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研究生:林明芳
研究生(外文):Ming-Fang Lin
論文名稱:利用磁振造影評估以重建膠原蛋白模板與高含量血小板血漿植入後膝關節半月板軟骨之再生─兔子動物實驗模型
論文名稱(外文):Magnetic Resonance Imaging Correlated with Histological Evaluation of Meniscal Regeneration Using Collagen-Platelet Rich Plasmain Knee Joints of Rabbits
指導教授:賴文福賴文福引用關係
指導教授(外文):Wen-Fu Lai
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:生物醫學材料研究所
學門:工程學門
學類:生醫工程學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:40
中文關鍵詞:膠原蛋白模板纖維化膝關節半月板磁振造影組織再生
外文關鍵詞:CollagenFibrosisKnee jointMeniscusMR ImagingRegeneration
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中文題目:利用磁振造影評估以重建膠原蛋白模板與高含量血小板血漿植入後膝關節半月板軟骨之再生-兔子動物實驗模型

以膠原蛋白模板促進膝關節半月板之再生已成功研發,另外高含量血小板血漿PRP(platlet-rich plasma)內含生長因子的生物材料亦已應用於臨床,本實驗為前測試驗,其目的是結合上述兩種材料特性,經由動物實驗以手術植入受損之半月板,利用非侵入性磁振造影(MRI)與組織切片對照觀察半月板的再生過程。
本實驗包含8隻紐西蘭母白兔(約3個月大小,重約3公斤),分為3組:
A組:半月板切除術合併高含量血小板血漿PRP和重建膠原蛋白模板之混合物種植(共5隻兔、右膝)
B組:半月板切除術(共3隻兔、右膝)
C組:正常半月板(利用A組兩隻兔之左膝)
MRI使用1.5-T儀及3-in之表面線圖,成像技術包括T1-, PD-, T2-加強影像及注射對比劑(Gadopentate dimeglumine)後的T1-加強影像。我們將固定以右膝關節的外側半月板中央區軟骨做為MRI影像,於手術前(0週、A1-5、B1-3),術後第4(A1、B1)、8(A2、B2)、12週(A3、B3)及24週(A4、A5)為MRI觀察期,隨即進行撲殺做組織切片。對照切片顯示組織之再生過程發現:MRI影像呈現高訊號表示組織再生不良,切片顯示有纖維母細胞增生現象。相反地,MRI影像呈現低訊號表示組織再生良好,切片結果顯示與原組織呈現相同染色。本實驗初步發現,手術後植入混合膠原蛋白與PRP生物材料,三個月後,其組織再生情況明顯優於未植入上述生物材料者,但再生組織之重塑(tissue remodeling)需要至6個月或更長的時間觀察。
Magnetic Resonance Imaging Correlated with Histological Evaluation of Meniscal Regeneration Using Collagen-Platelet Rich Plasma in Knee Joints of Rabbits

Previously, our laboratory has developed a collagen template for disc regeneration of knee meniscus and TMJ. Recently, biomaterial PRP (Platelet-Rich Plasma) has been applied in clinics. This pilot study attempts to employ both PRP and collagen templates to stimulate regeneration of the meniscal tissue of the knee in rabbit model by using MR imaging assessment and correlates the MR findings with histology. A total of 8 adult New Zealand female rabbits (age: 3 months old; weight: 3kg) were recruited and divided into 3groups: (Group A) partial meniscectomy with PRP and collagen implantation with follow-up at 4 weeks(A1), 8 wks(A2), 12 wks(A3), and 24 wks(A4, A5), and (Group B) those rabbits with partial meniscectomy only and follow-up at 4 weeks(B1), 8 wks(B2) and 12 wks(B3), Group C was a normal knee. (using 2 of the rabbits’ left knee in group A). MR imaging was performed on a 1.5-T magnet (Horizon LX, G.E.) by using sagittal T1-weighted, PDI, T2W, and postcontrast (gadopentetate dimeglumine) T1W images. The right knee was consistently to be acted as the experimental side for MR imaging and histology. MR imaging findings of higher signal with formless structure of the meniscal tissue indicated relative poor regeneration, which correlates well with histology. The histology revealed fibroblasts proliferation. On the contrary, regenerative meniscal tissue exhibits lower signal intensity relative to the parent meniscus. Our preliminary data concluded that regeneration of meniscal tissue after PRP and collagen implantation in 3 months, and further follow-up to 6 months is needed to observe entire remodeling process of regeneration. MR imaging of low signal intensity of the regenerative meniscal tissue correlates well with collagen-rich native tissue.
誌謝 I
中文摘要 III
ABSTRACT IV
目錄 VI
圖目錄 VII
第一章 緒論 1
第一節 正常半月板 (THE NORMAL MENISCI) 1
第二節 半月板破裂的治療方法 (TREATMENT OF MENISCAL TEARS) 3
第三節 膠原模板的發展 (DEVELOPMENT OF COLLAGEN TEMPLATE) 5
第四節 高含量血小板血漿 (PLATELET-RICH PLASMA) 6
第五節 磁振造影 (MR IMAGING) 8
第六節 研究目的 (PURPOSE) 9
第二章 研究設計 10
第一節 材料 (MATERIALS) 10
第二節 PRP的製備 (PRP PREPARATION) 12
第三節 手術與植入 (SURGERY AND IMPLANTATION) 14
第四節 磁振造影 (MR IMAGING) 17
第五節 資料分析 (DATA ANALYSIS) 19
第六節 解剖與組織病理檢查 (GROSS AND HISTOPATHOLOGIC EXAMINATIONS) 20
第三章 研究結果 21
第一節 結果 (RESULTS) 21
第二節 MRI與組織切片 (MR IMAGING AND HISTOLOGY) 22
第四章 討論 30
第一節 討論 (DISCUSSION) 30
第二節 研究限制 (STUDY LIMITATION) 34
第三節 結論 (SUMMARY) 35
參考文獻 36

圖目錄
頁碼
圖1-1. 膝關節的解剖(ANATOMY OF THE KNEE) 2
圖1-2. 人類與兔子的半月板。 2
圖1-3. 人類半月板的微血管構造分佈在半月板外側1/3處 4
圖2-1. 實驗動物紐西蘭白母兔 10
圖2-2. 臺灣大學實驗動物管理與使用委員會同意函 11
圖2-3. 生物材料 (THE BIOMATERIALS) 13
圖2-4. 外側半月板前端縱向切除(黃點示意圖) 14
圖2-5. 半月板切除手術 15
圖2-6. 植入生物材料手術 16
圖2-7. 磁振造影儀 (1.5 T MRI) 17
圖3-1. NORMAL CONTROL 22
圖3-2. A1:植入COLLAGEN-PRP一個月後的MRI與H&E染色 23
圖3-3. A2:植入COLLAGEN-PRP兩個月後的MRI與H&E染色 24
圖3-4. A3:植入COLLAGEN-PRP三個月後的MRI與H&E染色 25
圖3-5. A4:植入COLLAGEN-PRP術後6個月MRI與組織切片H&E染色 26
圖3-6. A4:僅做局部半月板切除術後三個月後的MRI與組織切片H&E染色 27
圖3-7. A5:連續6個月膝關節半月板前角MRI訊號變化:PDI及T1W+C 28
圖3-8. A4及A5之MRI訊號:依時序(術前1、2、3、6個月)顯影百分比曲線圖 29
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