CAJ | 학술논문

目的探讨Ilizarov牵张技术的牵拉应力对挛缩跟腱组织学的影响.方法 18只狗右后肢应用Ilizarov外固定支架中立位固定1周后开始牵拉,1 mm/d,分2次调整,连续3周,X线摄片确定足下垂15°,再维持固定3周,随机选取9只动物处死取材(挛缩组)；余动物再以同样的速度和方法牵拉矫正3周后处死取材(牵拉组)；所取健侧标本合并为对照组.(1) HE染色观察腱细胞排列分布,胶原纤维形态,并分析腱网膜厚度变化；(2)以苦味酸-天狼猩红染色法,偏振光显微镜观察Ⅰ、Ⅲ胶原,并分析二者含量变化；(3)采用间苯三酚分光光度法,测定蛋白多糖(主要为葡糖氨基葡聚糖)含量.结果 (1)挛缩组腱细胞与胶原纤维间隙不明显,腱细胞呈梭形,囊状,胶原纤维束扭曲,排列散乱,难见细胞间质.腱网膜厚度与健侧(对照组)有明显差异；牵拉组,腱细胞呈圆形或卵圆形,在胶原束间成串排列,细胞与胶原纤维间有基质间隔,见炎症细胞,形态与正常腱组织相似.腱网膜厚度与健侧无明显差异.(2)偏振光显微镜下,挛缩组Ⅰ、Ⅲ胶原构成比与对照组有明显差异,牵拉组Ⅰ、Ⅲ胶原构成比与健侧无明显差异.(3)挛缩组跟腱蛋白多糖含量明显减少,牵拉组基本恢复到正常水平.结论在Ilizarov牵张技术牵拉下,挛缩退化的跟腱组织在组织学上可基本恢复正常.
목적 탐토Ilizarov견장기술적견랍응력대련축근건조직학적영향.방법 18지구우후지응용Ilizarov외고정지가중립위고정1주후개시견랍,1 mm/d,분2차조정,련속3주,X선섭편학정족하수15°,재유지고정3주,수궤선취9지동물처사취재(련축조)；여동물재이동양적속도화방법견랍교정3주후처사취재(견랍조)；소취건측표본합병위대조조.(1) HE염색관찰건세포배렬분포,효원섬유형태,병분석건망막후도변화；(2)이고미산-천랑성홍염색법,편진광현미경관찰Ⅰ、Ⅲ효원,병분석이자함량변화；(3)채용간분삼분분광광도법,측정단백다당(주요위포당안기포취당)함량.결과 (1)련축조건세포여효원섬유간극불명현,건세포정사형,낭상,효원섬유속뉴곡,배렬산란,난견세포간질.건망막후도여건측(대조조)유명현차이；견랍조,건세포정원형혹란원형,재효원속간성천배렬,세포여효원섬유간유기질간격,견염증세포,형태여정상건조직상사.건망막후도여건측무명현차이.(2)편진광현미경하,련축조Ⅰ、Ⅲ효원구성비여대조조유명현차이,견랍조Ⅰ、Ⅲ효원구성비여건측무명현차이.(3)련축조근건단백다당함량명현감소,견랍조기본회복도정상수평.결론 재Ilizarov견장기술견랍하,련축퇴화적근건조직재조직학상가기본회복정상.
Objective To study the histologic changes of contracture Achilles tendon under Ilizarov distraction technique.Methods Eighteen dogs were installed ilizarov external fixation frames on the right hind leg in a neutral position.Pull traction started 1 week postoperatively with speed of 1 mm/day for 3 weeks.After 15 degrees of foot drop,the fixation was still maintained for 3 weeks.Nine animals were randomly selected and put to death (Contracture group),other animals corrected for 3 weeks with the same speed and methods,then put to death (Force group),health specimens as control group.(1)Observe tendon cells arranged distribution and collagen fiber form with HE dyeing,and analysis of tendon retinal thickness with image analysis software.(2)Observe collagen Ⅰ and Ⅲ with picrosirius red dying,and analyzed both content changes with image analysis software.(3)Determination of protein contents of polysaccharide with phloroglucinol spectrophotometry.Results (1)In the contracture group,the collagenous fibre gap was not obvious,the tendon cell assumes spindle-shaped,saccate,the collagen fibrous bundle distortion,the arrangement was scattered in disorder,difficult to see the intercellular substance.Tendon retinal thickness showed obvious differences with the health side (Control group).In the force group,the tendon cells were round or oval,located in collagen bundles in a string of alignment,inflammatory cells were seen.Tendon retinal thickness showed no differences with the health side.(2)With polarized light microscopy,the collagen Ⅰ and collagen Ⅲ composition proportion in the contracture group showed obvious differences with the control group,force group had not obvious differences with health side.(3)The content of polysaccharide in the contracture group were obviously reduced,while force group returned to normal level.Conclusion The tissue form of contracture Achilles tendon can recovered to normal with the Ilizarov technology.