CAJ | 학술논문

背景:到目前为止,几乎没有功能和外形满意的肌肉组织用于临床肌肉损伤的修复及构建.目的:拟观察自体筋膜作为支架材料在体内重建肌肉的可行性.设计、时间及地点:自身配对设计,随机分组实验,于2004-01/2006-06在深圳市第二人民医院烧伤研究室完成.材料:普通级健康成年新西兰兔28只,体质量(1.74±0.5)kg,雌雄不拘,建立兔后腿胫骨前肌中段缺损模型.方法:采用自身配对设计方法随机将兔的一侧后腿作为实验组(n=28).另一侧后腿分成支架连接组(n=10),肌肉微粒种植组(n=10),空白组(n=8).实验组用自体阔筋膜制成的支架连接肌肉缺损处,并取离断的肌肉微粒种植于支架内,原位缝合皮下组织和皮肤:支架连接组除不种植肌组织微粒外,余同实验组:汉肌肉微粒种植组不用支架连接,仅将肌肉组织微粒放置肌肉缺损处,余同实验组:空白组缺损处不作任何处置.主要观察指标:实验后2,3,4,6,9周分别解剖观察肌肉移植成功率,切取标本做组织学及超微结构观察和结蛋白免疫组织化学鉴定.实验组和支架连接组连接物中段各时间点切取标本用反转录-聚合酶链反应进行α-肌动蛋白cDNA相对定量分析.结果:实验组除1条肌肉近端连接处断裂外,余27条移植成功,缺损愈合处逐渐接近正常形态.支架连接组有4条断裂,余6条缺损处仍凹陷,肌肉微粒种植组,空白组缺损处依旧.实验组有大量骨骼肌卫星样细胞增生,二三周时细胞增生最活跃,细胞附于纤维结缔组织两侧,支架连接组仅见纤维结缔组织.免疫组织化学结果提示实验组细胞85%以上结蛋白阳性,而支架连接组阳性率小于25%.α-肌动蛋白cDNA相对定量分析显示不同时间点实验组和支架连接组差异均具有显著性意义(P<0.05).结论:用自体阔筋膜制成的支架连接肌肉缺损的成功率达93.33%,说明以自体筋膜为支架促使肌肉组织再生具有可行性. 揹景:到目前為止,幾乎沒有功能和外形滿意的肌肉組織用于臨床肌肉損傷的脩複及構建.目的:擬觀察自體觔膜作為支架材料在體內重建肌肉的可行性.設計、時間及地點:自身配對設計,隨機分組實驗,于2004-01/2006-06在深圳市第二人民醫院燒傷研究室完成.材料:普通級健康成年新西蘭兔28隻,體質量(1.74±0.5)kg,雌雄不拘,建立兔後腿脛骨前肌中段缺損模型.方法:採用自身配對設計方法隨機將兔的一側後腿作為實驗組(n=28).另一側後腿分成支架連接組(n=10),肌肉微粒種植組(n=10),空白組(n=8).實驗組用自體闊觔膜製成的支架連接肌肉缺損處,併取離斷的肌肉微粒種植于支架內,原位縫閤皮下組織和皮膚:支架連接組除不種植肌組織微粒外,餘同實驗組:漢肌肉微粒種植組不用支架連接,僅將肌肉組織微粒放置肌肉缺損處,餘同實驗組:空白組缺損處不作任何處置.主要觀察指標:實驗後2,3,4,6,9週分彆解剖觀察肌肉移植成功率,切取標本做組織學及超微結構觀察和結蛋白免疫組織化學鑒定.實驗組和支架連接組連接物中段各時間點切取標本用反轉錄-聚閤酶鏈反應進行α-肌動蛋白cDNA相對定量分析.結果:實驗組除1條肌肉近耑連接處斷裂外,餘27條移植成功,缺損愈閤處逐漸接近正常形態.支架連接組有4條斷裂,餘6條缺損處仍凹陷,肌肉微粒種植組,空白組缺損處依舊.實驗組有大量骨骼肌衛星樣細胞增生,二三週時細胞增生最活躍,細胞附于纖維結締組織兩側,支架連接組僅見纖維結締組織.免疫組織化學結果提示實驗組細胞85%以上結蛋白暘性,而支架連接組暘性率小于25%.α-肌動蛋白cDNA相對定量分析顯示不同時間點實驗組和支架連接組差異均具有顯著性意義(P<0.05).結論:用自體闊觔膜製成的支架連接肌肉缺損的成功率達93.33%,說明以自體觔膜為支架促使肌肉組織再生具有可行性.
배경:도목전위지,궤호몰유공능화외형만의적기육조직용우림상기육손상적수복급구건.목적:의관찰자체근막작위지가재료재체내중건기육적가행성.설계、시간급지점:자신배대설계,수궤분조실험,우2004-01/2006-06재심수시제이인민의원소상연구실완성.재료:보통급건강성년신서란토28지,체질량(1.74±0.5)kg,자웅불구,건립토후퇴경골전기중단결손모형.방법:채용자신배대설계방법수궤장토적일측후퇴작위실험조(n=28).령일측후퇴분성지가련접조(n=10),기육미립충식조(n=10),공백조(n=8).실험조용자체활근막제성적지가련접기육결손처,병취리단적기육미립충식우지가내,원위봉합피하조직화피부:지가련접조제불충식기조직미립외,여동실험조:한기육미립충식조불용지가련접,부장기육조직미립방치기육결손처,여동실험조:공백조결손처불작임하처치.주요관찰지표:실험후2,3,4,6,9주분별해부관찰기육이식성공솔,절취표본주조직학급초미결구관찰화결단백면역조직화학감정.실험조화지가련접조련접물중단각시간점절취표본용반전록-취합매련반응진행α-기동단백cDNA상대정량분석.결과:실험조제1조기육근단련접처단렬외,여27조이식성공,결손유합처축점접근정상형태.지가련접조유4조단렬,여6조결손처잉요함,기육미립충식조,공백조결손처의구.실험조유대량골격기위성양세포증생,이삼주시세포증생최활약,세포부우섬유결체조직량측,지가련접조부견섬유결체조직.면역조직화학결과제시실험조세포85%이상결단백양성,이지가련접조양성솔소우25%.α-기동단백cDNA상대정량분석현시불동시간점실험조화지가련접조차이균구유현저성의의(P<0.05).결론:용자체활근막제성적지가련접기육결손적성공솔체93.33%,설명이자체근막위지가촉사기육조직재생구유가행성.
BACKGROUND: There is nearly no muscle tissue with satisfactory function and appearance applying in clinical repair and construction of injured muscles to date. OBJECTIVE: To investigate the feasibility of applying autologous fascia as a scaffold to construct muscle in vivo. DESIGN, TIME AND SETTING: The randomized, self-matched control experiment was carried out between January 2004and June 2006 at Department of Burns & Plastic Surgery, Second Hospital of Shenzhen, Shenzhen, Guangdong Province, China MATERIALS: Twenty-eight healthy New Zealand rabbits, weighing (1.7±0.5) kg, without sex restriction, establishing middle part defect model of anterior tibial muscle of rabbit hind legs. METHODS: One hind leg of each rabbit was randomized to the experimental group (n=28), the other hind leg was assigned to one of 3 control groups, scaffold-connected group (n=10), muscle particle implant group (n=10) and blank control group(n=8). In experimental group, the defect was connected with an autologous fascial scaffold and filled with the mutilated muscle particles, and subcutaneous tissue and skin were sutured in situ. In scaffold-connected group, the treatments were same to the experimental group only except muscle particle implantation. In muscle particle implant group, the defect was filled with muscle particles but without fascial scaffold and other treatments were same to the experimental group. The defect in blank control group received no treatment. MAIN OUTCOME MEASURES: The success rate of muscle transplantation, histological and ultra structural observation,and immunohistochemical identification of desmin were observed at 2, 3, 4, 6 and 9 weeks after operation. The middle parts of samples were also harvested for relative quantitative analysis of α-actin cDNA using reverse transcription-polymerase chain reaction in the experimental group and scaffold-connected group.RESULTS: In experimental group, 1 muscle broke near the proximal junction, the other 27 succeeded and the appearance of healed defects became near normal gradually. In scaffold-connected group, 4 muscles broke, 6 muscles still depressed in defect area; in muscle particle implant group and blank control group, the defects had no change. In experimental group, a large quantity of skeletal muscle satellite cells proliferated, which reached peak at 2-3 weeks, cells attached to the ends of fibrous connective tissue; in scaffold-connected group only fibrous connective tissue was seen. lmmunohistochemistry showed that 85% cells in experimental group were desmin-positive, while the positive rate in scaffold-connected group was < 25%. The relative quantitative analysis of α -actin cDNA showed that there were significant differences between the experimental group and scaffold-connected group at different time points(P < 0.05).CONCLUSION: The success rate of repairing muscle defect with autologous fascial scaffold reached 93.33%, which indicates that it is feasible to promote muscle regeneration with autologous fascial scaffold.