后交叉韧带断裂对外侧半月板影响的生物力学和组织学研究
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摘要
后交叉韧带(posterior cruciate ligament, PCL)的主要作用是控制胫骨的后移和旋转。半月板是膝关节的重要组成部分,具有吸收震荡、传递负荷、维持膝关节稳定等重要功能。后交叉韧带损伤是否影响外侧半月板,研究甚少。本研究第一章采用生物力学的方法测试人体膝关节标本在PCL完全断裂和部分断裂时外侧半月板各部位的应变,研究PCL完全断裂和部分断裂对外侧半月板各部位生物力学特性的影响。第二章通过观察兔膝关节PCL断裂后外侧半月板组织结构的变化,MMP-1、MMP13、TIMP-1的表达,探讨PCL断裂后外侧半月板的组织学变化,及MMP-1、MMP13、TIMP-1在半月板继发性损伤中所起的作用。第三章通过对PCL在不同断裂程度、不同载荷和屈膝角度下,测量人膝关节外侧半月板周缘性移位情况,研究其生理性和病理性移位在PCL不同断裂程度、不同载荷和屈膝角度下的变化规律。
目的探讨后交叉韧带损伤后对外侧半月板各部位生物力学特性的影响。
方法新鲜成人正常膝关节标本12具作为PCL完整组,在200N、400N、600N、800N、1000N载荷下,测试膝关节0°、30°、60°、90°位外侧半月板前角、体部和后角的应变,测试完毕后将标本随机分为前外侧束(ALB)断裂组和后内侧束(PMB)断裂组,各6具,造模后同法测试,最后再将12具标本的PCL完全切断进行测试。
结果1.膝关节0°位,前角,体部和后角的应变均为负值,压应变。在200N、400N载荷下,前角、体部、后角的应变在PCL完整组和ALB断裂组之间无显著性差异,P>0.05,在PCL全断组和PMB断裂组之间无显著性差异,P>0.05,前角、体部在PCL全断组和PMB断裂组的应变大于PCL完整组和ALB断裂组,有显著性差异,P<0.05,后角在PCL全断组和PMB断裂组的应变小于PCL完整组和ALB断裂组,有显著性差异,P<0.05；在600N、800N、1000N载荷下各实验组之间均有显著性差异,P<0.05,前角和体部的应变绝对值表现为全断组>PMB断裂组>ALB断裂组>完整组,后角的应变绝对值表现为全断组0.05,全断组和ALB断裂组之间无显著性差异,P>0.05,前角,体部的应变在全断组和ALB断裂组为负值,压应变,在完整组和PMB断裂组为正值,拉应变,有显著性差异,P<0.05,后角的应变在全断组和ALB断裂组为正值,拉应变,在完整组和PMB断裂组为负值,压应变,有显著性差异,P<0.05；在600N、800N、1000N载荷下,前角、体部的应变在全断组和ALB断裂组为负值,压应变,在完整组和PMB断裂组为正值,拉应变,后角的应变在全断组和ALB断裂组为正值,拉应变,在完整组和PMB断裂组为负值,压应变,各实验组之间均有显著性差异,P<0.05,应变绝对值表现为全断组>ALB断裂组,完整组>PMB断裂组。3.膝关节60°、90°位,前角,体部的应变在全断组和ALB断裂组为负值,压应变,在完整组和PMB断裂组为正值,拉应变；后角的应变在全断组和ALB断裂组为正值,拉应变,在完整组和PMB断裂组为负值,压应变,相同载荷下各实验组应变之间有显著差异,P<0.05,应变绝对值表现为全断组>ALB断裂组,完整组>PMB断裂组。
结论(1)PCL完全断裂,在不同载荷和角度下,对外侧半月板前角、体部和后角的应变均有影响。(2)在200N和400N载荷下,ALB断裂在膝关节0。位和PMB切断在膝关节屈曲30°位对外侧半月板前角、体部和后角的应变均无影响。(3)在600N,800N和1000N载荷下,ALB断裂在膝关节O°位和PMB断裂在膝关节屈曲30°位对外侧半月板前角、体部和后角的应变均有影响。(4)在各实验载荷下,ALB断裂在屈膝30°、60°、90°位和PMB断裂在膝0°、60°、90°位对外侧半月板前角、体部和后角的应变均有影响。
目的探讨PCL断裂对外侧半月板组织学的影响和PCL断裂后MMP-1、MMP13、TIMP-1在半月板继发性损伤中所起的作用。
方法60只兔膝关节配对为实验侧和对照侧,实验侧行PCL切断造模,对照侧只显露但不切断PCL。造模后第4、8、12、16、24周各随机处死12只,行外侧半月板形态学观察,并进行HE染色,免疫组化检测MMP-1、MMP13、TIMP-1表达。
结果1.形态学观察,随时间延长,实验组外侧半月板出现磨损,甚至撕裂,呈黄色,弹性差。2.组织学观察,随时间延长,半月板表面不平整,组织疏松,胶原纤维排列紊乱,炎性细胞浸润,间质水肿,软骨细胞变性减少。各实验组和对照组组织学退变评分均有显著性差异,P<0.05。实验组组织学评分4周和8周之间无显著性差异,P>0.05；随实验进程至实验组12,16,24周组织学评分之间均有明显差异,P<0.05。3.实验组MMP-1、MMP13、TIMP-1表达均高于对照组,有显著性差异,P<0.05。4.实验组MMP-1的阳性表达率：4周和8周的阳性表达率之间没有统计学差异(P>0.05),12周,16周和24周的阳性表达率之间没有统计学差异(P>0.05)。12周,16周和24周阳性表达率明显高于4周和8周,均有统计学差异(P<0.05)；5.实验组MMP-13的阳性表达率：(12周,16周)的阳性表达率明显高于(4周,8周)和(24周),12周和4周,12周和8周,12周和24周,16周和4周,16周和8周,16周和24周的阳性表达率均有统计学差异(P<0.05)；4周,8周和24周的阳性表达率之间没有统计学差异(P>0.05)。6.实验组TIMP-1的阳性表达率：12周阳性表达率明显高于其他各周,与其他各周均有统计学差异,P<0.05,其他各周(4周,8周,16周,24周)之间均无统计学差异,P>0.05。
结论1.PCL断裂可引起外侧半月板组织退变,且退变随着时间的推移逐渐加重。2.MMP-1在PCL断裂后膝关节外侧半月板中的表达呈先增高后持续高表达的变化规律；MMP13、TIMP-1在PCL断裂后膝关节外侧半月板中的表达呈先增高后降低的变化规律。3.MMP-1、MMP13、TIMP-1表达的变化可以作为PCL断裂后外侧半月板受损的观察指标。MMP-1、MMP13、TIMP-1表达增高提示MMP-1、MMP13、TIMP-1介导的病理生理机制可能是PCL断裂后外侧半月板退变的原因之一。
目的探讨PCL断裂对外侧半月板周缘性移位的影响以及断裂程度与周缘性移位程度之间的关系。
方法新鲜成人正常膝关节标本12具作为PCL完整组,在200N、400N、600N、800N、1000N载荷下,测量膝关节0°、30°、60°90°位外侧半月板周缘性位移,测量完毕后将标本随机分成前外侧束(ALB)断裂组和后内侧束(PMB)断裂组,各6具,造模后同法测试,最后再将12具标本的PCL完全切断作为全断组进行测量。
结果1.PCL完整时的外侧半月板移位分布在0.5-2.6mm。2.膝O°位,在200N、400N载荷下,完整组和ALB断裂组移位基本相同,无显著性差异,P>0.05,全断组和PMB断裂组移位基本相同,无显著性差异,P>0.05,全断组和PMB断裂组移位大于完整组和ALB断裂组,有显著性差异,P<0.05；在600N、800N、1000N载荷下,完整组移位最小,全断组均最大,PMB断裂组移位大于ALB断裂组,各组间外侧半月板移位均有显著性差异,P<0.05。3.膝关节屈曲30°、60°,在200N、400N载荷下,PMB断裂组和完整组移位基本相同,无显著性差异,P>0.05,ALB断裂组和全断组移位基本相同,无显著性差异,P>0.05,ALB断裂组和全断组移位大于PMB断裂组和完整组,有显著性差异,P<0.05；在600N、800N、1000N载荷下,PMB断裂组移位较完整组增大,全断组移位较ALB断裂组增大,完整组移位最小,全断组移位最大, ALB断裂组移位大于PMB断裂组,各组间外侧半月板移位均有显著性差异,P<0.05。4.膝关节屈曲90。,在200N载荷下,PMB切断组移位与完整组大致相同,无显著性差异,P>0.05,ALB断裂组移位与全断组大致相同,无显著性差异,P>0.05,ALB断裂组和全断组移位大于PMB断裂组和完整组,有显著性差异,P<0.05；在400N、600N、800N、1000N载荷下,PMB断裂组移位较完整组明显增大,全断组移位较ALB断裂组明显增大。完整组移位最小,全断组移位最大, ALB断裂组移位大于PMB断裂组,各组间外侧半月板移位均有显著性差异,P<0.05。
结论(1)外侧半月板生理性移位范围为0.5-2.6mm。(2)ALB断裂后外侧半月板在膝关节屈曲时移位明显增大。(3)PMB断裂后外侧半月板在膝关节伸直时移位明显增大。(4)PCL完全断裂后外侧半月板在膝关节屈曲、伸直时移位均明显增大。(5)PCL损伤后外侧半月板移位明显,提示PCL损伤是外侧半月板退变的原因之一。
Main roles of the posterior cruciate ligament (PCL) are to controll the posterior translation of tibia and to regulate the rotation of tibia. Lateral meniscus is a vital part of the knee,which can absorp shock, transmiss stress and stabilize the knee. In this study, Chapter one:strainings changes in different sites of lateral meniscus caused by PCL deficiency or rupture are observed through biomechanical approach to investigate biomechanical effect of deficiency or rupture of PCL on lateral meniscus. Chapter two:histological changes of meniscus and expression of MMP-1,MMP13&TIMP-1 in lateral meniscus are observed for investigating roles of MMP-1,MMP13&TIMP-1 in the degradation of lateral meniscus. Chapter three:the circumferentia displacement of lateral meniscus after PCL deficiency or rupture is measured, so as to provide theoretical evidence about whether deficiency or rupture of PCL has effects on the lateral meniscus. This study have very important meanings for the protection of lateral meniscus and the avoidance of osteoarthritis after PCL injury.
OBJECTIVE To investigate biomechanical effect of rupture of PCL on lateral meniscus.
METHOD Strainings of lateral meniscus anterior horn, caudomedial part and posterior horn in all fresh normal adult knee joint specimens including 12 specimens of intact PCL,6 of antelateral bundle(ALB) rupture,6 of postmedial bundle(PMB) rupture and 12 of complete rupture PCL are tested when the knee joints are loaded 200N,400N,600N,800N and 1000N at 0°,30°,60°and 90°of flexion.
RESULT 1. At 0°of knee flexion, Strainings of anterior horn, caudomedial part& posterior horn are all negative values, pressing strainings. Strainings of lateral meniscus'anterior horn, caudomedial part and posterior horn show no significant difference between PMB rupture group and PCL complete rupture group,intact PCL group and ALB rupture group under the load of 200N and 400N,P>0.05, strainings of anterior horn, caudomedial part in PMB rupture group and PCL complete rupture group are bigger than that in intact PCL group and ALB rupture group,which have significant difference, P<0.05, strainings of posterior horn in PMB rupture group and PCL complete rupture group is smaller than intact PCL group and ALB rupture group, which have significant difference, P<0.05; significant difference is showed among all the groups under the loads of 600N,800N,1000N,P<0.05, under the same load and angle of flexion, the correlation of the absolute value of straining in every group of lateral meniscus'anterior horn and caudomedial part increases in this way of PCL complete rupture group> PMB rupture group>ALB rupture group>PCL intact group,and posterior horn increases in this way of PCL complete rupture group< PMB rupture group 0.05, Anterior horn& caudomedial part in PCL complete rupture group& ALB rupture group are negative values, pressing strainings, in PCL intact group& PMB rupture group are positive values, pulling strainings, which have significant difference, P<0.05, posterior horn in PCL complete rupture group& ALB rupture group are positive values, pulling strainings, in PCL intact group& PMB rupture group are negative values, pressing strainings, which have significant difference, P< 0.05; significant difference is showed among all the groups under the load of 600N,800N, 1000N,P<0.05, under the same load and angle of flexion, the correlation of the absolute value of straining in every group increases in this way of PCL complete rupture group>ALB rupture group,PCL intact group> PMB rupture group.3. At 60°and 90°of flexion, anterior horn &caudomedial part in PCL complete rupture group& ALB rupture group are negative values, pressing strainings, in PCL intact group& PMB rupture group are positive values, pulling strainings; posterior horn in PCL complete rupture group& ALB rupture group are positive values, pulling strainings, in PCL intact group& PMB rupture group are negative values, pressing strainings. There is significant difference among all the groups under the load of 200N,400N,600N,800N,1000N,P<0.05. under the same load and angle of flexion, the correlation of the absolute value of straining in every group increases in this way of PCL complete rupture group>ALB rupture group, PCL intact group>PMB rupture group.
CONCLUSION 1.PCL complete rupture is likely to cause abnormal strainings in all regions of lateral meniscus under different load and angle of flexion.2. Under the load of 200N and 400N, ALB rupture at 0°of flexion and PMB rupture at 30°of flexion have no effect on strainings in all regions of lateral meniscus.3. Under the load of 600N,800N and 1000N, ALB rupture at 0°of flexion and PMB rupture at 30°of flexion have obvious effect on strainings in all regions of lateral meniscus.4. Abnormal strainings in all regions of lateral meniscus can be caused by PMB rupture at 0°,60°,90°of flexion and ALB rupture at 30°,60°and 90°of flexion under different load.
OBJECTIVE To study histological effects on lateral meniscus and roles of MMP1,MMP13&TIMP-1 in the secondary injury of the lateral meniscus after rupture of PCL.
METHOD Lateral meniscus of 60 rabbits matched mode pairs in experiment side which PCL were transected and in control side which PCL were intact, at the 4th,8th,12th,16th,24th week,execute 12 rabbits randomly,then to observe lateral meniscus in general view and through HE staining and through immunohistological staining, to detect expressions of MMP1,MMP13&TIMP-1.
RESULT 1. The observation in general view showed that with times lateral meniscus of experiment group gradually wore,even ruptured, presenting yellow color and bad elasticity.2. With times the observation of histology shows uneven surface of meniscus,loose tissue, disorders of collagen fibers, infiltration of inflammatory cell,interstitial edema and deformation of intracytoplasm mitochondrion in the chondrocytes. Histological evaluation of the degeneration in fibrocartilage of meniscus in both groups:The scores at 4th,8th,12th,16th,24th week were higher in the experimental group than those in the control group,showing significant difference, P<0.05; the scores of experimental group at 12th,16th,24th week was higher than that at 4th and 8th week, showing significant difference, P< 0.05,but there is no significant difference between the 4th and 8th week, P> 0.05.3. At the 4th,8th,12th,16th,24th week,expressions of MMP1,MMP13&TIMP-1 are higher in experimental group than that in control group, showing significant difference, P< 0.05.4. In experimental group, the expression of MMP 1 is higher at (12w,16w,24w) than that at
(4w,8w),showing significant difference, P< 0.05,; but there is no significant difference between 4w and 8w, P> 0.05. there is no significant difference among 12w,16w,24w, P> 0.05.5. In experimental group, there is no significant difference between 4w and 8w, there is no significant difference between 12w and 16w, P> 0.05; the expression of MMP 13 is higher at (12w,16w) than that at (4w,8w)& (24w),showing significant difference among 12w&4w,12w&8w,12w&24w,16w&4w, 16w&8w,16w&24w, P< 0.05.6. In experimental group,the expression of TIMP-1 is obviously higher at 12w than any other weeks, P< 0.05, there is no significant difference among 4w,8w,16w& 24w, P> 0.05.
CONCLUSION 1. Rupture of PCL can cause the degeneration of lateral meniscus with times.2. MMP-1 displays rising firstly then expressing consistently after the rupture of PCL; MMP 13, TIMP-1 displays high expression firstly then low expression in advanced stage after the rupture of PCL.3. MMP-1,MMP13,TIMP-1 can be observed as an index for the injury of lateral menicus after the rupture of PCL. The high expression of MMP-1,MMP13,TIMP-1 hints that the physiopathological mechanism triggered by MMP-1,MMP13,TIMP-1 is maybe one cause of the degeneration of lateral meniscus after the rupture of PCL.
OBJECTIVE To explore the effect of PCL rupture on lateral meniscus circumferentia displacement and the correlation between the degree of PCL rupture and circumferentia displacement.
METHOD The circumferentia displacement of lateral meniscus in all fresh normal adult knee joint specimens including 12 specimens of PCL intact,6 of anterolateral bundle(ALB) rupture,6 of postmedial bundle rupture(PMB) and 12 of complete rupture PCL are tested when the knee joints loaded 200N,400N,600N,800N,1000N at 0°,30°,60°and 90°of flexion.
RESULT 1.The range of circumferentia displacement of lateral meniscus distributes between 0.5-2.6mm in PCL intact group.2. At 0°of knee flexion, under the loads of 200N,400N, the circumferentia displacement of lateral meniscus between PCL complete rupture group and PMB rupture group, PCL intact group and ALB rupture group shows no significant difference, P>0.05, the circumferentia displacement in PCL complete rupture group and PMB rupture group is bigger than in PCL intact group and ALB rupture group,showing significant difference, P<0.05; there is significant difference among each group under the load of 600N,800N,1000N, P<0.05.3. at 30°and 60°of flexion,under the loads of 200N and 400N, the circumferentia displacement of lateral meniscus between PCL intact group and PMB rupture group, PCL complete rupture group and ALB rupture group shows no significant difference, P>0.05, the circumferentia displacement in PCL complete rupture group and ALB rupture group is bigger than in PCL intact group and PMB rupture group,showing significant difference, P<0.05; Under the loads of 600N,800N and 1000N, the circumferentia displacement among every group shows significant difference at 30°and 60°of flexion, P<0.05.4. At 90°of flexion,under the loads of 200N, the circumferentia displacement of lateral meniscus between PCL intact group and PMB rupture group, PCL rupture group and ALB rupture group shows no significant difference at 90°of flexion,P>0.05, the circumferentia displacement in PCL complete rupture group and ALB rupture group is bigger than in PCL intact group and PMB rupture group,showing significant difference, P<0.05; Under the loads of 200N,600N,800N and 1000N the circumferentia displacement among every group shows significant difference at 90°of flexion, P<0.05.
CONCLUSION l.The physiological circumferentia displacement of lateral meniscus is between 0.5mm and 2.6mm.2.The circumferentia displacement of lateral meniscus in ALB rupture group at flexed position of the knee becomes much bigger than that in PCL intact group.3.The circumferentia displacement of lateral meniscus in PMB rupture group at extended position of the knee becomes much bigger than that in PCL intact group.4.The circumferentia displacement of lateral meniscus becomes much bigger at all position of the knee when the PCL is ruptured completely.5.The abnormal circumferentia displacement of lateral meniscus after PCL rupture hints that PCL rupture maybe a factor which causes the degeneration of lateral meniscus.
目的探讨后交叉韧带损伤后对外侧半月板各部位生物力学特性的影响。
方法新鲜成人正常膝关节标本12具作为PCL完整组,在200N、400N、600N、800N、1000N载荷下,测试膝关节0°、30°、60°、90°位外侧半月板前角、体部和后角的应变,测试完毕后将标本随机分为前外侧束(ALB)断裂组和后内侧束(PMB)断裂组,各6具,造模后同法测试,最后再将12具标本的PCL完全切断进行测试。
结果1.膝关节0°位,前角,体部和后角的应变均为负值,压应变。在200N、400N载荷下,前角、体部、后角的应变在PCL完整组和ALB断裂组之间无显著性差异,P>0.05,在PCL全断组和PMB断裂组之间无显著性差异,P>0.05,前角、体部在PCL全断组和PMB断裂组的应变大于PCL完整组和ALB断裂组,有显著性差异,P<0.05,后角在PCL全断组和PMB断裂组的应变小于PCL完整组和ALB断裂组,有显著性差异,P<0.05；在600N、800N、1000N载荷下各实验组之间均有显著性差异,P<0.05,前角和体部的应变绝对值表现为全断组>PMB断裂组>ALB断裂组>完整组,后角的应变绝对值表现为全断组
结论(1)PCL完全断裂,在不同载荷和角度下,对外侧半月板前角、体部和后角的应变均有影响。(2)在200N和400N载荷下,ALB断裂在膝关节0。位和PMB切断在膝关节屈曲30°位对外侧半月板前角、体部和后角的应变均无影响。(3)在600N,800N和1000N载荷下,ALB断裂在膝关节O°位和PMB断裂在膝关节屈曲30°位对外侧半月板前角、体部和后角的应变均有影响。(4)在各实验载荷下,ALB断裂在屈膝30°、60°、90°位和PMB断裂在膝0°、60°、90°位对外侧半月板前角、体部和后角的应变均有影响。
目的探讨PCL断裂对外侧半月板组织学的影响和PCL断裂后MMP-1、MMP13、TIMP-1在半月板继发性损伤中所起的作用。
方法60只兔膝关节配对为实验侧和对照侧,实验侧行PCL切断造模,对照侧只显露但不切断PCL。造模后第4、8、12、16、24周各随机处死12只,行外侧半月板形态学观察,并进行HE染色,免疫组化检测MMP-1、MMP13、TIMP-1表达。
结果1.形态学观察,随时间延长,实验组外侧半月板出现磨损,甚至撕裂,呈黄色,弹性差。2.组织学观察,随时间延长,半月板表面不平整,组织疏松,胶原纤维排列紊乱,炎性细胞浸润,间质水肿,软骨细胞变性减少。各实验组和对照组组织学退变评分均有显著性差异,P<0.05。实验组组织学评分4周和8周之间无显著性差异,P>0.05；随实验进程至实验组12,16,24周组织学评分之间均有明显差异,P<0.05。3.实验组MMP-1、MMP13、TIMP-1表达均高于对照组,有显著性差异,P<0.05。4.实验组MMP-1的阳性表达率：4周和8周的阳性表达率之间没有统计学差异(P>0.05),12周,16周和24周的阳性表达率之间没有统计学差异(P>0.05)。12周,16周和24周阳性表达率明显高于4周和8周,均有统计学差异(P<0.05)；5.实验组MMP-13的阳性表达率：(12周,16周)的阳性表达率明显高于(4周,8周)和(24周),12周和4周,12周和8周,12周和24周,16周和4周,16周和8周,16周和24周的阳性表达率均有统计学差异(P<0.05)；4周,8周和24周的阳性表达率之间没有统计学差异(P>0.05)。6.实验组TIMP-1的阳性表达率：12周阳性表达率明显高于其他各周,与其他各周均有统计学差异,P<0.05,其他各周(4周,8周,16周,24周)之间均无统计学差异,P>0.05。
结论1.PCL断裂可引起外侧半月板组织退变,且退变随着时间的推移逐渐加重。2.MMP-1在PCL断裂后膝关节外侧半月板中的表达呈先增高后持续高表达的变化规律；MMP13、TIMP-1在PCL断裂后膝关节外侧半月板中的表达呈先增高后降低的变化规律。3.MMP-1、MMP13、TIMP-1表达的变化可以作为PCL断裂后外侧半月板受损的观察指标。MMP-1、MMP13、TIMP-1表达增高提示MMP-1、MMP13、TIMP-1介导的病理生理机制可能是PCL断裂后外侧半月板退变的原因之一。
目的探讨PCL断裂对外侧半月板周缘性移位的影响以及断裂程度与周缘性移位程度之间的关系。
方法新鲜成人正常膝关节标本12具作为PCL完整组,在200N、400N、600N、800N、1000N载荷下,测量膝关节0°、30°、60°90°位外侧半月板周缘性位移,测量完毕后将标本随机分成前外侧束(ALB)断裂组和后内侧束(PMB)断裂组,各6具,造模后同法测试,最后再将12具标本的PCL完全切断作为全断组进行测量。
结果1.PCL完整时的外侧半月板移位分布在0.5-2.6mm。2.膝O°位,在200N、400N载荷下,完整组和ALB断裂组移位基本相同,无显著性差异,P>0.05,全断组和PMB断裂组移位基本相同,无显著性差异,P>0.05,全断组和PMB断裂组移位大于完整组和ALB断裂组,有显著性差异,P<0.05；在600N、800N、1000N载荷下,完整组移位最小,全断组均最大,PMB断裂组移位大于ALB断裂组,各组间外侧半月板移位均有显著性差异,P<0.05。3.膝关节屈曲30°、60°,在200N、400N载荷下,PMB断裂组和完整组移位基本相同,无显著性差异,P>0.05,ALB断裂组和全断组移位基本相同,无显著性差异,P>0.05,ALB断裂组和全断组移位大于PMB断裂组和完整组,有显著性差异,P<0.05；在600N、800N、1000N载荷下,PMB断裂组移位较完整组增大,全断组移位较ALB断裂组增大,完整组移位最小,全断组移位最大, ALB断裂组移位大于PMB断裂组,各组间外侧半月板移位均有显著性差异,P<0.05。4.膝关节屈曲90。,在200N载荷下,PMB切断组移位与完整组大致相同,无显著性差异,P>0.05,ALB断裂组移位与全断组大致相同,无显著性差异,P>0.05,ALB断裂组和全断组移位大于PMB断裂组和完整组,有显著性差异,P<0.05；在400N、600N、800N、1000N载荷下,PMB断裂组移位较完整组明显增大,全断组移位较ALB断裂组明显增大。完整组移位最小,全断组移位最大, ALB断裂组移位大于PMB断裂组,各组间外侧半月板移位均有显著性差异,P<0.05。
结论(1)外侧半月板生理性移位范围为0.5-2.6mm。(2)ALB断裂后外侧半月板在膝关节屈曲时移位明显增大。(3)PMB断裂后外侧半月板在膝关节伸直时移位明显增大。(4)PCL完全断裂后外侧半月板在膝关节屈曲、伸直时移位均明显增大。(5)PCL损伤后外侧半月板移位明显,提示PCL损伤是外侧半月板退变的原因之一。
Main roles of the posterior cruciate ligament (PCL) are to controll the posterior translation of tibia and to regulate the rotation of tibia. Lateral meniscus is a vital part of the knee,which can absorp shock, transmiss stress and stabilize the knee. In this study, Chapter one:strainings changes in different sites of lateral meniscus caused by PCL deficiency or rupture are observed through biomechanical approach to investigate biomechanical effect of deficiency or rupture of PCL on lateral meniscus. Chapter two:histological changes of meniscus and expression of MMP-1,MMP13&TIMP-1 in lateral meniscus are observed for investigating roles of MMP-1,MMP13&TIMP-1 in the degradation of lateral meniscus. Chapter three:the circumferentia displacement of lateral meniscus after PCL deficiency or rupture is measured, so as to provide theoretical evidence about whether deficiency or rupture of PCL has effects on the lateral meniscus. This study have very important meanings for the protection of lateral meniscus and the avoidance of osteoarthritis after PCL injury.
OBJECTIVE To investigate biomechanical effect of rupture of PCL on lateral meniscus.
METHOD Strainings of lateral meniscus anterior horn, caudomedial part and posterior horn in all fresh normal adult knee joint specimens including 12 specimens of intact PCL,6 of antelateral bundle(ALB) rupture,6 of postmedial bundle(PMB) rupture and 12 of complete rupture PCL are tested when the knee joints are loaded 200N,400N,600N,800N and 1000N at 0°,30°,60°and 90°of flexion.
RESULT 1. At 0°of knee flexion, Strainings of anterior horn, caudomedial part& posterior horn are all negative values, pressing strainings. Strainings of lateral meniscus'anterior horn, caudomedial part and posterior horn show no significant difference between PMB rupture group and PCL complete rupture group,intact PCL group and ALB rupture group under the load of 200N and 400N,P>0.05, strainings of anterior horn, caudomedial part in PMB rupture group and PCL complete rupture group are bigger than that in intact PCL group and ALB rupture group,which have significant difference, P<0.05, strainings of posterior horn in PMB rupture group and PCL complete rupture group is smaller than intact PCL group and ALB rupture group, which have significant difference, P<0.05; significant difference is showed among all the groups under the loads of 600N,800N,1000N,P<0.05, under the same load and angle of flexion, the correlation of the absolute value of straining in every group of lateral meniscus'anterior horn and caudomedial part increases in this way of PCL complete rupture group> PMB rupture group>ALB rupture group>PCL intact group,and posterior horn increases in this way of PCL complete rupture group< PMB rupture group
CONCLUSION 1.PCL complete rupture is likely to cause abnormal strainings in all regions of lateral meniscus under different load and angle of flexion.2. Under the load of 200N and 400N, ALB rupture at 0°of flexion and PMB rupture at 30°of flexion have no effect on strainings in all regions of lateral meniscus.3. Under the load of 600N,800N and 1000N, ALB rupture at 0°of flexion and PMB rupture at 30°of flexion have obvious effect on strainings in all regions of lateral meniscus.4. Abnormal strainings in all regions of lateral meniscus can be caused by PMB rupture at 0°,60°,90°of flexion and ALB rupture at 30°,60°and 90°of flexion under different load.
OBJECTIVE To study histological effects on lateral meniscus and roles of MMP1,MMP13&TIMP-1 in the secondary injury of the lateral meniscus after rupture of PCL.
METHOD Lateral meniscus of 60 rabbits matched mode pairs in experiment side which PCL were transected and in control side which PCL were intact, at the 4th,8th,12th,16th,24th week,execute 12 rabbits randomly,then to observe lateral meniscus in general view and through HE staining and through immunohistological staining, to detect expressions of MMP1,MMP13&TIMP-1.
RESULT 1. The observation in general view showed that with times lateral meniscus of experiment group gradually wore,even ruptured, presenting yellow color and bad elasticity.2. With times the observation of histology shows uneven surface of meniscus,loose tissue, disorders of collagen fibers, infiltration of inflammatory cell,interstitial edema and deformation of intracytoplasm mitochondrion in the chondrocytes. Histological evaluation of the degeneration in fibrocartilage of meniscus in both groups:The scores at 4th,8th,12th,16th,24th week were higher in the experimental group than those in the control group,showing significant difference, P<0.05; the scores of experimental group at 12th,16th,24th week was higher than that at 4th and 8th week, showing significant difference, P< 0.05,but there is no significant difference between the 4th and 8th week, P> 0.05.3. At the 4th,8th,12th,16th,24th week,expressions of MMP1,MMP13&TIMP-1 are higher in experimental group than that in control group, showing significant difference, P< 0.05.4. In experimental group, the expression of MMP 1 is higher at (12w,16w,24w) than that at
(4w,8w),showing significant difference, P< 0.05,; but there is no significant difference between 4w and 8w, P> 0.05. there is no significant difference among 12w,16w,24w, P> 0.05.5. In experimental group, there is no significant difference between 4w and 8w, there is no significant difference between 12w and 16w, P> 0.05; the expression of MMP 13 is higher at (12w,16w) than that at (4w,8w)& (24w),showing significant difference among 12w&4w,12w&8w,12w&24w,16w&4w, 16w&8w,16w&24w, P< 0.05.6. In experimental group,the expression of TIMP-1 is obviously higher at 12w than any other weeks, P< 0.05, there is no significant difference among 4w,8w,16w& 24w, P> 0.05.
CONCLUSION 1. Rupture of PCL can cause the degeneration of lateral meniscus with times.2. MMP-1 displays rising firstly then expressing consistently after the rupture of PCL; MMP 13, TIMP-1 displays high expression firstly then low expression in advanced stage after the rupture of PCL.3. MMP-1,MMP13,TIMP-1 can be observed as an index for the injury of lateral menicus after the rupture of PCL. The high expression of MMP-1,MMP13,TIMP-1 hints that the physiopathological mechanism triggered by MMP-1,MMP13,TIMP-1 is maybe one cause of the degeneration of lateral meniscus after the rupture of PCL.
OBJECTIVE To explore the effect of PCL rupture on lateral meniscus circumferentia displacement and the correlation between the degree of PCL rupture and circumferentia displacement.
METHOD The circumferentia displacement of lateral meniscus in all fresh normal adult knee joint specimens including 12 specimens of PCL intact,6 of anterolateral bundle(ALB) rupture,6 of postmedial bundle rupture(PMB) and 12 of complete rupture PCL are tested when the knee joints loaded 200N,400N,600N,800N,1000N at 0°,30°,60°and 90°of flexion.
RESULT 1.The range of circumferentia displacement of lateral meniscus distributes between 0.5-2.6mm in PCL intact group.2. At 0°of knee flexion, under the loads of 200N,400N, the circumferentia displacement of lateral meniscus between PCL complete rupture group and PMB rupture group, PCL intact group and ALB rupture group shows no significant difference, P>0.05, the circumferentia displacement in PCL complete rupture group and PMB rupture group is bigger than in PCL intact group and ALB rupture group,showing significant difference, P<0.05; there is significant difference among each group under the load of 600N,800N,1000N, P<0.05.3. at 30°and 60°of flexion,under the loads of 200N and 400N, the circumferentia displacement of lateral meniscus between PCL intact group and PMB rupture group, PCL complete rupture group and ALB rupture group shows no significant difference, P>0.05, the circumferentia displacement in PCL complete rupture group and ALB rupture group is bigger than in PCL intact group and PMB rupture group,showing significant difference, P<0.05; Under the loads of 600N,800N and 1000N, the circumferentia displacement among every group shows significant difference at 30°and 60°of flexion, P<0.05.4. At 90°of flexion,under the loads of 200N, the circumferentia displacement of lateral meniscus between PCL intact group and PMB rupture group, PCL rupture group and ALB rupture group shows no significant difference at 90°of flexion,P>0.05, the circumferentia displacement in PCL complete rupture group and ALB rupture group is bigger than in PCL intact group and PMB rupture group,showing significant difference, P<0.05; Under the loads of 200N,600N,800N and 1000N the circumferentia displacement among every group shows significant difference at 90°of flexion, P<0.05.
CONCLUSION l.The physiological circumferentia displacement of lateral meniscus is between 0.5mm and 2.6mm.2.The circumferentia displacement of lateral meniscus in ALB rupture group at flexed position of the knee becomes much bigger than that in PCL intact group.3.The circumferentia displacement of lateral meniscus in PMB rupture group at extended position of the knee becomes much bigger than that in PCL intact group.4.The circumferentia displacement of lateral meniscus becomes much bigger at all position of the knee when the PCL is ruptured completely.5.The abnormal circumferentia displacement of lateral meniscus after PCL rupture hints that PCL rupture maybe a factor which causes the degeneration of lateral meniscus.
引文
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