利用带血管骨膜重建腱-骨、腱-假体止点的实验研究

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Abstract Objective To investigate the feasibilityof reconstructing the tendon-bone attachment of the bone defect around the joint and tendon-bone anchor point on metal implant surface by using vascularized periosteum.Methods We established the rabbit model of bilateral radial humeral biceps tendon-bone insertion defect and repaired this model by the following 4 methods.Method A：The broken end of the tendon was placed in the center of the defect.Then the defect and broken end of the tendon were wrapped by the posterolateral periosteum flap with ulnar artery.And they were sutured and fixed.A1：The broken end of the tendon insertion point was not covered with free periosteum but sutured to the broken end of the bone tissue at the bone defect.B：The tendon insertion was sutured on the titanium plate.Then the bone defect and the titanium plate-tendon insertion suture were wrapped by periosteum flap.B1：The broken end of the tendon insertion point was sutured on the internal fixation titanium plate without free periosteum covering.The bone defect repair and tendon-bone healing were evaluated by gross observation，X-ray，histological morphology，immunohistochemistry and biomechanical measurement at the 6th and 12th week after surgery.Results After 12 weeks，bone defects recovery occurred in all the case of group A and group B.Only 1 case in group A1 and none in group B1 recovered.The tendonbone union forming could be observed in group A，group A1 and group B after 12 weeks，while group B1 failed.At the 6th and 12th week，the number of mature osteoblasts in group A was significantly higher than that in the other groups (P<0.01)，while the number of osteoblasts in group B was significantly higher than that in the other groups at the 12th week (P<0.01).The number of capillaries，thickness of tendon-bone ingrowth，BMP，IOD of bFGF immunohistochemical staining in group A and group B were significantly higher than those in group A1 without free periosteal repair(P<0.01).After 6 weeks，the tensile strength of the samples in normal control group were stronger than that in group A and group A1，but there was no difference between group A and group B.After 12 weeks，the tensile strength was shown as normal control group >group A >group B >group A1.Conclusion The method of wrapping tendon and bone defect with vascularized periosteum graft can not only effectively repair bone defect but also reconstruct tendon-bone healing point at the same time.Although the vascularized periosteum can not form a mature bone tissue interface on the surface of the titanium implant，it could form a tendon-bone fibrous connection，which could promote indirect healing.Meantime our result also indicate that tendons cannot"self-heal"at the plant interface in titanium.

Key words： free periosteal flap transplantation tendon-bone healing bone defect

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	Ru Neng
	Liang Jie

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Ru Neng,Liang Jie. Reconstruction of the Tendon-bone and Tendon-prosthesis Attachment with Vascularized Periosteum[J]. sygkzz, 2021, 27(4): 324-384.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2021/V27/I4/324

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