兔同種異體半月板移植后膝脛股關節面生物力學重建的研究_《中國修復重建外科雜志》

作者：

薛超 , 羅殿中 , 衷鴻賓 , 張軼超 , 章亞東 , 侯樹勛

解放軍總醫院第一附屬醫院骨科（北京，100048）;

關鍵詞：

同種異體半月板移植受力面積壓強生物力學重建兔

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　　目的?探討兔同種異體半月板移植后膝關節內側間隙受力面積、壓強的變化及其生物力學重建情況。?方法?6～7月齡清潔級日本大耳白兔28只，雌雄不限，體重3.0～3.5 kg；隨機取7只兔右膝關節內側半月板，制備同種異體半月板。余21只兔隨機分為3組，每組7只。A組為空白對照組，單純打開膝關節后縫合；B組為右膝內側半月板切除組；C組為右膝內側半月板切除后行同種異體半月板移植組。術后觀察各組實驗動物一般情況，于12周處死實驗動物取右膝關節行生物力學測試，并取A、C組半月板行組織學及免疫組織化學染色觀察。?結果?術后實驗動物均存活至實驗完成。術后12周大體觀察見C組移植半月板愈合較好，前后角及體部附著良好。術后12周膝關節屈膝0、30、60、90°時，B組膝關節內側間隙受力面積及壓強與A、C組比較，差異均有統計學意義（P lt; 0.05），A、C組間比較差異均無統計學意義（P gt; 0.05）；屈膝120°時，任意兩組間受力面積及壓強比較，差異均有統計學意義（P lt; 0.05）。組織學觀察顯示C組軟骨細胞及膠原纖維數量恢復正常；免疫組織化學染色示C組移植半月板內膠原纖維含有大量Ⅰ型膠原和Ⅱ型膠原。術后12周A、C組Ⅰ型膠原含量分別為0.612 5 ± 0.059 8和0.587 2 ± 0.063 9，差異無統計學意義（t=0.765，P=0.465）；Ⅱ型膠原含量分別為0.772 4 ± 0.081 5和0.814 3 ± 0.051 7，差異無統計學意義（t= —0.136，P=0.894）。?結論?兔同種異體半月板移植可增加膝關節受力面積，減小壓強，有利于保護關節軟骨，并可重建生物力學平衡。

引用本文： 薛超,羅殿中,衷鴻賓,張軼超,章亞東,侯樹勛. 兔同種異體半月板移植后膝脛股關節面生物力學重建的研究. 中國修復重建外科雜志, 2011, 25(4): 397-401. doi: 復制

1.	Stone KR, Adelson WS, Pelsis JR, et al. Long-term survival of concurrent meniscus allograft transplantation and repair of the articular cartilage: a prospective two- to 12-year follow upreport. J Bone Joint Surg (Br), 2010, 92(7): 941-948.
2.	Harris JD, Cavo M, Brophy R, et al. Biological knee reconstruction: a systematic review of combined meniscal allograft transplantation and cartilage repair or restoration. Arthroscopy, 2010. [Epub ahead of print].
3.	朱加亮, 衷鴻賓, 侯樹勛, 等. 異體半月板庫的建立及臨床初步應用. 中國矯形外科雜志, 2007, 15(19): 1445-1447.
4.	Lewis PB, Williams JM. Multiple freeze-thaw cycled meniscal allograft tissue: A biomechanical, biochemical, and histologic analysis. J Orthop Res, 2008, 26(1): 49-55.
5.	Gelber PE, Gonzalez G, Torres R, et al. Cryopreservation does not alter the ultrastructure of the meniscus. Knee Surg Sports Traumatol Arthrosc, 2009, 17(6): 639-644.
6.	康曉琦, 章亞東, 衷鴻賓, 等. 異體半月板移植的實驗研究和臨床應用. 實用骨科雜志, 2008, 14(1): 37-39.
7.	Flanigan DC, Lin F, Koh J, et al. Articular contact pressures of meniscal repair techniques at various knee flexion angles. Orthopedics, 2010, 33(7): 475.
8.	Paletta GA Jr, Manning T, Snell E, et al. The effect of allograft meniscal replacement on intraarticular contact area and pressures in the human knee. A biomechanical study. Am J Sports Med, 1997, 25(5): 692-698.
9.	Lee DH, Kim SB, Kim TH, et al. Midterm outcomes after meniscal allograft transplantation: comparison of cases with extrusion versus without extrusion. Am J Sports Med, 2010, 38(2): 247-254.
10.	van der Wal RJ, Thomassen BJ, van Arkel ER. Long-term clinical outcome of open meniscal allograft transplantation. Am J Sports Med, 2009, 37(11): 2134-2139.
11.	Gomoll AH, Kang RW, Chen AL, et al. Triad of cartilage restoration for unicompartmental arthritis treatment in young patients: meniscus allograft transplantation, cartilage repair and osteotomy. J Knee Surg, 2009, 22(2): 137-141.
12.	Vundelinckx B, Bellemans J, Vanlauwe J. Arthroscopically assisted meniscal allograft transplantation in the knee: a medium-term subjective, clinical, and radiographical outcome evaluation. Am J Sports Med, 2010, 38(11): 2240-2247.
13.	LaPrade RF, Wills NJ, Spiridonov SI, et al. A prospective outcomes study of meniscal allograft transplantation. Am J Sports Med, 2010, 38(9): 1804-1812.
14.	Bulgheroni P, Murena L, Ratti C, et al. Follow-up of collagen meniscus implant patients: clinical, radiological, and magnetic resonance imaging results at 5 years. Knee, 2010, 17(3): 224-229.
15.	章亞東, 侯樹勛, 張軼超, 等. 同種異體半月板移植術臨床效果的初步分析. 中華關節外科雜志(電子版), 2008, 2(6): 19-22.
16.	Bedi A, Kelly NH, Baad M, et al. Dynamic contact mechanics of the medial meniscus as a function of radial tear, repair, and partial meniscectomy. J Bone Joint Surg (Am), 2010, 92(6): 1398-1408.
17.	von Lewinski G, Stukenborg-Colsman C, Ostermeier S, et al. Experimental measurement of tibiofemoral contact area in a meniscectomized ovine model using a resistive pressure measuring sensor. Ann Biomed Eng, 2006, 34(10): 1607-1614.
18.	Flanigan DC, Lin F, Koh JL, et al. Articular contact pressures of meniscal repair techniques at various knee flexion angles. Orthopedics, 2010, 33(7): 475.
19.	Rijk PC, Tigchelaar-Gutter W, Bernoski FP, et al. Functional changes in articular cartilage after meniscal allograft transplantation: a quantitative histochemical evaluation in rabbits. Arthroscopy, 2006, 22(2): 152-158.

1. Stone KR, Adelson WS, Pelsis JR, et al. Long-term survival of concurrent meniscus allograft transplantation and repair of the articular cartilage: a prospective two- to 12-year follow upreport. J Bone Joint Surg (Br), 2010, 92(7): 941-948.
2. Harris JD, Cavo M, Brophy R, et al. Biological knee reconstruction: a systematic review of combined meniscal allograft transplantation and cartilage repair or restoration. Arthroscopy, 2010. [Epub ahead of print].
3. 朱加亮, 衷鴻賓, 侯樹勛, 等. 異體半月板庫的建立及臨床初步應用. 中國矯形外科雜志, 2007, 15(19): 1445-1447.
4. Lewis PB, Williams JM. Multiple freeze-thaw cycled meniscal allograft tissue: A biomechanical, biochemical, and histologic analysis. J Orthop Res, 2008, 26(1): 49-55.
5. Gelber PE, Gonzalez G, Torres R, et al. Cryopreservation does not alter the ultrastructure of the meniscus. Knee Surg Sports Traumatol Arthrosc, 2009, 17(6): 639-644.
6. 康曉琦, 章亞東, 衷鴻賓, 等. 異體半月板移植的實驗研究和臨床應用. 實用骨科雜志, 2008, 14(1): 37-39.
7. Flanigan DC, Lin F, Koh J, et al. Articular contact pressures of meniscal repair techniques at various knee flexion angles. Orthopedics, 2010, 33(7): 475.
8. Paletta GA Jr, Manning T, Snell E, et al. The effect of allograft meniscal replacement on intraarticular contact area and pressures in the human knee. A biomechanical study. Am J Sports Med, 1997, 25(5): 692-698.
9. Lee DH, Kim SB, Kim TH, et al. Midterm outcomes after meniscal allograft transplantation: comparison of cases with extrusion versus without extrusion. Am J Sports Med, 2010, 38(2): 247-254.
10. van der Wal RJ, Thomassen BJ, van Arkel ER. Long-term clinical outcome of open meniscal allograft transplantation. Am J Sports Med, 2009, 37(11): 2134-2139.
11. Gomoll AH, Kang RW, Chen AL, et al. Triad of cartilage restoration for unicompartmental arthritis treatment in young patients: meniscus allograft transplantation, cartilage repair and osteotomy. J Knee Surg, 2009, 22(2): 137-141.
12. Vundelinckx B, Bellemans J, Vanlauwe J. Arthroscopically assisted meniscal allograft transplantation in the knee: a medium-term subjective, clinical, and radiographical outcome evaluation. Am J Sports Med, 2010, 38(11): 2240-2247.
13. LaPrade RF, Wills NJ, Spiridonov SI, et al. A prospective outcomes study of meniscal allograft transplantation. Am J Sports Med, 2010, 38(9): 1804-1812.
14. Bulgheroni P, Murena L, Ratti C, et al. Follow-up of collagen meniscus implant patients: clinical, radiological, and magnetic resonance imaging results at 5 years. Knee, 2010, 17(3): 224-229.
15. 章亞東, 侯樹勛, 張軼超, 等. 同種異體半月板移植術臨床效果的初步分析. 中華關節外科雜志(電子版), 2008, 2(6): 19-22.
16. Bedi A, Kelly NH, Baad M, et al. Dynamic contact mechanics of the medial meniscus as a function of radial tear, repair, and partial meniscectomy. J Bone Joint Surg (Am), 2010, 92(6): 1398-1408.
17. von Lewinski G, Stukenborg-Colsman C, Ostermeier S, et al. Experimental measurement of tibiofemoral contact area in a meniscectomized ovine model using a resistive pressure measuring sensor. Ann Biomed Eng, 2006, 34(10): 1607-1614.
18. Flanigan DC, Lin F, Koh JL, et al. Articular contact pressures of meniscal repair techniques at various knee flexion angles. Orthopedics, 2010, 33(7): 475.
19. Rijk PC, Tigchelaar-Gutter W, Bernoski FP, et al. Functional changes in articular cartilage after meniscal allograft transplantation: a quantitative histochemical evaluation in rabbits. Arthroscopy, 2006, 22(2): 152-158.

《中國修復重建外科雜志》

兔同種異體半月板移植后膝脛股關節面生物力學重建的研究

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《中國修復重建外科雜志》

兔同種異體半月板移植后膝脛股關節面生物力學重建的研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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