开放手术与微创手术建立膝前交叉韧带本体感觉减退模型对比

张磊; 奉琦; 王萍; 程翰文; 熊鹿静

doi:10.16098/j.issn.0529-1356.2022.04.016

PDF(6156 KB)

解剖学报 ›› 2022, Vol. 53 ›› Issue (4) : 520-525. DOI: 10.16098/j.issn.0529-1356.2022.04.016

开放手术与微创手术建立膝前交叉韧带本体感觉减退模型对比

张磊^1*奉琦²王萍² 程翰文²熊鹿静²

作者信息 +

Comparison on the establishment of proprioceptive hypoesthesia model of anterior cruciate ligament by open surgery and minimally invasive surgery

ZHANG Lei^1* FENG Qi² WANG Ping² CHENG Han-wen² XIONG Lu-jing²

Author information +

文章历史 +

摘要

目的对比开放手术与微创手术在建立膝前交叉韧带(ACL)本体感觉减退模型时的差异，为基础研究提供一个优化的动物模型。方法 30只正常食蟹猴被随机分为5组，微创手术组：关节镜下进行单侧ACL损伤，n=6；开放手术组：直接切开膝关节进行单侧ACL损伤，n=6；微创假手术组：仅进行膝关节镜检清理不损伤单侧ACL，n=6；开放假手术组：直接切开膝关节仅作单侧ACL探查而不损伤单侧ACL，n=6；正常组：不作任何手术干预，n=6。4周后进行神经电生理检查［体感诱发电位（SEPs）与运动神经传导速度（MCV）］，再将食蟹猴处死并取其单侧ACL进行氯化金染色，观察和记录ACL本体感受器的变异数和数量。结果在神经电生理方面，除正常组以外的其余4组SEPs和MCV潜伏期均有延长，波幅均有下降。在本体感受器方面，微创手术组总数：578.00±12.68，波幅：36.33±3.72；开放手术组总数：367.67±9.33，波幅：77.00±5.55；开放假手术组总数：969.00±18.26，波幅：0±0；正常组总数：970.46±16.34，波幅：0±0；除正常组以外的其余4组本体感受器总数均有下降，变异数均上升在两方面的对比中，开放手术组与微创手术组，开放手术组与开放假手术组对比，微创手术组与微创假手术组对比，差异均有显著性（P<0.05）。开放假手术组与微创假手术组相比，以及两组分别与正常组相比，差异均无显著性（P > 0.05）。结论开放手术组和微创手术组均可建造ACL本体感觉减退模型，但微创手术对ACL周围组织的损伤更小，更能保证模型的科学性、单一性，减少了实验误差，在ACL损伤的基础研究中具有重要意义。

Abstract

Objective To provide an optimized animal model for basic research by comparing the establishment of proprioceptive hypoesthesia model of anterior cruciate ligament (ACL) by open surgery and minimally invasive surgery. Methods Totally 30 normal cynomolgus monkeys were randomly divided into five groups: minimally invasive surgery group: unilateral ACL injury under arthroscope, n=6; open surgery group: unilateral ACL injury through direct incision of knee joint, n=6; minimally invasive sham operation group: unilateral ACL without injury through arthroscopic cleaning only, n=6; open surgery group: unilateral ACL exploration without injury through direct incision of knee joint, n=6; positive normal group: no surgical intervention, n=6. Four weeks later, the neurophysiological examination ［somatosensory evoked potentials (SEPs) and motor nerve conduction velocity (MCV) ］ was carried out. The macaque was killed and its unilateral ACL was stained with gold chloride. The number and variation of ACL proprioceptors were observed and recorded. Results In the aspect of neuroelectrophysiology, except the normal group, the latency of SEPs and MCV were prolonged, and the amplitude decreased. In terms of proprioceptors, the total number of minimally invasive surgery group: 578.00±12.68, amplitude: 36.33±3.72; total number of open surgery group: 367.67±9.33, amplitude: 77.00±5.55; total number of open sham operation group: 969.00±18.26, amplitude: 0±0; total number of normal group: 970.46±16.34, amplitude: 0±0, the total number of proprioceptors decreased and the number of variation increased in all four groups except the normal group. At the same time, in the comparison of the two aspects, there were significant differences between the open operation group and the minimally invasive operation group, the open operation group and the open sham operation group, and the minimally invasive operation group and the minimally invasive sham operation group (P<0.05). There were no significant difference between the open sham operation group and the minimally invasive sham operation group, and between the two groups and the normal group, respectively (P>0.05). Conclusion Both the open operation group and the minimally invasive operation group can build ACL proprioceptive hypoesthesia model, but the minimally invasive operation has less damage to the tissues around ACL, more scientific and single model, and less experimental error, which is of great significance in the basic research of ACL injury.

导出引用

张磊奉琦王萍程翰文熊鹿静. 开放手术与微创手术建立膝前交叉韧带本体感觉减退模型对比[J]. 解剖学报. 2022, 53(4): 520-525 https://doi.org/10.16098/j.issn.0529-1356.2022.04.016

ZHANG Lei FENG Qi WANG Ping CHENG Han-wen XIONG Lu-jing. Comparison on the establishment of proprioceptive hypoesthesia model of anterior cruciate ligament by open surgery and minimally invasive surgery[J]. Acta Anatomica Sinica. 2022, 53(4): 520-525 https://doi.org/10.16098/j.issn.0529-1356.2022.04.016

中图分类号： R339.17

参考文献

［1］Parcells BW, Tria AJ. The cruciate ligaments in total knee arthroplasty ［J］. Am J Orthop (Belle Mead NJ), 2016, 45(4): E153-E160.

［2］Noyes FR, Huser LE, Levy MS. Rotational knee instability in acl-deficient knees: role of the anterolateral ligament and iliotibial band as defined by tibiofemoral compartment translations and rotations ［J］. J Bone Joint Surg Am, 2017, 99(4): 305-314.

［3］Dong YL, Qian YN, Zhong XQ, et al. Relationship between anterior cruciate ligament anatomical reconstruction femoral tunnel and lateral collateral ligament femoral tunne ［J］. Acta Anatomica Sinica, 2017, 48(1): 61-64. (in Chinese)

董伊隆，钱约男，钟熙强，等. 前交叉韧带解剖重建股骨隧道与外侧副韧带解剖重建股骨隧道的关系［J］. 解剖学报，2017，48(1): 61-64.

［4］Skoglund S. Anatomical and physiological studies of knee joint innervation in the cat ［J］. Acta Physiol Scand Suppl, 1956, 36(124): 1-101.

［5］Schultz RA, Miller DC, Kerr CS, et al. Mechanoreceptors in human cruciate ligaments. A histological study［J］. J Bone Joint Surg Am, 1984, 66(7): 1072-1076.

［6］Spindler KP. Clinical practice. Anterior cruciate ligament tear ［J］. N Engl J Med, 2016, 359(6): 2135-2142.

［7］Mir SM, Talebian S, Naseri N, et al. Assessment of knee proprioception in the anterior cruciate ligament injury risk position in healthy subjects: a cross-sectional study ［J］. J Phys Ther Sci, 2014, 26(10): 1515-1518.

［8］Li J, Kong F, Gao X, et al. Prospective randomized comparison of knee stability and proprioception for posterior cruciate ligament reconstruction with autograft, hybrid graft, and γ-irradiated allograft ［J］. Arthroscopy, 2016, 32(12): 2548-2555.

［9］Yang JX, Liu QP, Gao Y, et al. Reconstruction of anterior cruciate ligament with silk ligament and bone marrow stem cells in rabbits［J］. Chinese Journal of Orthopedics,2020, 28(20): 1883-1887. (in Chinese)

杨继祥, 刘庆鹏, 高勇, 等. 蚕丝韧带复合骨髓干细胞重建兔前交叉韧带［J］.中国矫形外科杂志, 2020, 28(20): 1883-1887.

［10］Murray MM, Spindler KP, Abreu E, et al. Collagen-platelet rich plasma hydrogel enhances primary repair of the porcine anterior cruciate ligament ［J］. J Orthop Res, 2017, 25(1): 81-91.

［11］Boguszewski DV, Shearn JT, Wagner CT. Investigating the effects of anterior tibial translation on anterior knee force in the porcine model: Is the porcine knee ACL dependent ［J］. J Orthop Res, 2011, 29(5): 641-646.

［12］Proffen BL, McElfresh M, Fleming BC, et al. A comparative anatomical study of the human knee and six animal species ［J］. Knee, 2012, 19(4):493-499.

［13］Zhang L, Qi J, Zeng Y, et al. Proprioceptive changes in bilateral knee joints following unilateral anterior cruciate ligament injury in cynomolgus monkeys ［J］. Med Sci Monit, 2018, 24: 105-113.

［14］Beard DJ, Kyberd PJ, Fergusson CM, et al. Proprioception after rupture of the anterior cruciate ligament. An objective indication of the need for surgery ［J］. J Bone Joint Surg Br, 1993, 75（2）: 311-315.

［15］Ochi M, Iwasa J, Uchio Y, et al. The regeneration of sensory neurones in the reconstruction of the anterior cruciate ligament ［J］. J Bone Joint Surg Br, 1999, 81(5): 902-906.

［16］Luo H, Zhang WG, Ao YF, et al. Anatomy of the femoral attachment of the posterolateral bundle of the anterior cruciate ligament ［J］. Acta Anatomica Sinica, 2012,43(2):232-235. (in Chinese)

罗浩，张卫光，敖英芳，等. 膝关节前交叉韧带后外束股骨止点位置的解剖［J］.解剖学报，2012，43(2)：232-235.

［17］Fisher MB, Liang R, Jung HJ, et al. Potential of healing a transected anterior cruciate ligament with genetically modified extracellular matrix bioscaffolds in a goat model ［J］. Knee Surg Sports Traumatol Arthrosc, 2012, 20（7）: 1357-1365.

［18］Smith PA, Stannard JP, Pfeiffer FM, et al. Suspensory versus interference screw fixation for arthroscopic anterior cruciate ligament reconstruction in a translational large-animal model ［J］. Arthroscopy, 2016, 32(6): 1086-1097.

［19］Mandelbaum BR, Silvers HJ, Watanabe DS, et al. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up ［J］. Am J Sports Med, 2005, 33(7):1003-1010.

［20］Yeung J, Cleves A, Griffiths H, et al. Mobility, proprioception, strength and FMS as predictors of injury in professional footballers ［J］. BMJ Open Sport Exerc Med, 2016, 2(1): e000134.

［21］Lowe WR, Warth RJ, Davis EP, et al. Functional bracing after anterior cruciate ligament reconstruction: a systematic review ［J］. J Am Acad Orthop Surg, 2017, 25(3): 239-249.

［22］Torres R, Ferreira J, Silva D, et al. Impact of patellar tendinopathy on knee proprioception: a cross-sectional study ［J］. Clin J Sport Med, 2017(1), 27: 31-36.

［23］Zelle S, Zantop T, Schanz S, et al. Arthroscopic techniques for the fixation of a three-dimensional scaffold for autologous chondrocyte transplantation: Structural properties in an in vitro model ［J］. Arthroscopy, 2007, 23(10): 1073-1078.

［24］Krause M, Freudenthaler F, Frosch KH, et al. Operative versus conservative treatment of anterior cruciate ligament rupture ［J］. Dtsch Arztebl Int, 2018, 115(51-52): 855-862.

［25］Zhang HY, Chen Sh, Jiao F. The research progress of treatment for anterior cruciate ligament tibial eminence avulsion fracture ［J］. Chinese Journal of Clinical Anatomy, 2017, 35(6): 705-707. (in Chinese)

张宏艺, 陈帅, 焦锋. 前交叉韧带胫骨止点撕脱骨折治疗研究进展［J］. 中国临床解剖学杂志, 2017, 35(6): 705-707.