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目的研究人工补片重建胫骨近端肿瘤切除后髌韧带附丽的生物力学特点和组织学表现。方法在胫骨近端肿瘤行瘤段截除术后,将髌韧带断端缝合于人工补片上,以重建髌韧带附丽。从因肿瘤复发而行截肢的标本中分离获得髌韧带-补片复合体标本5枚,对照组从因股骨近端肿瘤行截肢的标本中获取正常髌韧带-胫骨标本5枚(髌韧带附丽无病变)。将标本的两端分别固定在生物力学测试仪上,进行拉力测试。测量髌韧带-补片复合体的最大抗拉载负荷,记录分离的部位及分离时的位移。对标本进行HE染色,分析其组织学特征。结果髌韧带-补片复合体的最大抗拉载荷为(226.2±42.2)N,正常髌韧带-胫骨为(341.0±33.8)N,其差异具有统计学意义(P<0.005)。其位移分别为24.4mm和21.8mm,两组间的差异无统计学意义(P>0.05)。髌韧带-补片复合体的分离部位均为髌韧带与补片连接部,而髌韧带-胫骨分离部位有3枚在髌韧带本身,2枚在髌韧带与胫骨连接部。组织病理学显示机体组织能够很好地长入补片。结论人工补片重建髌韧带附丽的方法具有良好的生物力学特点和组织学表现,值得在临床上进行进一步应用和评价。
Objective To study the biomechanical characteristics and histological features of patellar ligament appendage after artificial tibial reconstruction with proximal tibial resection. Methods Tumor resection of the proximal tibial tumor segment, the patellar ligament stump sutured to the artificial patch to reconstruct the patellar ligament attachment. Five patellar ligament - patch composite specimens were isolated from specimens amputated due to tumor recurrence. Five patellar tendon - tibia specimens were obtained from the amputation of the proximal femur tumor in the control group Lesions). The specimens were fixed on both ends of the biomechanical tester for tensile testing. The maximum tensile load of the patellar ligament-patch complex was measured, and the position of the separation and the displacement at the time of separation were recorded. The specimens were HE stained and analyzed for histological features. Results The maximum tensile load of the patellar ligament - patch complex was (226.2 ± 42.2) N, and the normal patellar tendon - tibia was (341.0 ± 33.8) N, with statistical significance (P <0.005). The displacement was 24.4mm and 21.8mm, respectively, with no significant difference between the two groups (P> 0.05). The patellar tendon - patch composite separation sites are patellar ligament and patch connections, and the patellar tendon - tibial separation of three patellar ligaments itself, two in the patellar tendon and tibia junction. Histopathology shows that body tissues grow well into the patch. Conclusion Artificial patch reconstruction of the patellar tendon with Li has good biomechanical characteristics and histological manifestations, it is worth further clinical application and evaluation.