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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 363 -367. doi: 10.3877/cma.j.issn.1674-134X.2018.03.011

所属专题： 文献；

基础论著

骨形态发生蛋白诱导移植物成骨化促进腱－骨愈合
吴波1, 罗永忠1, 梁晓松1, 李乃义1, 周慧1, 孙磊1,†()   
  1. 1. 271000　泰安，解放军第八十八医院全军骨科中心
  • 收稿日期:2017-10-09 出版日期:2018-06-01
  • 通信作者: 孙磊
  • 基金资助:
    全军青年培育项目(14QNP027); 山东省自然科学基金(ZR2014HQ010); 中国博士后科学基金(2013M532177)

Bone morphogenetic protein-induced osteogenesis of tendon graft enhances healing of tendon-bone interface

Bo Wu1, Yongzhong Luo1, Xiaosong Liang1, Naiyi Li1, Hui Zhou1, Lei Sun1,†()   

  1. 1. Department of Orthopaedics 88th hospital of PLA, Tai’an 271000, China
  • Received:2017-10-09 Published:2018-06-01
  • Corresponding author: Lei Sun
  • About author:
    Corresponding author: Sun Lei, Email:
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引用本文：

吴波, 罗永忠, 梁晓松, 李乃义, 周慧, 孙磊. 骨形态发生蛋白诱导移植物成骨化促进腱－骨愈合[J]. 中华关节外科杂志(电子版), 2018, 12(03): 363-367.

Bo Wu, Yongzhong Luo, Xiaosong Liang, Naiyi Li, Hui Zhou, Lei Sun. Bone morphogenetic protein-induced osteogenesis of tendon graft enhances healing of tendon-bone interface[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(03): 363-367.

目的

探讨骨形态发生蛋白(BMP)诱导肌腱移植物成骨化对肌腱－骨隧道愈合(简称腱－骨)的影响。

方法

取健康成年新西兰兔26只建立腱－骨愈合模型，实验组采用BMP处理移植物及腱－骨界面，对照组仅采用生理盐水处理。术后12周时研究对象进行大体解剖观察、组织形态学检测及CT扫描，采用t检验比较各组之间腱－骨愈合情况。

结果

12周时，实验组移植肌腱质地变硬，与宿主骨组织紧密连接、局部相互融合。苏木精－伊红染色(HE)和Masson染色显示实验组腱－骨界面以纤维软骨及Sharpey’s纤维连接为主。肌腱内部及界面之间均可见新生骨组织形成，部分区域新生骨与宿主骨组织形成骨性连接。而对照组移植物肌腱形态结构无变化，腱－骨界面间隙明显，以纤维结缔组织连接为主、未见新生骨形成。组织学评分结果显示BMP处理组腱－骨愈合更加成熟(6.6±0.8) vs( 2.7±0.7)，(t＝13.361，P <0.01)。CT扫描检测结果显示实验组肌腱移植区域骨密度(191±17)，明显高于对照组(11±4)(t＝31.591，P <0.01)，提示肌腱移植区域发生成骨化。

结论

BMP能够诱导肌腱移植物成骨化并促进腱－骨愈合。

关键词: 骨－移植物界面, 腱转移术, 骨生成, 骨形态发生蛋白质类
Objective

To study bone morphogenetic protein(BMP)-induced osteogenesis of tendon graft and its effect on the healing of tendon-bone interface.

Methods

The model of tendon-bone healing was established in twenty-six adult New Zealand rabbits. Both tendon graft and tendon-bone interface were simultaneously treated with BMP in the experimental group, and the control group was only treated with normal saline. Twelve weeks after treatment, the animals were sacrificed and studied by gross anatomy, histomorphology and computer tomography(CT). The healing of tendon-bone interface in different groups was analysed by Student’s t test correspondingly.

Results

Twelve weeks after treatment, the tendon graft within bone tunnel of experimental group became hard in texture and connected close to adjacent host bone. Especially, the calcified tendon graft integrated with host bone to some extent. With hematoxylin-eosin (HE)and Masson staining, it was found that the tendon-bone interface mainly consisted of fibrocartilage and Sharpey’s fibers in the BMP-treated group. New bone formed in both tendon graft and tunnel gap. In some place, the newly-formed trabecula connected closed to the host bone. However, there was mainly connective tissue present in the gap of control group. According to the histological scoring system, the BMP-treated group got higher scores(6.6±0.8) as compared to that of control group(2.7±0.7), the difference was statistical significant(t=13.361, P<0.01). With CT scanning, the higher signal of density was present in the bone tunnel of BMP-treated group(191±17) than that of control group(11±4), which indicated the osteogenesis of tendon graft within the host tunnel(t=31.591, P<0.01).

Conclusion

BMP is able to induce osteogenesis of tendon graft and this further enhances the healing of tendon-bone interface.

Key words: Bone-implant interface, Tendon transfer, Osteogenesis, Bone morphogenetic protein
图1 动物模型建立。图A　切开膝关节囊显露趾长伸肌腱；图B　在股骨髁起点处切断，断端编织缝合；图C　在胫骨近端建立骨隧道；图D　将肌腱移植入骨隧道内
表1 组织学检测评分系统
特征 分值
纤维软骨形成 ?
大量 3
中等 2
少量 1
没有 0
新生骨组织 ?
大量 3
中等 2
少量 1
没有 0
肌腱移植物与邻近组织连接 ?
广泛 3
中等 2
少许 1
没有 0
图2 术后12周时，实验组腱－骨复合体大体解剖观察。图A　骨隧道内移植肌腱质地变硬、与宿主骨组织紧密连接(箭头示移植肌腱)；图B　部分区域肌腱组织形态消失、与宿主骨组织相互融合(箭头示融合区域)
图3 术后12周时，腱－骨复合体HE和Masson染色检测。图A: HE　染色显示实验组骨隧道内移植肌腱结构发生改变，肌腱纤维内骨组织形成(箭头示新生骨组织及髓腔，×100)；图B: HE　染色显示对照组骨隧道内移植肌腱未发生明显变化，肌腱纤维纵行排列，成纤维细胞均与分布(箭头所示)。移植肌腱与宿主骨组织之间间隙明显、结缔组织充填为主(星形所示，×100)；图C Masson　染色显示实验组移植肌腱内部及腱－骨界面均可见软骨样细胞及骨样组织形成并相互连接，提示可能与软骨内成骨有关(箭头所示，×100)；图D Masson　染色显示实验组腱－骨界面区域可见肌腱新生骨组织与宿主骨组织之间形成骨性连接(星形所示，×200)；(B－宿主骨组织，N－新生骨组织，F－肌腱纤维)
图4 术后12周时，BMP处理组腱－骨复合体CT影像(星形示隧道口)。图A　横断位重建像显示骨隧道内肌腱移植物密度增高(箭头所示)；图B　冠状位重建像显示骨隧道内肌腱移植物密度增高(箭头所示)
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