摘要
背景:射频紧缩已广泛用于临床,前交叉韧带松弛为射频紧缩治疗的适应证,但紧缩治疗后前交叉韧带的组织学变化尚不清楚。目的:观察前交叉韧带不同部位进行射频紧缩后的组织学变化,以确定前交叉韧带射频紧缩的最佳部位。设计、时间及地点:随机分组动物实验,组织形态学观察,于2005-01/2006-07在中山大学附属第二医院医学研究中心完成。材料:成年健康家犬29只,体质量(16.5±2.2)kg,年龄(4.1±0.7)年,X射线片确定动物骨骺已经闭合。方法:随机选取1只家犬解剖股动脉和股静脉,将股动脉近端结扎,远端插管,以Krebs平衡液以50mL/(min·kg)流量灌流15min,结扎股静脉近端,远端插管。将墨汁灌注液由远端注入,直至下肢皮肤变成黑色,观察家犬前交叉韧带的血液供应。24只犬采用抽签法随机分为射频紧缩中间部组、射频紧缩两端组。紧缩方式:射频探头从一个端开始以2.5mm/s速度开始向另一端移动,无遗漏,不重叠,射频紧缩中间部组紧缩韧带中间1/3,射频紧缩两端组紧缩两端各1/3,术后6,12周进行组织形态学观察。另外4只家犬取前交叉韧带8条,2条用于即时射频紧缩后的组织学观察,另外6条作为空白对照组不进行紧缩。主要观察指标:MASSON染色、苏木精-伊红染色观察前交叉韧带内部纤维的变化特点、细胞计数及血管密度。结果:分布在前交叉韧带的血管形成树状分支,前交叉韧带胫骨端和股骨端的血管分布明显丰富于前交叉韧带中端的血管分布,两端的血管网有一部分交通支经过中部相连。MASSON染色显示射频处理部位重新修复组织均为胶原纤维组织,以射频紧缩韧带两端组更明显。术后12周,两组细胞密度均较6周时降低(P<0.05),射频紧缩两端组细胞密度始终高于射频紧缩中间部组(P<0.05);两组滑膜下血管密度均较6周时降低(P<0.05)。术后6周射频紧缩两端组滑膜下血管密度高于射频紧缩中间部组(P<0.05)。结论:射频处理后前交叉韧带的再血管化模式是由滑膜向韧带射频渗透区域进行的,韧带两端组织的修复优于韧带的中间部分,提示射频紧缩的最佳部位为韧带两端。
BACKGROUND： The radiofrequency （RF） reefing has been widely used in clinic, and anterior cruciate ligament （ACL） laxity is one of its indications. However, the histologic changes of ACL following reefing treatment remain unknown. OBJECTIVE： To observe the histologic changes of ACL following reefing treatment, so as to investigate the optimal location to exercise RF reefing on. DESIGN, TIME AND SETTING： A randomized group animal experiment and histomorphological observation was carried out in the Medical Research Center, the Second Affiliated Hospital of Sun Yat-sen University between January 2005 and July 2006. MATERIALS： Twenty-nine healthy adult dogs, weighting 16.5±2.2 kg, aged 4.1±0.7 years; Closed animal osteoepiphysis determined by X-ray. METHODS： One of the dogs was picked out randomly to dissect the femoral artery and femoral vein. Then hypodesis was exercised to the proximal end and canoula was performed to the distal end of the femoral artery to perfuse 50 mL/（min？kg） Krebs balanced solution into it for 15 min; As for the femoral vein, hypodesis was performed to the proximal end and canoula to the distal end to perfuse ink into it until the skin of lower extremity turned to black. Then the blood supply of the ACL of the dog was observed. Another 24 dogs were divided randomly by sortition into two groups, one receiving RF reefing on midportion （midportion group） and the other on amph-portions （amph-portions group）. The RF reefing was carried out to the 1/3 midportion （midportion group） or 1/3 each of the amph-portions （amph-portions group） in the way of moving RF probe from one end to another at a speed of 2.5 mm/s, avoiding any missing or overlapping. Histomorphological observation was taken at week 6 and 12 following reefing respectively. The last 4 dogs were used to obtain 8 ACLs, out of which 2 ones received immediate RF reefing and the following histomorphological observation and the other 6 ones who received no reefing were taken as the controls. MAIN OUTCOME MEASURES： The fiber changing features, cell counting and blood vessel density in the ACLs were observed through MASSON staining and haematoxylin-eosin staining. RESULTS： The blood vessel of ACL appeared like branches, and it was obviously richer in the amph-portions than in the midportion. The vascular net in the amph-portions connected with each other by the communicating branches penetrating the midportion. The MASSON staining showed that the repairing tissues of the RF-treated parts were all collagen fibrils, especially in the amph-portions. Compared with week 6 following reefing, the cell density in both groups decreased at week 12 （P 〈 0.05）, with a higher one in the midportion group than in the amph-portions group （P 〈 0.05）; the subsynovial vascularity in both groups all decreased （P 〈 0.05） at week 12. In week 6 following reefing, the subsynovial vascularity in the amph-portions group were higher than in the midportion group （P 〈 0.05）. CONCLUSION： The revascularization of ACL following RF treatment originates from the synovial membrane to the RF-penetrated parts. The repair of the amph-portions is better than that of the midportion, which indicates that the optimal parts for exercising RF reefing on is the amph-portions of ligament.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第37期7262-7266,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
广东省中医药局科研项目课题(1050180)~~
