屈肌腱损伤后愈合早期粘连功耗变化的实验研究

Characteristics of work of adhesion release in the early period of flexor tendon healing

目的探讨在术后不同时间拉断粘连带所需功耗的变化特点.方法分别以改良Kessler法和Tsuge法缝合三黄鸡的第3趾趾深屈肌腱各42条,于术后即刻、1、4、7、10、14、21 d取材,将肌腱标本进行生物力学测试,测试内容包括趾深屈肌腱完成屈曲动作的滑动距离,拉断粘连带的功耗.测试结束后,检查肌腱缝合口与周围组织的粘连带是否被完全拉断.结果拉断粘连带的功耗:改良Kessler法在术后7、10、14 d组较术后即刻,1、4 d组显著增高,术后21 d组较术后即刻和术后1 d组显著增高;Tsuge法在术后10 d以后各组较术后7 d以前各组显著增高;改良Kessler法只在术后7 d较Tsuge法显著增高.术后21 d,粘连带不能被完全拉断.结论术后7～10 d,肌腱滑动克服粘连带所需的功耗开始逐渐增加;术后21 d,趾深屈肌腱完全屈曲并不能有效的拉断粘连带.

Objective To investigate the characteristics of work needed to release adhesion in the early stage of flexor tendon healing. Methods Eighty-four profoundus flexor tendons of the 3~ rd toe of Sanhuang chicken were severed and repaired by either Modified Kessler technique or Tsuge technique randomly. At 0,1,4,7,10,14,21 d after the operation, 6 tendons from each repair technique group were harvested and tested by biomechanical test machine. An elongation force-elongation distance curve was obtained and work of adhesion release was calculated in this curve. Whether adhesion band had been released or not was confirmed by gross inspection immediately after the test. Results Work of adhesion release: this work significantly increased at the 7~ th day in Modified Kessler group and at the 10~ th day in Tsuge group. Modified Kessler group was significantly higher than Tsuge group at the 7~ th day. At the 21~ st day after operation, adhesion could not be effectively released by full range excursion of flexor tendon profoundus. Conclusion Work of adhesion release begins to increase significantly since the 7~ th ~10~ th day postoperatively.At the 21~ st day after the operation, adhesion could not be fully released by full range of flexor tendon proundus flexion.