Vai trò của cơ học trong việc hiểu biết về dây chằng và gân bình thường, bị tổn thương và đang hồi phục

Hosung Jung1, Matthew B. Fisher1, Savio L‐Y. Woo1
1Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, USA

Tóm tắt

Tóm tắt

Dây chằng và gân là các mô liên kết mềm, có vai trò quan trọng trong chức năng sinh học của hệ thống cơ xương thông qua việc ổn định và hướng dẫn chuyển động của các khớp hoạt dịch. Tuy nhiên, các mô này thường bị chấn thương do sự lặp lại, sử dụng quá mức cũng như do các chuyển động cắt nhanh có liên quan đến gia tốc và giảm tốc. Những chấn thương này thường làm mất cân bằng giữa khả năng di động và ổn định của khớp, dẫn đến tổn hại cho các mô mềm khác, biểu hiện dưới dạng đau đớn và các bệnh lý khác, chẳng hạn như thoái hóa khớp.

Quá trình hồi phục của các chấn thương dây chằng và gân thay đổi từ mô này sang mô khác. Các bệnh lý gân là rất phổ biến và có thể kéo dài đến 12 tháng để cơn đau giảm bớt trước khi người bệnh có thể trở lại hoạt động bình thường. Một vết rách dây chằng bên trong (MCL) thường có khả năng tự hồi phục; tuy nhiên, quá trình tái tạo của nó mất nhiều năm và các tính chất sinh học của nó vẫn kém hơn so với MCL bình thường. Cũng cần lưu ý rằng một vết rách toàn bộ dây chằng chéo trước (ACL) có khả năng hồi phục hạn chế, và đã có các phương pháp tái tạo bằng các ghép mô mềm được thực hiện thường xuyên để phục hồi chức năng gối. Tuy nhiên, các nghiên cứu theo dõi lâu dài đã tiết lộ rằng 20–25% bệnh nhân gặp phải kết quả không đạt yêu cầu. Do đó, việc hiểu rõ hơn về chức năng của các dây chằng và gân, cùng với kiến thức về khả năng hồi phục của chúng, có thể giúp các nhà nghiên cứu phát triển các chiến lược mới để tăng tốc và cải thiện quá trình hồi phục của dây chằng và gân.

Với hàng nghìn bài báo mới được công bố trong mười năm qua liên quan đến cơ học của dây chằng và gân, lĩnh vực này ngày càng được đánh giá cao. Sự chú ý này đã có tác động tích cực đến thực hành lâm sàng. Mặt khác, dữ liệu cơ học phức tạp về bản chất, và có nguy cơ bị hiểu sai. Do đó, trong bài đánh giá này, chúng tôi sẽ cung cấp cho độc giả một cái nhìn tổng quan ngắn gọn về dây chằng và gân, cũng như giới thiệu các phương pháp phù hợp được sử dụng để thu thập các tính chất sinh học của chúng. Cụ thể, chúng tôi hy vọng độc giả sẽ chú ý đến cách mà các thuộc tính của những mô này có thể bị thay đổi do các yếu tố thí nghiệm và sinh học khác nhau. Sau phần tài liệu nền tảng này, chúng tôi sẽ trình bày cách mà cơ học có thể được áp dụng để hiểu các cơ chế cũng như quản lý lâm sàng các rối loạn liên quan đến dây chằng và gân. Để kết thúc, công nghệ mới, bao gồm hình ảnh y học, robot cũng như kỹ thuật tạo cấu trúc chức năng, có thể hình thành các chiến lược điều trị mới nhằm tăng cường hồi phục cho dây chằng và gân sẽ được trình bày.

Từ khóa


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Reider B, Sathy MR, Talkington J, Blyznak N, Kollias S: Treatment of isolated medial collateral ligament injuries in athletes with early functional rehabilitation. A five-year follow-up study. Am J Sports Med. 1994, 22: 470-477. 10.1177/036354659402200406.

Woo SL-Y, Inoue M, McGurk-Burleson E, Gomez MA: Treatment of the medial collateral ligament injury. II: Structure and function of canine knees in response to differing treatment regimens. American Journal of Sports Medicine. 1987, 15: 22-29. 10.1177/036354658701500104.

Inoue M, Woo SL-Y, Gomez MA, Amiel D, Ohland KJ, Kitabayashi LR: Effects of surgical treatment and immobilization on the healing of the medial collateral ligament: a long-term multidisciplinary study. Connect Tissue Res. 1990, 25: 13-26. 10.3109/03008209009009809.

Loitz-Ramage BJ, Frank CB, Shrive NG: Injury size affects long-term strength of the rabbit medial collateral ligament. Clinical Orthopaedics & Related Research. 1997, 272-280.

Ohno K, Pomaybo AS, Schmidt CC, Levine RE, Ohland KJ, Woo SL-Y: Healing of the medial collateral ligament after a combined medial collateral and anterior cruciate ligament injury and reconstruction of the anterior cruciate ligament: comparison of repair and nonrepair of medial collateral ligament tears in rabbits. J Orthop Res. 1995, 13: 442-449. 10.1002/jor.1100130319.

Frolke JP, Oskam J, Vierhout PA: Primary reconstruction of the medial collateral ligament in combined injury of the medial collateral and anterior cruciate ligaments. Short-term results. Knee Surg Sports Traumatol Arthrosc. 1998, 6: 103-106. 10.1007/s001670050081.

Hillard-Sembell D, Daniel DM, Stone ML, Dobson BE, Fithian DC: Combined injuries of the anterior cruciate and medial collateral ligaments of the knee. Effect of treatment on stability and function of the joint. J Bone Joint Surg Am. 1996, 78: 169-176.

Inoue M, McGurk-Burleson E, Hollis JM, Woo SL-Y: Treatment of the medial collateral ligament injury. I: The importance of anterior cruciate ligament on the varus-valgus knee laxity. Am J Sports Med. 1987, 15: 15-21. 10.1177/036354658701500103.

Abramowitch SD, Yagi M, Tsuda E, Woo SL-Y: The healing medial collateral ligament following a combined anterior cruciate and medial collateral ligament injury–a biomechanical study in a goat model. J Orthop Res. 2003, 21: 1124-1130. 10.1016/S0736-0266(03)00080-9.

Bellincampi LD, Closkey RF, Prasad R, Zawadsky JP, Dunn MG: Viability of fibroblast-seeded ligament analogs after autogenous implantation. J Orthop Res. 1998, 16: 414-420. 10.1002/jor.1100160404.

Spindler KP, Murray MM, Detwiler KB, Tarter JT, Dawson JM, Nanney LB, Davidson JM: The biomechanical response to doses of TGF-beta 2 in the healing rabbit medial collateral ligament. J Orthop Res. 2003, 21: 245-249. 10.1016/S0736-0266(02)00145-6.

Woo SL-Y, Takakura Y, Liang R: Treatment with bioscaffold enhances the collagen composition and fibril morphology of the healing medial collateral ligament in rabbits. Tissue Eng. 2006, 12: 159-166. 10.1089/ten.2006.12.159.

Liang R, Woo SL-Y, Takakura Y, Moon DK, Jia F, Abramowitch SD: Long-term effects of porcine small intestine submucosa on the healing of medial collateral ligament: a functional tissue engineering study. J Orthop Res. 2006, 24: 811-819. 10.1002/jor.20080.

Jacobson M, Fufa D, Abreu EL, Kevy S, Murray MM: Platelets, but not erythrocytes, significantly affect cytokine release and scaffold contraction in a provisional scaffold model. Wound Repair Regen. 2008, 16: 370-378. 10.1111/j.1524-475X.2008.00376.x.

Agung M, Ochi M, Yanada S, Adachi N, Izuta Y, Yamasaki T, Toda K: Mobilization of bone marrow-derived mesenchymal stem cells into the injured tissues after intraarticular injection and their contribution to tissue regeneration. Knee Surg Sports Traumatol Arthrosc. 2006, 14: 1307-1314. 10.1007/s00167-006-0124-8.

Karaoglu S, Fisher MB, Woo SL-Y, Fu YC, Liang R, Abramowitch SD: Use of a Bioscaffold to Improve Healing of a Patellar Tendon Defect After Graft Harvest for ACL Reconstruction: A Study in Rabbits. J Orthop Res. 2008, 26: 255-263. 10.1002/jor.20471.

Woo SL-Y, Takakura Y, Liang R, Jia F, Moon DK: Treatment with bioscaffold enhances the the fibril morphology and the collagen composition of healing medial collateral ligament in rabbits. Tissue Eng. 2006, 12: 159-166. 10.1089/ten.2006.12.159.

Liang R, Woo SL-Y, Nguyen TD, Liu PC, Almarza A: Effects of a bioscaffold on collagen fibrillogenesis in healing medial collateral ligament in rabbits. J Orthop Res. 2008, 26: 1098-1104. 10.1002/jor.20616.

Murray MM: Current status and potential of primary ACL repair. Clin Sports Med. 2009, 28: 51-61. 10.1016/j.csm.2008.08.005.

Murray MM, Fleming BC, Abreu E, Magarian E, Mastrangelo A, Palmer M, Spindler KP: Collagen-Platelet Rich Plasma Hydrogel Enhances Primary Repair of the Porcine Anterior Cruciate Ligament. International Symposium on Ligaments and Tendons VIII; March 1; Stanford, CA. 2008, 38.

Nguyen TD, Liang R, Woo SL-Y, Burton SD, Wu C, Almarza A, Sacks MS, Abramowitch S: Effects of Cell Seeding and Cyclic Stretch on the Fiber Remodeling in an Extracellular Matrix-Derived Bioscaffold. Tissue Eng Part A. 2009, 15: 957-963. 10.1089/ten.tea.2007.0384.

Giphart JE, Shelburne KB, Anstett K, Brunkhorst JP, Pault JD, Woo SL-Y, Steadman JR, Torry MR: Measurement of 3D In Vivo Knee Motion Using Biplane Fluoroscopy: Investigation of Non-contact ACL Injuries. XVIth International Conference on Mechanics in Medicine and Biology; July 23–25; Pittsburgh, PA. 2008