双侧自体腘绳肌腱一期重建前后交叉韧带损伤的临床疗效

目的:探讨关节镜辅助下使用双侧自体腘绳肌腱一期修复膝关节前后交叉韧带损伤的方法和临床疗效。方法:内窥镜微创双侧自体腘绳肌腱修复膝关节内韧带,术后用IKDC分级、影像学IKDC分级、Lysholm功能评分和KT2000TM测量进行关节机能打分。结果:11例患者获得3-5年随访,平均随访3.8年。术前Lysholm功能评分平均(46.8±5.7)分,终末随访时平均(81.3±10.5)分,差异有显著性(P<0.05)。术后关节稳定性测量,在20磅时、30磅和最大拉力时健膝和患膝分别是:6.1±0.3和6.8±0.8;6.3±0.5和7.7±1.3;7.5±0.6和9.6±2.4,统计学上差异无显著性(P>0.05)。主观IKDC分级:A级4例,B级6例,C级1例;影像学IKDC分级:A级8例,B级2例,C级1例。结论:关节镜辅助下使用双侧自体腘绳肌腱一期修复膝关节前后交叉韧带损伤是重建膝关节稳定性的良好有效方法。     

人工韧带

人工韧带是利用生物或非生物材料经加工制作而成的韧带替代物,可用于修复人或动物机体由于各种原因造成的韧带损伤或缺损;也可用于替代某些损伤的肌腱。从人工韧带出现以来,人们曾试用过多种材料,目前较常用于制作人工韧带的材料有:碳素纤维、绦纶、聚四氟乙烯及小牛肌腱制品等。根据不同需要,可做成具有不同形状、强度和柔韧性的人工韧带。与传统的用自体组织替代物修复损伤韧带的方法相比,人工韧带具有高强度、高弹性模量、手术损伤小、操作     

双侧自体腘绳肌腱一期重建前后交叉韧带损伤的临床疗效

目的：探讨关节镜辅助下使用双侧自体腘绳肌腱一期修复膝关节前后交叉韧带损伤的方法和临床疗效。方法：内窥镜微创双侧自体腘绳肌腱修复膝关节内韧带,术后用IKDC分级、影像学IKDC分级、Lysholm功能评分和KT2000TM测量进行关节机能打分。结果：11例患者获得3—5年随访,平均随访3．8年。术前Lysholm功能评分平均（46．8±5．7）分,终末随访时平均（81．3±10．5）分,差异有显著性（P〈0．05）。术后关节稳定性测量,在20磅时、30磅和最大拉力时健膝和患膝分别是：6．1±0．3和6．8±0．8;6．3±0．5和7．7±1。3;7．5±0．6和9．6±2．4,统计学上差异无显著性（P〉0．05）。主观IKDC分级：A级4例,B级6例,C级1例;影像学IKDC分级：A级8例,B级2例,C级1例。结论：关节镜辅助下使用双侧自体腘绳肌腱一期修复膝关节前后交叉韧带损伤是重建膝关节稳定性的良好有效方法。     

肌腱组织工程的研究进展

肌腱组织工程的发展为肌腱损伤的修复提供了新的希望.本文综合国内外最新文献,就肌腱组织工程的种子细胞、应用生物材料及转基因技术应用研究等方面的进展进行了综述.     

膝关节镜下交叉韧带重建术的手术配合

膝关节镜下交叉韧带重建术是利用膝关节镜直视下行半腱肌和半膜肌肌腱自体移植重建交叉韧带的一种安全有效的手术方法.由于膝关节交叉韧带损伤后易引起关节不稳定等症状,若时间长,易导致关节内软骨损伤,半月板损伤及其他严重后果,给患者带来严重的生活、工作障碍[1].     

张力带钢丝法治疗髌韧带断裂

目的:探讨张力带钢丝法治疗髌韧带断裂的疗效。方法:回顾分析13例髌韧带断裂的手术治疗情况。结果:1例于术后2月出现钢丝断裂,但韧带连续性和强度恢复良好。其它所有病例功能恢复均达伤前水平,无韧带再断裂。结论:采用张力带钢丝法,以及对合并髌韧带挛缩或者缺损病例,结合半腱肌肌腱重建修复髌韧带断裂效果良好。     

带线锚钉修复三角韧带损伤的效果及对患者踝关节功能的影响

目的:研究带线锚钉修复三角韧带损伤在踝关节骨折内固定治疗中的作用及对踝关节功能的影响。方法:回顾性分析2012年9月至2016年8月本院收治的72例裸关节骨折并三角韧带损伤患者并且行切开复位钢板置入内固定,及采取带线锚钉内固定方式修复三角韧带损伤视为观察组;另选取同期在本院进行踝关节骨折内固定治疗但不修复三角韧带的72例患者视为对照组。分析患者治疗前、治疗后1个月、3个月、6个月踝关节功能恢复情况,观察患侧内踝间隙和不良反应。结果:观察组在治疗后1个月、3个月、6个月的AOFAS评分显著高于对照组(P0.05)。观察组在治疗后6个月后的患侧内踝间隙显著小于对照组(P0.05)。结论:带线锚钉修复三角韧带损伤在踝关节骨折内固定治疗中,可明显降低患侧内踝间隙距离,可促进患者踝关节功能恢复,无严重不良反应,值得进一步广泛推广使用。     

人工肌腱与韧带

一、概述人体有206块骨骼,靠被人们称为“筋”的韧带和肌腱连结,才能形成一体,关节才能活动自如。每一根韧带与肌腱都有一定的功用,损伤常使韧带与肌腱断裂,关节脱位;久病又会引起韧带与肌腱变性、过紧或过松;这些都引起人的运动功能障碍,不但痛苦难忍,甚至终生残废。肌腱与韧带具有韧性与弹性,是能对抗强拉力的纤维组织,其损坏与短缺,传统的治法是用石膏固定,直到断裂处愈合,但不甚牢固,长期固定还易引起关节僵硬。若用手术切开修复,寻找     

膝关节镜下自体中1/3骨-髌韧带-骨重建前交叉韧带手术配合

前交叉韧带 ( ACL)的撕裂是膝关节损伤中最常见的严重的韧带损伤 ,ACL损伤后严重影响膝关节功能 ,继发关节软骨、半月板等主要结构损伤 ,导致关节退变和骨关节病的早期发生。由于关节镜技术具有创伤小、操作精细、康复快的优点 ,用来修复 ACL明显提高了 ACL损伤的治愈率。关节镜内自体中 1 /3骨 -髌韧带 -骨 ( B- PT- B)重建 ACL是近几年标准的重建 ACL手术 [1] ,我院自2 0 0 2年 8月至 2 0 0 3年 3月共开展此类手术 5例 ,疗效确切 ,现将手术配合报道如下。1　临床资料　　本组共 5例患者 ,男 4例 ,女 1例 ,年龄最大46岁 ,最小 2 6…     

猪膝关节与人膝关节的对比及其在生物力学测试中的应用

人膝关节结构复杂,韧带较多,其中交叉韧带对维持膝关节的稳定性至为重要.后交叉韧带(posterior cruciate ligament,PCL)对于维持膝关节的后向稳定性和旋转稳定性具有至关重要的作用.PCL损伤后的主观不适症状要明显少于前交叉韧带损伤,所以过去对PCL的关注及研究要少于前交叉韧带.近年来高能量损伤致使PCL的损伤越来越多,学者们对PCL的关注度也在增加,进行了大量与PCL相关的实验,同时我们发现很多学者用动物的膝关节来代替人尸体进行体外生物力学实验,其中猪膝关节应用的最为广泛,基于这种情况,本文就猪膝关节的解剖结构与人的进行了比较,对其在体外生物力学实验中的应用进行了综述.     

Synthesis,characterization, and preliminary biological study of poly(3-(tert-butoxycarbonyl)-N-vinyl-2-pyrrolidone)

Poly(3-(tert-butoxycarbonyl)-N-vinyl-2-pyrrolidone) has been synthesized and characterized by gel permeation chromatography, Fourier transform infrared spectroscopy, NMR spectroscopy, and thermal analysis. The polymer is a chemically amplified photoresist. Arrays of lines with 25 microm width and 25 microm spacing were successfully patterned with this polymer by photolithography. Rat fibroblast cells were seeded on these patterned surfaces as well as the smooth glass surface. Phase contrast microscopy showed that cells on the patterned surfaces were strongly aligned and elongated along the grooves as compared to randomly spreading on the smooth surface. Since controlling cell orientation is critical for the development of advanced forms of tissue repair and cell engineering therapies, for example, peripheral nerve repair, production of tendon and ligament substitutes in vitro, and control of microvascular repair, the described polymer may be useful for applications in tissue reconstruction.     

Stem cell therapies in tendon-bone healing

Tendon-bone insertion injuries such as rotator cuff and anterior cruciate ligament injuries are currently highly common and severe. The key method of treating this kind of injury is the reconstruction operation. The success of this reconstructive process depends on the ability of the graft to incorporate into the bone. Recently, there has been substantial discussion about how to enhance the integration of tendon and bone through biological methods. Stem cells like bone marrow mesenchymal stem cells (MSCs), tendon stem/progenitor cells, synovium-derived MSCs, adipose-derived stem cells, or periosteum-derived periosteal stem cells can self-regenerate and potentially differentiate into different cell types, which have been widely used in tissue repair and regeneration. Thus, we concentrate in this review on the current circumstances of tendon-bone healing using stem cell therapy.     

Tendon tissue engineering: progress, challenges, and translation to the clinic

The tissue engineering field has made great strides in understanding how different aspects of tissue engineered constructs (TECs) and the culture process affect final tendon repair. However, there remain significant challenges in developing strategies that will lead to a clinically effective and commercially successful product. In an effort to increase repair quality, a better understanding of normal development, and how it differs from adult tendon healing, may provide strategies to improve tissue engineering. As tendon tissue engineering continues to improve, the field needs to employ more clinically relevant models of tendon injury such as degenerative tendons. We need to translate successes to larger animal models to begin exploring the clinical implications of our treatments. By advancing the models used to validate our TECs, we can help convince our toughest customer, the surgeon, that our products will be clinically efficacious. As we address these challenges in musculoskeletal tissue engineering, the field still needs to address the commercialization of products developed in the laboratory. TEC commercialization faces numerous challenges because each injury and patient is unique. This review aims to provide tissue engineers with a summary of important issues related to engineering tendon repairs and potential strategies for producing clinically successful products.     

Proteomic differences between native and tissue‐engineered tendon and ligament

Tendons and ligaments (T/Ls) play key roles in the musculoskeletal system, but they are susceptible to traumatic or age‐related rupture, leading to severe morbidity as well as increased susceptibility to degenerative joint diseases such as osteoarthritis. Tissue engineering represents an attractive therapeutic approach to treating T/L injury but it is hampered by our poor understanding of the defining characteristics of the two tissues. The present study aimed to determine differences in the proteomic profile between native T/Ls and tissue engineered (TE) T/L constructs. The canine long digital extensor tendon and anterior cruciate ligament were analyzed along with 3D TE fibrin‐based constructs created from their cells. Native tendon and ligament differed in their content of key structural proteins, with the ligament being more abundant in fibrocartilaginous proteins. 3D T/L TE constructs contained less extracellular matrix (ECM) proteins and had a greater proportion of cellular‐associated proteins than native tissue, corresponding to their low collagen and high DNA content. Constructs were able to recapitulate native T/L tissue characteristics particularly with regard to ECM proteins. However, 3D T/L TE constructs had similar ECM and cellular protein compositions indicating that cell source may not be an important factor for T/L tissue engineering.     

Biomechanics of tendon injury and repair

Many clinical and experimental studies have investigated how tendons repair in response to an injury. This body of work has led to a greater understanding of tendon healing mechanisms and subsequently to an improvement in their treatment. In this review paper, characterization of normal and healing tendons is first covered. In addition, the debate between intrinsic and extrinsic healing is examined, and the cellular and extracellular matrix response following a tendon injury is detailed. Next, clinical and experimental injury and repair methods utilizing animal models are discussed. Animal models have been utilized to study the effect of various activity levels, motions, injury methods, and injury locations on tendon injury and repair. Finally, current and future treatment modalities for improving tendon healing, such as tissue engineering, cell therapy, and gene therapy, are reviewed.     

Tendon and ligament: development, repair and disease

Tendons and ligaments (T/L) are very similar fibrous tissues that respectively connect muscle to bone and bone to bone. They are comprised of fibroblasts that produce large amounts of extra-cellular matrix, resulting in a dense and hypocellular structure. The complex molecular organization of T/L, together with high water content, are responsible for their viscoelastic properties, hence insuring their mechanical function. We will first review recent work on tendon embryology and discuss ligament formation, which has been less documented. We will next summarize our current knowledge of T/L molecular architecture, alterations of which are a major cause for disease. We will finally focus on T/L repair after injury and on genetic diseases responsible for T/L defects.     

Bioactive nanofibers for fibroblastic differentiation of mesenchymal precursor cells for ligament/tendon tissue engineering applications

Mesenchymal stem cells and precursor cells are ideal candidates for tendon and ligament tissue engineering; however, for the stem cell-based approach to succeed, these cells would be required to proliferate and differentiate into tendon/ligament fibroblasts on the tissue engineering scaffold. Among the various fiber-based scaffolds that have been used in tendon/ligament tissue engineering, hybrid fibrous scaffolds comprising both microfibers and nanofibers have been recently shown to be particularly promising. With the nanofibrous coating presenting a biomimetic surface, the scaffolds can also potentially mimic the natural extracellular matrix in function by acting as a depot for sustained release of growth factors. In this study, we demonstrate that basic fibroblast growth factor (bFGF) could be successfully incorporated, randomly dispersed within blend-electrospun nanofibers and released in a bioactive form over 1 week. The released bioactive bFGF activated tyrosine phosphorylation signaling within seeded BMSCs. The bFGF-releasing nanofibrous scaffolds facilitated BMSC proliferation, upregulated gene expression of tendon/ligament-specific ECM proteins, increased production and deposition of collagen and tenascin-C, reduced multipotency of the BMSCs and induced tendon/ligament-like fibroblastic differentiation, indicating their potential in tendon/ligament tissue engineering applications.     

Tissue engineering: chondrocytes and cartilage

Tissue engineering offers new strategies for developing treatments for the repair and regeneration of damaged and diseased tissues. These treatments, using living cells, will exploit new developments in understanding the principles in cell biology that control and direct cell function. Arthritic diseases that affect so many people and have a major impact on the quality of life provide an important target for tissue engineering. Initial approaches are in cartilage repair; in our own programme we are elucidating the signals required by chondrocytes to promote new matrix assembly. These principles will extend to other tissues of the musculoskeletal system, including the repair of bone, ligament and tendon.     

Contribution of biomechanics to management of ligament and tendon injuries

The contribution of biomechanics to the advancement of management of ligament and tendon injuries has been significant. Thanks to Professor Y.C. Fung's writing and guidance, our field of research has done fundamental work on anatomy and biology of ligaments and tendons, developed methods to accurately determine mechanical properties, identified various experimental factors which could change the outcome measurements as well as examined biological factors that change tissue properties in-vivo. Professor Fung also gave us his quasi-linear viscoelastic theory for soft tissues so that the time and history dependent properties of ligaments and tendons could be properly described. We have further adopted Professor Fung's eight steps on methods of approach for biomechanical investigation to understand as well as enhance the treatment of ligament and tendon injuries during work or sports related activities. Examples on how to better treat the tears of the medial collateral ligament of the knee, as well as how to improve reconstruction procedures for the anterior cruciate ligament are presented in detail. Currently the use of functional tissue engineering for ligament and tendon healing is a topic of great interest. Here the use of biological scaffolds, such as porcine small intestinal submucosa, has shown promise. For the last 35 to 40 years, the field of biomechanics has made great strides in the treatment of ligament and tendon injuries, and many patients have benefited. The future is even brighter because of what has been done properly in the past. Exciting advances can be made in the field of tissue engineering through novel in-vitro culture and bioscaffold fabrication techniques. Recent technology can also allow the collection of in-vivo data so that ligament and tendon injuries can be better understood. Yet, solving new and more complex problems must still follow the stepwise methods of approach as taught by Professor Fung.     

Differential effects of growth factors and cytokines on the synthesis of SPARC, DNA, fibronectin and alkaline phosphatase activity in human periodontal ligament cells

Growth factors and cytokines play an important role in tissue development and repair. However, it remains unknown how they act on proliferation and differentiation of periodontal ligament cells. In this study, we investigated the effects of several growth factors and cytokines on the synthesis of DNA, alkaline phosphatase (ALPase), fibronectin, and secreted protein acidic and rich in cysteine (SPARC) in human periodontal ligament (HPL) cells. Transforming growth factor-beta (TGF-beta) increased the synthesis of DNA, fibronectin and SPARC, whereas it decreased ALPase activity. Basic fibroblast growth factor (bFGF), platelet-derived growth factor (PDGF) and tumor necrosis factor-alpha (TNF-alpha) decreased SPARC and ALPase levels, whereas these peptides increased DNA synthesis and did not affect fibronectin synthesis. Epidermal growth factor (EGF) up-regulated the synthesis of DNA and fibronectin and inhibited SPARC and ALPase levels. Interleukin-1beta (IL-1beta) decreased the synthesis of DNA, ALPase, fibronectin and SPARC. These findings demonstrate that TGF-beta, bFGF, EGF, PDGF, TNF-alpha and IL-1beta have characteristically different patterns of action on DNA, SPARC, fibronectin and ALPase synthesis by HPL cells. The differences in regulation of function of periodontal ligament cells by these peptides may be involved in the regeneration and repair of periodontal tissue.