分米波防治屈肌腱粘连的机制研究(英文)

Mechanism of decimeter wave in the prevention of flexor tendon adhesion

背景:肌腱损伤是手外科中的多发损伤,肌腱修复术后常因肌腱粘连影响患者术后手功能恢复,防治肌腱粘连特别是屈指肌腱损伤术后粘连一直是手外科康复工作中的重点。目的:研究分米波对肌腱粘连和愈合的影响。设计:以实验动物为研究对象的随机对照研究。单位:省级骨科研究所。材料:实验于2001-01/2003-06在河北省骨科研究所完成。选用Leghorn鸡28只,随机分为术后分米波治疗组、手术对照组。方法:将Leghorn鸡的趾深屈肌腱切断、修复后局部分米波照射,分别于术后3,6周处死动物进行大体和光镜、电镜观察及生物力学检测。主要观察指标:主要指标:两组肌腱的大体解剖、光镜及电镜观察的结果。生物力学检测结果。次要指标:肌腱粘连、愈合分级结果。结果:大体和组织学观察见分米波治疗组粘连明显减少,电镜检查分米波治疗组成纤维细胞蛋白合成代谢较对照组更旺盛。生物力学检测显示分米波治疗组肌腱滑动距离(mm)(3周为5.37±1.06,6周为6.76±1.52)、康复顺应性(3周为1.04±0.65)均大于手术对照组(分别为4.43±1.03,5.33±1.27;0.63±0.31)(P<0.05),抗张力强度(N)(26.93±4.80,47.12±7.76)亦大于手术对照组(21.29±4.88,38.96±7.52),差异有非常显著性意义(P<0.01)。结论:分米波可有效地促进肌腱愈合,减少肌腱粘连。

BACKGROUND:Tendon injury is a common injury in the department of hand surgery.The postoperative recovery of hand function is always affected by tendon adhesion after tendon repair.To prevent tendon adhesion,especially the adhesion after flexor tendon repair is always the key in the rehabilitation of hand surgery. OBJECTIVE:To investigate the impact of decimeter wave therapy on tendon adhesion and healing after flexor tendon repair. DESIGN:Randomized controlled study based on experimental animal SETTING:Provincial Institute of Orthopaedics. MATERIALS:The study was conducted in Hebei Provincial Institute of Orthopaedics from January 2001 to June 2003.Totally 28 Leghorn chickens were randomly divided into decimeter wave therapy group and operation control group. METHODS:The flexor digitorum profundus tendons of Leghorn chickens were transected and repaired.Decimeter wave therapy was applied to the toes on chickens of decimeter wave therapy group.Animals were executed at week 3 or 6 after operation for macroscopical observation and histological observation under optical and electron microscopes,and biomechanical analysis. MAIN OUTCOME MEASURES:Principle index:results of macroscopical observation and the observatory results under optical and electron microscope,and the results of biomechanics.Secondary index:results of the classification of tendon adhesion and healing. RESULTS:It could be seen under macroscopical and histological observation that the adhesion significantly reduced in decimeter wave therapy group.The protein synthesis of fibroblast was significantly more than that of the control group under electron microscope.As indicated by biomechanical analysis,the tendon gliding distance[(5.37± 1.06)mm at week 3,(6.76± 1.52)mm at week 6]and the rehabilitative compliance( 1.04± 0.65 at week 3) of decimeter wave therapy group were bigger than those of the control group respectively[(4.43± 1.03)mm,(5.33± 1.27)mm and 0.63± 0.31](P< 0.05),and the anti tension strength of decimeter wave in therapy group(N,26.93± 4.80,47.12± 7.76)was significantly bigger than that of the control group respectively(21.29± 4.88 and 38.96± 7.52) (P< 0.01). CONCLUSION:Decimeter wave therapy can effectively promote tendon healing and reduce tendon adhesions and provide prerequisites for early rehabilitative training after flexor tendon repair. Hence,it is an ideal assistance in the prevention of tendon adhesion.