自体外周血富白细胞-血小板纤维蛋白对兔关节外骨道内移植肌腱腱骨早期愈合的影响

摘要

Objective To evaluate the early effect of leukocyte-and platelet-rich fibrin (L-PRF)on tendon-bone healing in rabbits' extra-articular bone tunnel.Methods Thirty healthy New Zealand rabbits were randomly divided into an experimental group and a control group,each of 15.The semitendinosus tendon harvested from the hind leg of each rabbit was prepared as free autografts.Each autograft was implanted into the bone tunnel created at ipsilateral proximal tibial metaphysis.The experimental group was added with autologous peripheral blood-derived L-PRF,while the control group did not add anything.Speciments from each group were harvested at 4,8 and 12 weeks after operation.The morphological changes were observed and evaluated at each time point.The fibroblasts on the tendon-bone interface were counted and analyzed under the high magnification microscope.Results The number of fibroblasts between the tendon and bone in the experimental group was significantly higher than that of the control group at each time point (P＜0.05).And the connection between tendon and bone was closer and the collagen fibers were more regular in the experimental group than the control group at each time point.Sharpey's-like fibers which marked the early healing of the tendon to bone,were observed at 4th week in the experimental group,while they were observed at 8th week in the control group.As the healing time extended,Sharpey's like fibers continue to increase in both groups and significant differences were observed in the histological morphology (Buark grades)between the two groups (P＜0.05).Conclusion Autologous peripheral blood-derived L-PRF can promote early healing of autologous tendon to bone in the extra-articular bone tunnel of model rabbit.%目的:探讨兔关节外骨道内使用自体外周血富白细胞-血小板纤维蛋白(L-PRF)对移植肌腱早期腱骨愈合的影响.方法:30只健康新西兰大白兔平均分为实验组和空白对照组.将兔的半腱肌腱取出制成游离肌腱,植入同侧关节外胫骨近端的横向骨道内制成腱骨愈合模型.实验组加入自体血来源的L-PRF,对照组不加入L-PRF.分别于术后4、8、12周三个时间点处死实验动物取材,切片染色,行腱骨界面的组织形态学观察、Buark评级,并在高倍镜下行成纤维细胞计数并分析.结果:各个时间点实验组成纤维细胞数目均多于对照组,差异均具有统计学意义(P＜0.05);在3个时间点中,与对照组相比,实验组腱骨连接更加紧密,腱骨间隙更小,胶原纤维排列更有序规则;标志腱骨早期愈合的Sharpey样纤维在4周时的实验组即可观察到,而对照组8周时才可观察到,并且随着时间延长,两组Sharpey样纤维均持续增多;两组标本的腱骨界面组织形态学Buark评级差异有统计学意义(P＜0.05).结论:自体血来源的L-PRF可促进关节外骨道内移植半腱肌腱腱骨的早期愈合.