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髌骨骨腱结合部损伤延迟愈合模型建立及冲击波治疗效果的研究
Establishment of Bone-Tendon Junction Delayed Healing Animal Model and Treatment Efficiency of Extracorporeal Shock Wave Therapy on the Model
【作者】 王琳；
【作者基本信息】 北京体育大学 ， 运动人体科学， 2007， 博士
【摘要】 运动员常发生骨腱结合部损伤,并治疗相当困难。寻找有效的非手术性治疗方法一直是临床需要解决的主要问题之一。本研究在新西兰大白兔髌骨髌腱结合部创建动物延迟性愈合模型,并进行体外冲击波治疗效果的研究,探讨冲击波疗法对这类损伤的作用机理。研究对象及方法:研究对象为47只成年雌性新西兰白兔,分为对照组(CON)、延迟愈合组(DH)和冲击波治疗组(ESWT);分别于术后8周和12周取材,进行放射线学、组织学和生物力学研究。通过手术在骨腱结合部植入一橡胶片,造模后进行石膏固定。4周后取出胶片及解除石膏固定;ESWT组在第6周进行一次体外冲击波治疗。第8和12周取材进行相应的放射学、组织学和力学分析。评价指标有新骨面积,BMD,BMC,新骨生长速度,骨小梁数量、厚度、间隙,新骨体积、骨质相对体积,肌腱细胞密度、纤维软骨带厚度、蛋白粘多糖分布、胶原纤维排列、组织学结构,拉断载荷,极限拉应力等指标。结果与分析:放射学测量结果显示,DH组在骨腱结合部的骨生长速度明显减慢。DH组的BMD和BMC在第8周时比对照组低56.0%,但是这一差距在第12周时减小。DH组骨腱结合部的愈合质量明显差于对照组,拉断载荷在第8和12周时比对照组低了22.9%和24.2%。修复和重建过程在DH组不论是第8还是第12周均明显慢于CON,特别表现在纤维软骨带的厚度在第8和12周时仅为CON的39.7%和57.8%。拉断载荷结果在第8和12周时仅为CON的76.77%和75.26%。放射学测量结果提示,ESWT组的新骨面积在第8和12周时为DH组的293.37%和185.77%。DH组和ESWT组之间BMD和BMC的显著性差异在第12周时才显现出来。组织学观察结果显示,ESWT组表现出更好的胶原纤维排列、更厚和成熟的纤维软骨带厚度说明其重建得更好。力学测试显示,ESWT组的拉断载荷在第8和12周时为DH组的167.66%和145.14%。结论:1.第一次通过在部分髌骨切除术后的肌腱与骨之间植入无菌橡胶片4周的方法建立了具有可重复性的骨腱结合部延迟性损伤愈合动物模型2.一次体外冲击波治疗可以加速骨腱结合部延迟性愈合损伤的新骨形成、纤维软骨带重建和力学特性的改善,证实了该疗法的有效性和作用机理。
【Abstract】 Bone-tendon(B-T) junction injury is common and its repair is difficult because of poor regeneration capacity of its interface fibrocartilage. Extracorporeal shock wave treatment(ESWT) was proven to be able to treat the chronic injuries of soft tissues and delayed fracture healing or non-union fracture.No study was conducted to show if ESWT could be indicated for treatment of delayed healing(DH) at bone-tendon junction. This experiment was designed to establish a B-T interface delayed healing animal model and to study the treatment efficiency of ESWT on this model. The research would provide a DH model on B-T junction for the further study in this area and revealed the effect mechanism of ESWT.Hope the result of this research will be utilized in the clinic to improve the treatment for patients.Methods:A standard partial patellectomy was used for establishing the delayed B-T repair by shielding the B-T surgical repair for 4 weeks once ESWT at week 6 on the healing interface of patella in 47 female mature rabbits. Evaluations were performed at week 8 and 12 after surgery radiographically,densotometrically,biomechanically,and histologically.Results:Establishment of B-T junction delayed healing animal model:Radiological measurements showed significant delayed osteogenesis at B-T healing junction in the delayed healing groups.Bone mineral density(BMD) of new bone was 56.0%lower in the delayed healing group at week 8,but this difference diminished at week 12.The healing quality of B-T healing was significantly poor in the delayed healing group,as shown with 22.9%and 24.2%lower failure load than that of control group at week 8 and week12, respectively.The repair quality was explained by histological findings that the healing process of B-T junction was found slower in both early repair and later remodeling stage,typically with a limited regeneration of the B-T junctional fibrocartilage zone in the delayed healing group, with a thickness of the regenerated fibrocartilage zone only 39.7%and 57.8%of the control group at week 8 and week 12,respectively.The failure load of DH group was only 39.7%and 57.8%of CON group.Treatment efficiency of ESWT on the B-T junction delayed healing model: Radiographic measurements showed 293.37%and 185.77%more newly formed bone at the patella-patellar tendon(PPT) healing junction in the ESWT group compared with the DH group at week 8 and week 12 after partial patellectomy.Significant differences in bone mineral density and content(BMD and BMC) were only found at week 12 between the ESWT and DH groups.Histologically,the ESWT group showed advanced remodeling in terms of better alignment of collagen fibers,thicker and mature regenerated fibrocartilage zone at both weeks 8 and 12 as compared with DH group,correspondingly.Tensile testing showed 167.66%and 145.14% higher tensile load and strength in the ESWT group than DH group, respectively at week 8 and week 12.Conclusions:This study demonstrated for the first time a delayed B-T healing experimental model characterized with delay in osteogensis,regeneration of fibrocartilage zone and tensile load.ESWT was able to treat delayed healing at bone-to-tendon junction by promoting osteogenesis,regeneration of fibrocartilage zone and tissue remodeling at PPT healing complex in rabbits.