本文選題：肌腱 + 跟腱缺損��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：背景及目的： 在臨床工作中經(jīng)常會(huì)遇到肌腱缺損需要移植肌腱進(jìn)行修復(fù)的情況，目前的治療的“金標(biāo)準(zhǔn)”是自體肌腱移植，但自體肌腱來源非常有限，，同時(shí)自體肌腱移植還會(huì)造成供區(qū)功能喪失；而同種異體肌腱移植、異種肌腱移植存在著免疫排斥反應(yīng)，會(huì)導(dǎo)致移植物壞死、局部炎癥反應(yīng)等嚴(yán)重并發(fā)癥。最終解決這些問題需要依靠肌腱愈合機(jī)制的基礎(chǔ)研究以及組織工程學(xué)肌腱研究的進(jìn)展來解決。目前學(xué)者認(rèn)為肌腱愈合有兩種方式，一種認(rèn)為肌腱愈合是依靠腱周組織長入形成粘連的外源性愈合，據(jù)此推論肌腱移植中移植肌腱僅起到支架和通路作用。另一種是內(nèi)源性愈合，認(rèn)為肌腱可依靠肌腱內(nèi)細(xì)胞自身再生增殖和合成膠原直接完成愈合修復(fù)。這兩種愈肌腱合方式何者、何時(shí)、何種情況下在肌腱移植修復(fù)中起主要作用尚不清楚。與此同時(shí)失去內(nèi)源性愈合的去細(xì)胞肌腱移植物能否達(dá)到生物力學(xué)要求尚有爭議。因此我們設(shè)計(jì)了本實(shí)驗(yàn)，通過對(duì)比觀察去細(xì)胞大鼠跟腱移植和未經(jīng)處理的大鼠跟腱移植的組織學(xué)和生物力學(xué)特性，研究去除肌腱內(nèi)細(xì)胞對(duì)移植肌腱愈合的影響，探討肌腱愈合的機(jī)制，為組織工程學(xué)肌腱研究做準(zhǔn)備。 方法： 實(shí)驗(yàn)選用96只健康成年雄性Wistar大白鼠為實(shí)驗(yàn)動(dòng)物,將大鼠隨機(jī)分成為實(shí)驗(yàn)組和對(duì)照組，制備跟腱缺損動(dòng)物模型。實(shí)驗(yàn)組大鼠行深低溫凍融冷凍去細(xì)胞跟腱自體移植，而對(duì)照組行自體跟腱移植。在術(shù)后1、2、4、8周處死大鼠取移植跟腱，在光學(xué)顯微鏡下進(jìn)行HE染色形態(tài)學(xué)觀察，I型和III型膠原免疫組化染色觀察及圖像分析，并測量移植跟腱最大載荷和彈性模量生物力學(xué)參數(shù)，進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果： 實(shí)驗(yàn)結(jié)果顯示:隨著跟腱移植后時(shí)間延長，移植跟腱內(nèi)I型和III型膠原表達(dá)逐漸增加，其中1周、2周時(shí)對(duì)照組表達(dá)水平高于實(shí)驗(yàn)組（P 0.05),而4周和8周時(shí)兩組表達(dá)無顯著差異（P0.05)；移植跟腱生物力學(xué)檢測結(jié)果顯示1、2周時(shí)對(duì)照組跟腱最大載荷和彈性模量均高于實(shí)驗(yàn)組（P 0.05），而4、8周時(shí)兩組差異無顯著性（P0.05)。 結(jié)論： 本實(shí)驗(yàn)借助深低溫去細(xì)胞跟腱移植與新鮮跟腱移植做組織學(xué)和生物力學(xué)特性比較，發(fā)現(xiàn)去細(xì)胞的肌腱移植物較之未經(jīng)處理的移植物愈合滯后，同時(shí)發(fā)現(xiàn)了此種去細(xì)胞肌腱移植體在晚期可滿足生物力學(xué)強(qiáng)度的需要。通過對(duì)本實(shí)驗(yàn)結(jié)果分析證明：深低溫處理去細(xì)胞肌腱移植和自體移植遠(yuǎn)期生物學(xué)效果近似，去細(xì)胞肌腱可用于肌腱缺損的移植治療；同時(shí)也證明了去細(xì)胞肌腱移植物用于異體肌腱移植的可行性。為進(jìn)一步組織工程學(xué)肌腱研究做了基礎(chǔ)理論準(zhǔn)備。
[Abstract]:Background and purpose:
In clinical work, tendon defects are often encountered in the repair of tendon graft. The current "gold standard" is autologous tendon transplantation, but the source of autologous tendon is very limited and the autograft of autologous tendon can cause loss of donor function; allograft tendon transplantation and xenograft tendon transplantation have immune rejection. The reaction, which leads to severe complications such as graft necrosis and local inflammatory response, needs to be solved by the foundation of the mechanism of tendon healing and the progress of the research of tissue engineering tendon. Currently, there are two ways of tendon healing. One thinks that tendon healing depends on the growth of tendon tissue to form adhesion. It is concluded that the transplantation of tendon only plays the role of scaffolding and pathway in tendon transplantation. The other is endogenous healing. It is believed that the tendon can rely on the regeneration and proliferation of the cells in the tendon and synthesize the collagen to complete the healing and repair directly. At the same time, it is still controversial whether the loss of endogenous acellular tendon grafts without endogenous healing can meet the biomechanical requirements. Therefore, we designed this experiment to compare the histological and biomechanical properties of Achilles tendon transplantation and untreated rat Achilles tendon transplantation, and to study the removal of intracellular cells in the tendon. To investigate the mechanism of tendon healing, we will prepare for tendon tissue engineering.
Method:
In the experiment, 96 healthy adult male Wistar rats were selected as experimental animals. Rats were randomly divided into experimental and control groups. The rat model of Achilles tendon defect was prepared. Rats in the experimental group underwent cryopreservation and cryopreservation and autologous transplantation of Achilles tendon in the control group. The Achilles tendon transplantation was performed in the control group. The Achilles tendon was harvested at 1,2,4,8 weeks after the operation. The morphological observation of HE staining, immunohistochemical staining of type I and type III collagen and image analysis were carried out under the microscope, and the biomechanical parameters of the maximum load and modulus of elasticity of the allograft tendon were measured, and the statistical analysis was made.
Result:
The results showed that the expression of type I and type III collagen in the transplanted Achilles tendon increased gradually with the time of Achilles tendon transplantation. The expression level of the control group was higher than that of the experimental group at 1 weeks and at the 2 week (P 0.05), but there was no significant difference between the two groups at the 4 and 8 weeks (P0.05). The biomechanical results of the transplanted Achilles tendon showed the maximum load of the Achilles tendon in the control group at 1,2 weeks. The loading and elastic moduli were higher than those in the experimental group (P 0.05), but there was no significant difference between the two groups at 4,8 weeks (P0.05).
Conclusion:
In this experiment, the histological and biomechanical characteristics of the deep hypothermic Achilles tendon transplantation and the fresh Achilles tendon transplantation were compared. It was found that the tendon grafts in the cell were lagged behind the untreated grafts. At the same time, the need to meet the biomechanical strength of this kind of cell tendon graft at the late stage was found. The analysis shows that the long-term biological effect of deep hypothermia treatment and autologous transplantation is similar. The decellularized tendon can be used for the transplantation of tendon defect, and the feasibility of the allograft of allograft for the acellular tendon graft is also proved. The basic theoretical preparation for further tissue engineering tendon research is made.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.2

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