本文選題：前交叉韌帶重建 + 腱骨愈合　； 參考：《蘇州大學(xué)》2013年碩士論文

【摘要】：1目的結(jié)合組織學(xué)與生物力學(xué)研究來觀察腱骨愈合腱骨界面的生長(zhǎng)情況，以確定建議肌腱內(nèi)固定取出的最短時(shí)間，及更好的來指導(dǎo)臨床康復(fù)鍛煉。為進(jìn)一步臨床研究提供實(shí)驗(yàn)依據(jù)。 2材料與方法 2.1實(shí)驗(yàn)動(dòng)物與前交叉韌帶重建模型選用健康成熟的雄性比格犬36條，體重12.5±1.48kg，將36條比格犬36個(gè)膝關(guān)節(jié)分別取同側(cè)趾長(zhǎng)屈肌腱進(jìn)行單束雙股重建。 2.2隨機(jī)分組隨機(jī)分為2組，每組18條比格犬，，分別組織學(xué)切片組為18條比格犬(18個(gè)膝關(guān)節(jié))，和同期生物力學(xué)組18條比格犬(18個(gè)膝關(guān)節(jié)）。 2.3標(biāo)本處理術(shù)后第2、4、6、8、10、12周隨機(jī)抽取一小組（6條比格犬，6個(gè)膝關(guān)節(jié)）按順序處死，取膝關(guān)節(jié)對(duì)象（包括股骨端與前交叉韌帶），分別隨機(jī)取3個(gè)膝關(guān)節(jié)做生物力學(xué)拉脫試驗(yàn)，和將另3個(gè)膝關(guān)節(jié)標(biāo)本固定、脫鈣、取腱骨界面切片、染色。 3結(jié)果 3.1組織學(xué)觀察組在愈合早期，即第2周內(nèi)，腱骨界面細(xì)胞重構(gòu)和多血管形成，伴有在骨隧道壁上大量成骨細(xì)胞，軟骨樣細(xì)胞和成纖維細(xì)胞的增生。骨生長(zhǎng)因子，如BMPs，大量表達(dá)和在骨隧道壁附近可見少量新形成的骨小梁。術(shù)后大約4周時(shí)，纖維血管界面組織密集，并排列有序，隨后逐漸減少，伴有II型膠原的沉積的軟骨樣細(xì)胞從骨向肌腱生長(zhǎng)。由于肌腱周圍的新骨形成，骨隧道壁增厚。但在此期間，膠原纖維機(jī)化不充分，腱骨的連續(xù)性只能偶爾可見。隨后，6周時(shí)，膠原纖維生長(zhǎng)成熟，腱骨的連續(xù)性進(jìn)行重建。術(shù)后8周，垂直排列的Sharpey樣纖維在腱骨界面中心可見。這些Sharpey樣纖維由III型膠原組成，并連接骨與移植的肌腱，被認(rèn)為是腱骨整合最早的征象。早期的生物力學(xué)結(jié)果也被認(rèn)為是膠原纖維的連續(xù)性與腱骨整合的共同作用所產(chǎn)生。而這種早期的腱骨愈合方式幾乎取決于骨隧道中的生物學(xué)或生物力學(xué)環(huán)境。而在8至12周后，腱骨愈合進(jìn)程進(jìn)入慢性炎癥反應(yīng)期，此時(shí)腱骨愈合已逐步趨于穩(wěn)定。 3.2生物力學(xué)研究組術(shù)后第2、4、6、8周，肌腱都能從骨隧道里拉脫出來，且隨著時(shí)間的延長(zhǎng)，肌腱拉脫的力量也在增長(zhǎng)，在第10—12周時(shí)，肌腱逐漸開始不能被拉脫出來，而是肌腱中間斷裂。 4結(jié)論自體肌腱重建前交叉韌帶愈合早期，腱骨界面經(jīng)歷了急性炎癥期、缺血壞死期、膠原纖維重構(gòu)期和慢性炎癥期后趨于穩(wěn)定。在此期間腱骨愈合界面強(qiáng)度較弱，直到第八周時(shí)，才較為牢固，在此期間活動(dòng)度的鍛煉不宜過激，力量和運(yùn)動(dòng)功能的康復(fù)訓(xùn)練也應(yīng)該在8周以后，以免發(fā)生肌腱松弛和微動(dòng)，建議內(nèi)固定取出的時(shí)間至少也應(yīng)大于12周。
[Abstract]:Objective to observe the growth of tendon bone interface in combination with histological and biomechanical studies in order to determine the shortest time for tendon internal fixation and better guide clinical rehabilitation. Materials and methods 2.1 36 healthy and mature male Beagle dogs were used to reconstruct the anterior cruciate ligament (ACL) model in the experimental animals and the anterior cruciate ligament (ACL) reconstruction model. The body weight was 12.5 鹵1.48 kg. The knee joints of 36 Beagle dogs were harvested from the same side of flexor digitorum longus tendon for single bundle and double strand reconstruction. 2.2 each group was randomly divided into two groups, 18 Beagle dogs in each group. The histological section group was divided into 18 Beagle dogs (18 knees) and the biomechanics group (18 knees) respectively. Three knee joints (including femur and anterior cruciate ligament) were randomly selected for biomechanical pullout test, and the other three knee joint specimens were fixed, decalcified, and tendon bone interface sections were taken. 3Results in the 3.1 histological observation group, in the early healing stage, that is, the 2nd week, the tendon bone interface cells were reconstructed and many blood vessels were formed, accompanied by a large number of osteoblasts in the bone tunnel wall. Proliferation of chondroid cells and fibroblasts. Bone growth factors, such as BMPs, are highly expressed and a small number of newly formed trabeculae are observed near the bone tunnel wall. At about 4 weeks after operation, the fibrous vascular interface was densely organized and arranged, then gradually decreased, and the chondroid cells with type II collagen deposition grew from bone to tendon. The bone tunnel wall is thickened by the formation of new bone around the tendon. During this period, however, collagen fibers are not sufficiently organized and the continuity of tendons can only be seen occasionally. At the end of 6 weeks, the collagen fibers matured and the tendon bone was reconstructed. Sharpey-like fibers perpendicular to the center of the tendon bone interface were observed 8 weeks after operation. These Sharpey-like fibers are composed of type III collagen and connect the bone to the transplanted tendon, which is considered to be the earliest sign of tendon bone integration. Early biomechanical results are also thought to be the result of collagenous fiber continuity and tendon bone integration. This early healing of tendons almost depends on the biological or biomechanical environment in the bone tunnel. However, after 8 to 12 weeks, the healing process of tendons entered a chronic inflammatory reaction period, and the healing of tendons gradually stabilized. 3.2 in the biomechanical study group, the tendons could be pulled out of the bone tunnel at the 2nd and 6th week after operation. As time went on, the strength of tendon pullout also increased. At the 10-12 weeks, the tendon gradually began to be not pulled out, but the intertendinous rupture. 4 conclusion autogenous tendon reconstruction of the anterior cruciate ligament is early in healing. The interface of tendon and bone was stable after acute inflammation, ischemic necrosis, collagen remodeling and chronic inflammation. During this period, the strength of the healing interface of tendon bone is weaker, but it is not more firm until the eighth week. During this period, the exercise of movement should not be excessive, and the rehabilitation training of strength and motor function should be done after 8 weeks, so as to avoid tendon relaxation and fretting. The recommended time for internal fixation should also be at least 12 weeks.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R318.01

【共引文獻(xiàn)】

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