轴卷猪小肠黏膜下层修复异种肌腱缺损后免疫排斥反应及生物力学适应性(英文)

Immunological rejection and biomechanical adaptability following xenogenic tendon defect repaired with rolled porcine small intestinal submucosa

背景:自体肌腱移植治疗外伤后肌腱缺损存在机体再次损伤和取材局限的不足。碳纤维人工肌腱、人发肌腱等人工肌腱被证实也可进行移植,但其植入体内后存在着免疫排斥反应和生物力学强度的不适应。因此,开发新的人工肌腱替代物是目前需要解决的主要问题。目的:观察轴卷的猪小肠黏膜下层作为人工肌腱移植修补鸡左、右足第3趾2cm肌腱缺损,以及修补后的免疫排斥反应和生物力学适应性。设计:随机对照动物实验。单位:上海交通大学附属第六人民医院骨科。材料:12周Leghorn鸡45只,雌雄不限,体质量4.0～4.5kg。方法:实验于2002-09/2003-06在上海交通大学附属第六人民医院骨科完成。①将45只12周的Leghorn鸡随机分为3组。取自体移植组20只和猪小肠黏膜下层移植组20只鸡的左、右足第3趾,于中节趾骨处切断趾深屈肌腱并造成2cm的肌腱缺损模型。自体移植组缺损的肌腱进行原位缝合;猪小肠黏膜下层移植组缺损的肌腱用猪小肠黏膜下层进行修补;空白组5只,不作任何处理。②在肌腱移植术后3,6,9周进行组织形态学、移植免疫学、生物力学及功能恢复的测定。主要观察指标:①各组鸡手术趾大体观察及植入物光镜观察。②术前3d、移植后3d、1周、2周白细胞分类计数。③各组鸡生物力学测试及功能恢复试验结果。结果:45只鸡均进入结果分析。①术后9周时,肉眼下,猪小肠黏膜下层形态同正常肌腱已基本相同,光镜下,猪小肠黏膜下层上成纤维细胞沿长轴方向有序排列且出现胶原细胞外间质。②术后2周内,猪小肠黏膜下层移植组与自体移植组白细胞测量结果差异无显著性意义(P>0.05),表明猪小肠黏膜下层作为异种材料没有明显免疫排斥。③在生物力学测试中,猪小肠黏膜下层移植组在术后12周时生物力学强度要优于自体移植组[(22.22±0.90),(20.78±0.94),P<0.05]。④在功能恢复试验中,3组掌趾关节的活动度无明显差异(P>0.05),空白组的近节趾间关节活动度要优于猪小肠黏膜下层移植组及自体移植组[(21.0±1.6)°,(15.1±1.7)°,(16.0±2.1)°,P<0.05)。结论:猪小肠黏膜下层植入鸡体内后,没有发现有免疫排斥反应的迹象,可作为修复肌腱缺损的异种材料。

BACKGROUND： Re-injury of organism and sufficient of materials exist in the autologous transplantation of tendon to treat defected tendon following trauma. Carbon fiber artifical tendon, human hair tendon and other artifical tendons are also proved to be transplantable. But immunological rejection and biomechanical inadaptability exist following artifical tendons are transplanted. Therefore, the development of new human tendon substitute is the major problem to be solved at present. OBJECTIVE： To observe the porcine small intestinal submucosa as artificial tendon to repair 2 cm tendon defect of the 3rd toe of the left and right feet of chicken, and the immunological rejection and biomeehanieal adaptability following repair. DESIGN： A randomized and controlled animal experiment. SETTING： Department of Orthopaedics, Sixth Hospital Affiliated to Shanghai Jiaotong University. MATERIALS： Totally 45 Leghorn chickens, aged 12 weeks, of either gender, with body mass of 4.0 to 4.4 kg, were chosen. METHODS： This experiment was conducted at the Department of Orthopaedics, Sixth Hospital Affiliated to Shanghai Jiaotong University from September 2002 to June 2003. ① Totally 45 Leghorn chicken, aged 12 weeks, were randomly divided into 3 groups. The third toe of the left and right feet was chosen from 20 chicken respectively of autologous transplan- tation group and porcine small intestinal submucosa group, flexor digitorum profundus muscle tendon was cut off at middle phalanx, and 2 cm tendon defect model was created. The defected tendon in the autologous transplantation group was performed in situ suture; the defected tendon in the porcine small intestinal submucosa transplantation group was repaired with porcine small intestinal submueosa; There was not any treatment on the 5 Leghorn chicken in the blank control group. ② Histomorphologyl, transplantation immunology, biomechanics and functional recovery were measured at 3,6 and 9 weeks following tendon transplantation. MAIN OUTCOME MEASURES： ① Gross observation of operated toes of chicken and optical observation of grafts in each group. ② White blood cell （WBC） differential count at 3 days preoperation,3 days postoperation, and 1 week and 2 weeks postoperation. ③Biomechanical test and functional recovery test of chicken in each group. RESULTS： Totally 45 chicken entered the stage of result analysis. ① At 9 weeks after operation, morphology of porcine small intestinal submucosa was basically the same as that of normal tendon by naked eyes; Under optical microscope, fibroblasts on the porcine small intestinal submucosa arranged in order along long-axis and collagen extracellular matrix appeared. ② Within 2 weeks after operation, there was no significant difference of WBC measurement between porcine small intestinal submucosa transplantation group and autogolous transplantation group （P 〉 0.05）, suggesting that porcine small intestinal submueosa, as xenogenie material, has no obvious immunological rejection. ③ In the biomechanical test, biomechanical adaptability at postoperative 12 weeks was superior in the porcifie small intestinal submucosa group to in the autologous transplantation group [（22.22±0.90）, （20.78±0.94） ,P 〈 0.05]. ④ In the test of functional recovery, there was no obvious difference of activity of metecarpophalangeal joint （P 〉 0.05）, the activity of proximal interphalangeal joint was superior in the blank control group to in the porcine small intestinal submucosa group and autologous transplantation group [（21.0±1.6）°, （ 15.1±1.7）°,（16.0±2.1）°,P 〈 0.05].CONCLUSION： There is no evidence of immunological rejection after porcine small intestinal suhmucosa is transplanted into the body of chicken. Therefore, porcine small intestinal suhmucosa can he used as the xenogenic material to repair tendon defect.