外源性碱性成纤维细胞生长因子对鞘内肌腱愈合和粘连的影响

EFFECTS OF EXOGENOUS BASIC FIBROBLAST GROWTH FACTOR ON IN-SHEATHED TENDON HEALING AND ADHESION FORMATION

目的探讨外源性碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)对鞘内肌腱愈合和粘连形成的作用。方法成年雄性来亨鸡90只随机平均分成3组,每组30只,制备右爪第3趾趾深屈肌腱横断模型。A组肌腱横行切断后原位缝合;B组肌腱断端应用纤维蛋白封闭剂(fibrin sealant,FS)0.6μl后,原位缝合修复横断肌腱;C组则在断端使用bFGF和FS混合物0.6μl(内含bFGF500ng)后,原位缝合修复横断肌腱。术后1、2、4、8周,每组各取6只鸡第3趾行大体及组织学观测,术后8周每组再取6只鸡第3趾行生物力学测定。结果大体观察:术后8周各组肌腱粘连程度分级差异均无统计学意义(P>0.05)。组织学观测:术后1、2、4、8周成纤维细胞计数及术后4、8周胶原纤维含量,A、B两组间差异均无统计学意义(P>0.05);C组与A、B两组比较,术后1、2、4周成纤维细胞数及术后4、8周胶原纤维含量差异均有统计学意义(P<0.05)。生物力学测定:术后8周,A、B、C组肌腱滑动距离分别为3.44±0.43、3.51±0.56和2.84±0.42mm,屈曲功分别为14.87±1.72、14.08±1.85和20.62±3.52Nmm,最大抗拉力分别为10.34±1.45、11.26±1.83和15.02±2.20N,A、B两组间差异均无统计学意义(P>0.05),但C组与A、B两组比较,各指标差异均有统计学意义(P<0.05)。结论在肌腱断端使用外源性bFGF能促进鞘内肌腱的愈合,但也加重了肌腱的粘连。

Objective To explore the effects of exogenous basic fibroblast growth factor （bFGF） on insheathed tendon healing and adhesion formation. Methods Ninety Leghorn chickens were randomly divided into 3 groups （groups A, B and C）, 30 animals for each group, and the right third digitorum longus tendon of the chicken was transected to make defect models. In group A, the tendon was sutured in situ after transection. In group B, the tendon was sutured after 0. 6μl fibrin sealant （FS） was applied at repair site. In group C, the tendon was sutured after 0. 6μl FS mixed with 500 ng bFGF was applied at repair site. At 1, 2, 4 and 8 weeks after operation, the tendons of 6 chickens in each group were harvested for morphological and histological evaluation. Six specimens of each group was obtained for biomechanical test at 8 weeks. Results The gross observation showed that the differences of grading of tendon adhesion were not significant between groups A, B, and C 8 weeks after operation （P〉0.05）. Histological evaluation showed that there were no significant differences in fibroblast counting and the content of collagen fibers between groups A and B（P〉0.05）. The angiogenesis, fibroblast proliferation and collagen production in the sheath, epitendon and parenchyma at repair site in group C occurred earlier and were more than those in groups A and B, showing significant differences （P〈0. 05）. The biomechanical tests showed that the gliding excursion of the tendon in group A, B and C were 3.44±0.43,3.51±0.56 and 2.84±0.42 mm respectively; the work of flexion were 14.87±1.72,14.08±1.85 and 20.62±3.52 Nmm respectively; the ultimate tensile strength of the tendon was 10.34±1.45, 11.26±1.83 and 15.02±2.20 N respectively; showing no significant differences between groups A and B（P〉0.05）, but showing significant differences between group C and groups A, B（P〈0.05）. Conclusion The exogenous bFGF at tendon repair site can facilitate in-sheathed tendon healing, but also increase the tendon adhesion formation.