体外冲击波干预治疗对大鼠肌腱损伤修复的观察

摘要

目的 探讨体外冲击波干预对大鼠肌腱损伤后组织形态和相关生长因子表达的影响.方法 选择健康雄性Wistar大鼠43只,随机分为治疗组20只、对照组20只、空白组3只.空白组大鼠不做任何处理,治疗组和对照组的40只大鼠制作肌腱慢性跟腱损伤模型.治疗组给予损伤跟腱处冲击波干预治疗,冲击能量为0.16 mJ/mm,冲击次数3 000;每天治疗1次,连续治疗1周.对照组不做任何处理.分别在治疗后1 d、3 d、7 d、14 d、21 d处死大鼠,取跟腱组织,光镜下观察组织学形态,并采用双抗夹心ELISA方法进行肌腱组织血管内皮生长因子(vascular endothelial growth factor,VEGF)含量测定.结果 对照组在损伤后1 d、3 d、7 d、14 d、21 d可以观察到受损跟腱纤维排列较紊乱,修复过程中再生肌腱纤维不明显,瘢痕组织形成;治疗组经过体外冲击波治疗后1 d、3 d、7 d可以看到受损跟腱组织内胶原纤维排列不规则,跟腱周围组织充血、水肿;在14 d、21 d时,跟腱内腱细胞的数量开始增多,再生的胶原纤维排列比较整齐,未见明显瘢痕组织.对照组跟腱组织在伤后1 d、3 d、7 d、14 d、21 d时VEGF含量逐渐增加,21 d时VEFG含量达到最大;治疗组中经冲击波干预后1 d、3 d、7 d、14 d,VEGF的表达逐渐增高,至14 d时达到最高点,21 d时表达反而减少.结论 体外冲击干预治疗可以改善大鼠损伤肌腱的修复.%Objective To evaluate the effect of extracorporeal shock wave therapy on rats with tendon injury.Methods Forty-three male rats were randomly selected and divided into 3 groups: treatment group (n=20), control group (n=20), blank group (n=3). Rats in blank group did not receive any treatment, and tendon injury models were established with rats in treatment and control groups. Rats from treatment group were given extracorporeal shock wave therapy with the power of 0.16 mJ/mm for 3 000 times, once per day for a week, and then rats were sacrificed after treatment for 1 d, 3 d, 7 d, 14 d, 21 d. The tendon tissue were taken and observed under light microscope. Morphology changes and VEGF levels were detected and evaluated by ELISA.Results In control group, the tissue of tendon showed irregular arrangement, the regenerated tendonfiber was unapparent, and scar tissue was formed after injury for 1 d, 3 d, 7 d, 14 d, 21 d. While in treatment group, the tissue of tendon was observed with edema and hyperemia and the collagenfiber network was destructed after treatment for 1 d, 3 d, 7 d. The tendon cells were regenerating, the collagenfiber network showed regular arrangement, and no apparent scar tissue was observed at 14th d, 21th d after treatment comparedwith control group. The level of VEGF in control group increased gradually after injury for 1 d, 3 d, 7 d, 14 d, and it achieved its maximum at 21th d. In therapy group, the level of VEGF increased at 1st d, 3rd d, 7th d, 14th d after treatment, and it achieved its maximum at 14th d, while it decreased at 21th d.Conclusion Extracorporeal shock wave therapy can improve the repair of injury tendon effectively.