【作者】 宋光虎；

【导师】 练克俭；

【作者基本信息】 福建中医学院 ， 中医骨伤科学， 2007， 硕士

【摘要】 背景和目的：腘绳肌腱移植重建前交叉韧带(anterior cruciate ligament，ACL)术后，肌腱两端要逐渐与骨隧道愈合，这一过程不同于用骨-髌腱-骨重建ACL那样存在着较快的骨-骨愈合，如果腱-骨愈合不良就会对手术效果产生影响。目前的研究还发现，腘绳肌腱移植重建ACL术后骨隧道总是出现不同程度的扩大，隧道扩大造成的直接问题在于扩大部位的骨缺损会对韧带重建术的翻修造成困难。因此，我们需要研究促进腱-骨愈合及减轻或避免骨隧道扩大的方法。本实验通过建立ACL重建模型，术中将骨形态发生蛋白(bone morphogenetic protein，BMP)植入骨隧道中，一组通过载体——脱蛋白松质骨(deproteined bone，DPB)植入，另一组不用载体，观察BMP对ACL重建术后腱-骨愈合及骨隧道扩大的影响，为临床应用提供实验依据。方法：将128只新西兰大白兔随机分为四组，即骨形态发生蛋白+脱蛋白松质骨组(BMP+DPB)、骨形态发生蛋白组(BMP)、脱蛋白松质骨组(DPB)、空白对照组，建立兔自体半腱肌腱移植重建ACL模型，分别在前三组动物股骨隧道内植入BMP+DPB、BMP、DPB。术后2、4、6、8周时取材，做标本大体观察、组织学检查，并测量手术后骨隧道的宽度，所得实验数据进行统计学分析，观察对比腱-骨愈合情况以及骨隧道扩大情况。结果：ACL重建后的各个时间点上，BMP+DPB组的骨隧道扩大程度小于BMP组、DPB组及空白对照组，其差别具有统计学意义；BMP组的骨隧道扩大程度小于DPB组及空白对照组，其差别具有统计学意义；DPB组的骨隧道扩大程度与空白对照组相比无显著性差异。组织学观察发现，BMP+DPB组的腱-骨愈合质量优于BMP组、DPB组及空白对照组；BMP组的腱-骨愈合质量优于DPB组、空白对照组；DPB组与空白对照组的腱-骨愈合质量无明显差别。结论：1、在重建ACL模型中，BMP对腱-骨愈合有促进作用，并且降低了骨隧道扩大的程度，在载体的协助下，这种效果得到增强。2、单纯用DPB无法达到促进腱-骨愈合的作用，也不能减轻骨隧道扩大的程度。3、BMP促进腱-骨愈合的可能机制是通过软骨化骨形成新生骨长入肌腱组织。4、腱-骨的早期愈合有助于减轻骨隧道扩大程度。更多还原

【Abstract】 Background and Objective After the operation of ACL reconstruction withhamstring tendon, the tendon should integrated with bone tunnel. This processis different from the bone-bone integration process when reconstructed withBone-Patella Tendon-Bone. The operation effect will be contaminated if thereis a bad tendon bone healing. Besides, clinical authors found that the bone tunnelalways enlarged after operation when researched the imageology documents ofoperated patients. Bone defection resulted from bone tunnel enlargement wasadverse to ACL reconstruction rebuilding operation. So, it is necessary toexplore the way to diminish bone tunnel enlargement. We established the modelof ACL reconstruction with autologous hamstring tendon, and put BMP into thebone tunnel. Then, we observed its influnce to tendon bone healing and tunnelenlargement. We offerd basis for clinical apply in ACL reconstruction.Methods One hundred and twenty-eight New Zealand and white rabbits wererandomly divided into four groups, including BMP&DPB group, BMP group, DPB groupand control group. There were eight rabbits in each group. We established themodel of ACL reconstruction with autologous hamstring tendon, and put BMP&DPB、BMP and DPB into the bone tunnel respectively. Specimens were taken at 2, 4,6, 8 weeks after operation for macroscopical observation and histologicalexamination. We also measured the diameter of bone tunnel post operation tocalculate the rate of bone tunnel enlargement. At last, we analysed the data by statistics.Results At individual time points of this experiment, the rate of bonetunnel enlargement in BMP&DPB group was lower than that of BMP group、DPB groupand control group. The rate of bone tunnel enlargement in BMP group was lowerthan that of DPB group and control group. But there was no significant diferencein DPB group and control group. In histological examination, the quality of tendonbone healing in BMP&DPB group was better than that of other groups. The qualityof tendon bone healing in BMP group was better than that of DPB group and controlgroup. But there was no significant diference in DPB group and control group.Conclusions 1. In the model of ACL reconstruction, BMP had effect inaccelerating tendon bone healing, andit also diminished bone tunnel enlargementafter operation. When BMP was assisted with some carrier, the effect of BMP wasenhanced. 2. The single use of DPB wash’ t able to accelerate tendon bone healing,and it won’t diminish bone tunnel enlargement after operation. 3. BMP mayaccelerate tendon bone healing through endochondral ossification. 4、Tendon bonehealing in the early period was benefit to diminish bone tunnel enlargement.更多还原