| ObjectiveThis research bases on traditional Chinese medicine theories "the kidney dominates bone, manufactures marrow" to conduct basic and clinical research on how the nourishing kidney herbs effecting of tendon-bone healing after ACL reconstruction, with a expectation to reducing the incidence of bone tunnel enlargement after ACL reconstruction, promoting the growth of graft, finding the theory and evidence of Chinese herbs in prevention and treatment of bone tunnel enlargement after ACL reconstruction.Method1. basic research36 healthy New Zealand rabbit is divided into 3 groups randomly named invigorating kidney yang group, nourishing kidney yin group and control group. these rabbits are all in the model that useing autologous semitendinosus tendon to reconstruct anterior cruciate ligament.After operation, the rabbits in invigorating kidney yang group are feeded kidney-qi-tonifying pill by intragastric administration, the rabbits in nourishing kidney group are feeded liuwei-dihuang pills by intragastric administration and the control group are just feeded saline. The 4th,8th and 12th week after acl reconstruction operation,4 rabbits of each group are executed for bio-mechanical test and histological observation (HE staining and Masson trichrome staining) in the tendon-bone structure.2. clinical research70 patients who need to reconstruct ACL are selected and divided into two groups, Observation group (liuwei dihuang pills+with celecoxib) and control group (celecoxib). there are 35 patients in each group. All these patients underwent tendon autograft transplantation, two groups of patients received basic treatment:taking 0.2g celecoxib capsule twice a day orally, period to 3 months after operation. Observation group take a traditional Chinese medicine-liuwei dihuang pill 30 capsules (0.6g) twice a day addly, period to 12 months after surgery. Lysholm and IKDC score are graded respectively in the preoperation,6 months and 12 months postoperative follow-up on all the patients, in the meantime, two groups of patients are also take MRI examination for the Extracting date of Bone tunnel enlargement ratio, Graft enlargement ratio and Signal-noise ratio in 6 months and 12 months postoperation for comparation.Result1. basic researchThe extreme tension of the graft that implanted to the rabbits during the ACL reconstruction operation were respectively compared by analysis of variance, there is a significant difference from the comparison of data that collected in the 4th,8th, and 12th postoperation (P<0.01).In the 4th week, the degree of tendon-bone healing of the invigorating kidney yang group (87.03+16.50) and the nourishing kidney Yin group(105.36 ±7.94) are better than the control group (52.31 ± 10.70), the differences were statistically significant (P<0.01). Moreover, the degree of tendon-bone healing of nourishing kidney yin group is better than invigorating kidney yang group, the differences between the two groups is significantly (P<0.01) in the 4th week. In the 8th week, the degree of tendon-bone healing of invigorating kidney yang group (121.68+18.24) and nourishing kidney yin group (137.90 ±6.23) is superior to the control group (79.93 ± 18.92).The differences are of statistics significance (P<0.01). There is no statistics significant difference between invigorating kidney yang group and nourishing kidney yin group (P>0.05). In 12th week, the degree of tendon-bone healing of invigorating kidney yang group (143.87±5.69) and invigorating kidney yang group (157.73 ± 5.79) are also superior to control group (87.91 ± 9.78), the differences were statistically significant (P<0.01), however the degree of tendon-bone healing of nourishing kidney yin group is superior to invigorating kidney yang group significantly (P<0.01). Fracture parts of Ligament that grafted to the rabbits during the bio-mechanical test can be divided into three types: dislocate from the bone tunnel, break in the bone tunnel and break outside the bone tunnel. A big part of the Fracture parts in the invigorating kidney yang group and nourishing kidney yin group is break outside the bone tunnel while the control group is dislocate from the bone tunnel, the differences between groups is significantly (P<0.01). In the histological observation, we took HE staining and Masson trichrome staining. During the HE staining observation of the tendon-bone structure, we found that the growth of Fibroblast cells and cartilage cells in the nourishing kidney yin group superior to the invigorating kidney yang group. while the invigorating kidney yang group superior to the control group.During the Masson trichrome staining observation, we found the the growth of the collagenous fiber in the tendon-bone structure of the the nourishing kidney yin group is best, followed the invigorating kidney yang group and the control group is the third.2. clinical researchThere is no statistical significant difference between the observation groupcontrol group on gender, age, Lysholm score, IKDC score, courseofdisease preoperation. The 6th month postoperation,one patient from the observation group lost to follow-up because of going goabroad. The 12th month postoperation,, one patient from the observation group was excluded because of ACL fracture due to trauma, in the meantime, two patient from the control group lost to follow-up because of on business trip. We found that Lysholm score and IKDC scoresignificantly improved based on the date we collected on the 6th and 12th months postoperation compared with preoperation both in item and total score (P<0.05). In Lysholm score, the item of the observation group named instability and climbing and the total score of the observation group improved significantly when compared with the control group when follow-upsurvey on 6th and 12th months postoperation (P<0.05). In IKDC score, the item of the observation group named malaise and subjectivefunction and the total score of the observation group improved significantly when compared with the control group when follow-upsurvey on 6th and 12th months postoperation (P<0.05). On 6th months postoperation, we found that the proximal and middle part of the graft in the observation group expanded greater than the control group (P <0.05). On 12th months postoperation, we found that the The entire graft in the observation group expanded greater than the control group (P<0.05). In the coronal plane observed, two groups of tibial bone tunnel expanded, and the export of the bone tunnel expanded greater than non-export on 6th months and 12th postoperation (P<0.01). In the coronal plane observed, the tibial bone tunnel of the observation groupexpanded less than the control group both in export and non-exportposition on 6th months and 12th postoperation (P< 0.05). In the sagittal plane observed, two groups of tibial bone tunnel expanded, and export position of the bone tunnel expanded greater than non-export on 6th months and 12th postoperation (P<0.05). In the sagittal plane observed, the tibial bone tunnel of the observation groupexpanded less than the control group both in export and non-exportposition on 6th months and 12th postoperation (P<0.05). In the coronal plane observed, two groups of femoral bone tunnel expanded, and the export of the bone tunnel expanded greater than non-export on 6th months and 12th postoperation (P<0.05). In the coronal plane observed, the femoral bone tunnel of the observation groupexpanded less than the control group both in export and non-exportposition on 6th months and 12th postoperation (P<0.05). In the sagittal plane observed, two groups of femoral bone tunnel expanded, and export position of the bone tunnel expanded greater than non-export on 6th month postoperation (P<0.05). In the sagittal plane observed, the femoral bone tunnel of the observation groupexpanded less than the control group in export position on 12th month postoperation (P<0.05).In the coronal plane observed, the femora bone tunnel of the observation groupexpanded less than the control group both in export and non-exportposition on 6th month postoperation (P< 0.05).The export and non-exportposition of the femora bone tunnel of the observation group that observed in the coronal planeexpanded less than that observed in the sagittal plane on 12th month postoperation (P<0.05). The export and non-exportposition of the tibial and femora bone tunnel of the control group that observed in the coronal planeexpanded less than that observed in the sagittal plane on 6th month postoperation (P<0.05). The export and non-exportposition of the tibial bone tunnel and the export of the position of the femorabone tunnel of the observation group that observed in the coronal planeexpanded less than that observed in the sagittal plane on 12th month postoperation (P<0.05). The signal-noise ratio of the tibial side and the middle of the graft in the observation group is higher than the control group on 6th month postoperation (P <0.01). The signal-noise ratio of the tibial side and the middle of the graft in the observation group is lower than the control group on 12th month postoperation (P<0.05).Conclusion1. basic researchKidney tonifying herbs can effectively promotetendon-bone healing after anterior cruciate ligament reconstruction operation and increases the strength of graft in rabbits.2. clinical researchLiuwei dihuang pills help to improve stability of the joint after ACL reconstruction, it maybe involved with its possibility of the reinnervation with ACL and proprioceptive rehabilitation of knee joint. Liuwei dihuang pill promoting tendon-bone healing, prevent bone tunnel enlargement, this role may be involved in the regulation of micro-environment within the joint cavity, and related chemical factors, bone marrow-derived mesenchymal stem cells, osteoblasts and resultant impacts. Liuwei dihuang pill promoting tendon vascularization and accelerated remodeling effects. |
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