外置式人工关节控制下的家兔膝关节再生与功能恢复
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科技部公益项目(DIB1J165),北京市自然科学基金项目(7072050),中国中医科学院名医名家传承项目(CM20121012)


Regeneration and functional recovery of rabbit knee joint after osteotomy under control of external artificial joint
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    摘要:

    目的 探讨仿生运动生物力学环境下关节再生的可能性。方法 采用实验家兔7只,在实验家兔一侧股骨干和胫骨骨干各穿2枚直径1.5 mm 克氏针,分别安装框架平台。然后在体外通过在膝关节内、外侧分别安装模拟膝关节矢状面运动轨迹的平面四杆机构,连接股骨和胫骨上已经安装好的框架平台。在股骨髁和胫骨平台同时截骨去除关节软骨、部分软骨下骨及十字交叉韧带和半月板等结构,但不损伤肌腱起止点,保留关节囊及囊外韧带,保留髌骨和籽骨。术后家兔自然活动。在关节截骨后的愈合过程中定期拍摄X线片,测量关节矢状面的活动度和骨性间隙。结果 7只实验家兔中6例成功安装外置式人工关节,截骨微创骨穿针仿生运动外置式人工关节控制下自然活动。膝关节被动活动范围分别为:术后第1周,极限屈曲位(144.7±15.62)°, 极限伸直位(44.2±25.77)°, 活动度(100.5±29.03)°; 术后第12周,极限屈曲位(139.4 ± 12.92)°, 极限伸直位(40.4±22.04)°,活动度(99.0±23.39)°。截骨术后第12周与截骨术后第1周相比,屈曲位、伸直位和活动度均没有显著差异。X线显示骨性关节间隙依然存在。截骨侧骨性关节间隙明显减小,由截骨术后第1周(4.03±1.84) mm 减小到第12周(2.32±1.05) mm,而对侧正常骨性关节间隙为(1.27±0.22) mm。术后16周拆除外置式人工关节,切开关节囊观察,发现新生白色软骨覆盖截骨再生表面,表面光滑,具有典型关节滑车结构,并且观察到类似韧带的纤维束从再生的股骨下端发出,终止于新生的胫骨上端。术后第25周,所有6只实验家兔截骨再生膝关节屈曲位(148.3±4.75)°,伸直位(48.30±17.57)°,活动范围(100.0±20.80)°;对侧(左侧)正常膝关节屈曲位(148.3±7.5)°,伸直位(21.6±9.09)°,活动范围(126.7±6.88)°。截骨侧、对侧骨性关节间隙分别为(1.4±0.59)、(0.92±0.35) mm。结论 外置式仿生运动人工关节为家兔膝关节再生保留了再生空间,提供了一种运动模拟环境、印证了骨折愈合过程的应力适应性。本研究结果提示仿生运动生物力学环境下,正常家兔膝关节内截骨后再生是可能的。

    Abstract:

    Objective To discuss the possibility for regeneration of knee joint with normal function under bionics biomechanical environment. Methods Seven normal rabbits with two metal frames respectively mounted on their femur and tibia of single (right) side leg by two threading pins of 1.5 mm diameter were used. Then the external artificial joints, containing two four-bar-linkage inside and outside of the knee to simulate motion trajectory of the joint in sagital plane were connected with the two preset fixed frames before osteotomy. The arthro-cartilage of the knee joint, crucial ligaments, semi-lunar fibro-cartilages, and partial under-cartilage-osseous intra articular capsule were cut off during osteotomy, with the patella, sesamoid bones remained intact. Insertion sites of muscle tendons were not invaded as far as possible, and capsules with ligaments outside were kept complete when the incision wound was closed by suture. The rabbits could move freely after osteotomy. The range of motion (ROM) of the knees in sagital plane and bony gap between the femur and tibia were measured by X-Ray films during the fracture healing after osteotomy. Results External artificial knee joints were successfully installed on right legs of 6 rabbits among the seven. The rabbits moved freely after osteotomy under the control of minimal invasive external artificial joint in bionics trajectory. The average angles between femoral shaft and tibial shaft at the 1st week after osteotomy were from (144.7±15.62)° in extremely flexed position to (44.2±25.77)° in extremely extended position, with ROM of (100.5±29.03)°. At the 12th week, the average angles were from (139.4 ± 12.92)° in extremely flexed position to (40.4±22.04)° in extremely extended position, with ROM of (99.0±23.39)°. No significant differences were displayed in flexed/extended position and ROM between the 1st and 12th week, with the bony gaps of the knees still existed but decreased significantly from (4.03±1.84) mm at the 1st week to (2.32±1.05) mm at the 12th week. In contrast, bony gaps of the opposite knees were not changed significantly, which were (1.27±0.22) mm on average. At the end of 16th week after osteotomy, the external artificial joints were removed. Newly born cartilage, with white color and smooth surface, were covered at lower end of the femur and upper end of the tibia. Typical trochlear surface appeared at the front side of regenerated cartilage corresponding to the posterior surface of the patella. And the regenerated fibro-bundle linkage similar with ligament, which started from bony structure of regenerated lower end of the femur and inserted into regenerated upper end of the tibia, was observed in each rabbit. At the 25th week, the average angles between femoral shaft and tibial shaft were from (148.3 ± 4.75)° in extremely flexed position to (48.30±17.57)° in extremely extended position, with ROM of (100.0±20.80)°. In the opposite (left) leg, the average angles between femoral shaft and tibial shaft were from (148.3±7.5)° in extremely flexed position to (21.6±9.09)° in extremely extended position, with ROM of (126.7±6.88)°, and the average bony gap of the knees after osteotomy was (1.4±0.59) mm, while that of the opposite (left) knees was (0.92±0.35) mm. Conclusions The external artificial joint with bionics trajectory could reserve the space for regeneration of rabbit knee joint by providing motion modeling environment, and proved the stress adaption during fracture healing. The present results indicated that regeneration of the knee joint after intra-capsular osteotomy in bionics biomechanical environment was possible.

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钟红刚,张万强,关继超,卜海滨,董福慧,钱民全,孟和.外置式人工关节控制下的家兔膝关节再生与功能恢复[J].医用生物力学,2014,29(4):370-376

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  • 收稿日期:2013-09-26
  • 最后修改日期:2013-12-12
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  • 在线发布日期: 2014-08-22
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