconstructed at ipsilateral autologous tendon anterior cruciate ligament, the right knee to do for the surgical side group.A cruciate ligament reconstruction in self tendon before surgery from the proximal tibia medial periosteum, the size of about 1.5cm*0.5cm, used to wrap the trimmed tibial tendon, the germinal layer toward the bone tunnel, with absorbable suture. That will be the periosteum wrapped tendon implanted into the tibial tunnel within the germinal layer in close contact with the bone tunnel; B group without periosteum wrapped tendon, only self tendon anterior cruciate ligament reconstruction. Given gentamycin 40 thousand units to prevent infection during operation, postoperative anti-inflammatory treatment for 3 days, with a fixed surgical knee joint, conventional 14 days of dressing, suture, respectively for second weeks, after fourth weeks, sixth weeks, eighth weeks after anesthesia were experimental rabbit knee joint surgery, anatomy, the experimental rabbit knee joint ligament reconstruction surgery includes complete transection and anatomic section of the tunnel, excluding the surrounding soft tissue. The tibial tunnel position divided into two sections, one fixed segment in the 4% Formaldehyde Solution, another fixed in 2% glutaraldehyde solution. The decalcified specimens were placed in liquid containing 30% formic acid and 10% Formaldehyde Solution in the 48h configuration after decalcification water 48h. 4% formaldehyde solution Liquid fixed specimens were stained with HE and toluidine blue respectively (toluidineblue, TB) after staining by light microscope method, were fixed in 2% glutaraldehyde solution for the electron microscope (transmission electron microscope, TEM) production, production is completed respectively by light microscope and electron microscopy observation cross tendon bone healing of two groups before reconstruction.
Result錛

本文編號：1664834