目的:本研究旨在探讨两种手术方法的有效性,自体髌腱移植重建和胫骨平台拔出修复,使用猪模型。主要重点是评估内侧半月板后部(MMPP)缺陷的修复能力,弯月面的整体结构完整性,以及两个手术组之间股骨和胫骨软骨的保护。总体目标是使用这些发现为临床研究提供实验指南。
方法:选择12头猪,建立距胫骨平台插入点10mm的MMPP损伤模型。他们被随机分为三组,每组四只动物:重建(MMPP的自体肌腱移植重建),拔出修复(通过胫骨平台骨隧道缝合修复MMPP),和对照(使用正常内侧半月板作为阴性对照)。术后12周对动物实施安乐死,以评估半月板,肌腱骨愈合评估,膝关节软骨的大体观察。使用国际软骨修复学会(ICRS)分级和Mankin评分评估胫骨和股骨软骨损伤。对半月板-肌腱连接区进行组织学和免疫组织化学染色,初生半月板,和肌腱。Ishida评分用于评估重建组的再生半月板。磁共振成像(MRI)用于评估半月板愈合。
结果:所有12头猪手术后恢复良好;所有切口均愈合,无感染,无明显并发症发生。总体观察显示,与对照组相比,重建和拔出修复组的效果更好。在胫骨软骨中,重建组有ICRSI级损伤,而拔出修复组和对照组有ICRSII级和III级损伤,分别。Mankin评分在重建组和对照组之间有明显差异;组织学染色显示,重建组再生半月板的结构与原始半月板相似。免疫组化染色显示,重建组再生半月板与原始半月板的Ⅰ型和Ⅱ型胶原染色程度类似。在重建组中,再生半月板与正常初生半月板之间的Ishida评分没有显着差异。MRI显示重建和拔除修复组的MMPP已完全愈合,而对照组尚未愈合。
结论:自体髌腱移植重建MMPP可产生纤维软骨样再生半月板。重建和拔出修复都可以保持半月板的结构完整性,促进MMPP的愈合,延迟半月板变性,保护膝盖软骨.
OBJECTIVE: This
study was performed to investigate the effectiveness of two surgical procedures, autologous patellar tendon graft reconstruction and trans-tibial plateau pull-out repair, using a pig model. The primary focus was to assess the repair capability of medial meniscus posterior portion (MMPP) deficiency, the overall structural integrity of the meniscus, and protection of the femoral and tibial cartilage between the two surgical groups. The overall aim was to provide experimental guidelines for clinical research using these findings.
METHODS: Twelve pigs were selected to establish a model of injury to the MMPP 10 mm from the insertion point of the tibial plateau. They were randomly divided into three groups of four animals each: reconstruction (autologous tendon graft reconstruction of the MMPP), pull-out repair (suture repair of the MMPP via a trans-tibial plateau bone tunnel), and control (use of a normal medial meniscus as the negative control). The animals were euthanized 12 weeks postoperatively for evaluation of the meniscus, assessment of tendon bone healing, and gross observation of knee joint cartilage. The tibial and femoral cartilage injuries were evaluated using the International Society for Cartilage Repair (ICRS) grade and Mankin score. Histological and immunohistochemical staining was conducted on the meniscus-tendon junction area, primary
meniscus, and tendons. The Ishida score was used to evaluate the regenerated
meniscus in the reconstruction group. Magnetic resonance imaging (MRI) was used to evaluate meniscal healing.
RESULTS: All 12 pigs recovered well after surgery; all incisions healed without infection, and no obvious complications occurred. Gross observation revealed superior results in the reconstruction and pull-out repair groups compared with the control group. In the tibial cartilage, the reconstruction group had ICRS grade I injury whereas the pull-out repair and control groups had ICRS grade II and III injury, respectively. The Mankin score was significantly different between the reconstruction and control groups; histological staining showed that the structure of the regenerated meniscus in the reconstruction group was similar to that of the original
meniscus. Immunohistochemical staining showed that the degree of type I and II collagen staining was similar between the regenerated meniscus and the original
meniscus in the reconstruction group. The Ishida score was not significantly different between the regenerated meniscus and the normal primary
meniscus in the reconstruction group. MRI showed that the MMPP in the reconstruction and pull-out repair groups had fully healed, whereas that in the control group had not healed.
CONCLUSIONS: Autologous patellar tendon graft reconstruction of the MMPP can generate a fibrocartilage-like regenerative meniscus. Both reconstruction and pull-out repair can preserve the structural integrity of the meniscus, promote healing of the MMPP, delay meniscal degeneration, and protect the knee cartilage.