中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (30): 4879-4884.doi: 10.3969/j.issn.2095-4344.2017.30.021

• 材料生物相容性 material biocompatibility • 上一篇    下一篇

自体与异体材料后交叉韧带重建与基质金属蛋白酶2水平的关联

唐  炬,娄方勇,朱  伟,姜海涛,张震祥
  

  1. 泰州市人民医院骨关节外科,江苏省泰州市   225300
  • 收稿日期:2017-07-21 出版日期:2017-10-28 发布日期:2017-10-28
  • 通讯作者: 张震祥,博士,副主任医师,泰州市人民医院骨关节外科,江苏省泰州市 225300
  • 作者简介:唐炬,男,1978年生,江苏省泰州市人,汉族,2001年徐州医科大学毕业,副主任医师,主要从事人工髋膝关节置换,运动医学研究。

Arthroscopic posterior cruciate ligament reconstruction using autologous and allogeneic materials and the association with matrix metalloproteinases 2

Tang Ju, Lou Fang-yong, Zhu Wei, Jiang Hai-tao, Zhang Zhen-xiang
  

  1. Department of Bone and Joint Surgery, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
  • Received:2017-07-21 Online:2017-10-28 Published:2017-10-28
  • Contact: Zhang Zhen-xiang, M.D., Associate chief physician, Department of Bone and Joint Surgery, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
  • About author:Tang Ju, Associate chief physician, Department of Bone and Joint Surgery, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China

摘要:

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文题释义:
后交叉韧带重建:由于后交叉韧带损伤后自我修复困难,故临床主要通过自体或异体移植重建韧带,主要方法包括:经胫骨隧道技术重建是后交叉韧带重建术的传统方式;此外还包括胫骨嵌入技术,这种方法手术体位摆放有一定难度,手术中需要特别注意后侧切口有可能造成副损伤;双侧重建术重建前外侧束和后内侧束,近期疗效满意,远期疗效有待观察等等。
基质金属蛋白酶:基质金属蛋白酶是一个大家族,因其需要Ca2+、Zn2+等金属离子作为辅助因子,家族成员结构近似,主要由功能不同的若干结构域组成;各成员间具有一定的底物特异性,同一种基质金属蛋白酶可降解多种细胞外基质成分,某一种细胞外的基质成分往往可以被多种不同的基质金属蛋白酶所降解,不同酶的降解效率会略见不同。
 
背景:损伤的后交叉韧带自我恢复能力差,韧带损伤后的修复过程常会伴随损伤的细胞外基质的降解和新基质的合成进程,而基质金属蛋白酶家族在这个降解与合成的动态平衡中起着重要的作用。
目的:观察分析关节镜下后交叉韧带重建效果与基质金属蛋白酶2水平的关联。
方法:收集60例后交叉韧带撕裂手术患者的临床资料,其中37例为自体重建;13例为异体重建;收集同期外伤截肢等无韧带损伤者的韧带和滑膜细胞备用。观察手术前后Lysholm和Tegner评分;分析术后抽屉实验结果;比较自体重建和异体重建后交叉韧带的胫骨移位;明胶酶谱法测定后交叉韧带细胞单培养及与滑膜细胞共培养基质金属蛋白酶2蛋白表达水平;以及手术时间、切口长度、术后发热时间及性别差异等因素。
结果与结论:①末次随访胫骨移位男性和女性中分别显示异体重建组的移位高于自体重建组,后抽屉试验分布在自体重建与异体重建之间和不同性别之间均未见显著差异;②韧带重建后患者Lysholm和Tegner评分显著优于术前(P < 0.01);③随着时间推移,无论后交叉韧带细胞单培养还是与滑膜细胞共培养,韧带损伤后基质金属蛋白酶2表达均呈增高趋势;各个时点的基质金属蛋白酶2共培养组表达增高;④男性和女性后交叉韧带重建手术均显示自体重建手术时间较长(P < 0.05或0.01),自体重建切口显著长于异体重建(P < 0.01);异体重建后全身发热时间更长(P < 0.01);⑤末次随访结果显示,自体重建后交叉韧带稳定性好于异体重建,重建后全身发热时间较短,但有手术时间和切口较长,韧带损伤后基质金属蛋白酶2表达呈增高趋势的特点。

关键词: 生物材料, 材料相容性, 后交叉韧带撕裂, 关节镜下后交叉韧带重建术, 基质金属蛋白酶2, 疗效

Abstract:

BACKGROUND: Self-healing ability of the posterior cruciate ligament is poor, and the degradation and synthesis of extracellular matrix often follow the ligament repair. The matrix metalloproteinase family plays a critical role in the dynamic equilibrium between the matrix degradation and synthesis.
OBJECTIVE: To investigate the effect of arthroscopic reconstruction of the posterior cruciate ligament, and to study its correlation with matrix metalloproteinase 2 level.
METHODS: Sixty patients with posterior cruciate ligament rupture were studied, including 37 cases of autologous reconstruction and 13 cases of allogeneic reconstruction. Ligament and synovial cells from traumatic amputation patients with no ligament injury in the corresponding period were collected. Lysholm and Tegner scores were detected before and after operation. The results of postoperative drawer test were analyzed. The tibial displacement of the posterior cruciate ligament after autologous reconstruction and allogeneic reconstruction was compared. The posterior cruciate ligament cells were cultured alone or co-cultured with synovial cells, and then the level of matrix metalloproteinase 2 protein was detected. In addition, operation time, incision length, postoperative fever time and gender differences were also detected and compared.
RESULTS AND CONCLUSION: Tibial displacement, irrespective of genders, was higher in the allogeneic reconstruction group than the autologous reconstruction group, while there were no significant differences in the posterior drawer test between the two reconstruction groups as well as between males and females. Postoperative Lysholm and Tegner scores were both improved significantly (P < 0.01). As time went by, the level of matrix metalloproteinase 2 had an increasing trend in the posterior cruciate ligament cells cultured alone or co-cultured with synovial cells, but the level in the co-culture group was higher than that in the single culture group. For both male and female, the autologous reconstruction group showed a longer operative time (P < 0.05 or 0.01) and a longer incision length (P < 0.01), as compared with the allogeneic reconstruction group, while the time of fever was significantly longer in the allogeneic reconstruction group (P < 0.01). Results from the last follow-up show that the autologous reconstruction is better than the allogeneic reconstruction to restore the stability of posterior cruciate ligament and shorten fever time, but longer operative time and surgical incision as well as increased level of matrix metalloproteinase 2 cannot be ignored. 

Key words: Posterior Cruciate Ligament, Arthroscopes, Matrix Metalloproteinase 2, Tissue Engineering

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