聚-DL-乳酸可吸收膜对兔膝关节术后肌肉周围组织黏连的影响

Effect of poly-DL-lactide resorbable film on postoperative muscle adhesion of the knee joint in rabbits

目的:以往膝关节术中放置硅胶膜减少术后肌肉黏连是预防关节僵硬的有效方法,但术后需二次手术将膜取出。实验拟观察聚-DL-乳酸可吸收防黏连膜在减少关节术后肌肉黏连的作用效果。方法:实验于2006-03/08在上海交通大学医学院附属第三人民医院动物实验室完成。选择雄性成年新西兰兔30只,按随机数字表法分为实验组和对照组,每组15只。在兔的左膝关节内侧切口,切除髌骨上方股直肌股骨面的薄层肌肉和大部分滑膜,实验组将聚-DL-乳酸可吸收防黏连膜修剪至合适大小(0.8cm×1.2cm),完全覆盖在股直肌下方滑膜切除处,对照组不放膜。术后用石膏管型固定将兔膝关节固定在屈膝90°,持续3周后拆石膏,在术后8周将所有兔麻醉后处死,行病理学检查。检测损伤前及损伤后3,8周的膝关节被动屈曲角度;检测膝关节的局部黏连,组织变化,生物膜的吸收情况。结果:①大体观察结果:术后8周对照组黏连较严重,呈致密的纤维性黏连,限制膝关节被动活动。实验组黏连呈松散状,无关节强直发生。②组织学观察结果:术后8周对照组有较多的厚而致密的胶原纤维形成,与骨皮质或肌肉组织黏连,实验组有较薄而松散的胶原纤维存在,无致密黏连存在。③兔膝关节屈曲角度比较:实验组术后3,8周膝关节屈曲角度均明显小于对照组,差异均有显著性意义(P<0.01)。两组兔中,术后3,8周膝关节屈曲角度间比较,术后8周时的角度均小于术后3周,差异均有显著性意义(P<0.01)。结论:用聚-DL-乳酸可吸收防黏连膜可减轻术后肌肉周围组织间的黏连,有效预防关节僵硬。

AIM： Previously, the use of silica gel for knee joint is effective for reducing the muscle adhesion so as to prevent the stiffness of knee joint, but secondary operation is needed to fetch the film. This study was to observe the effect of anti-adhesion poly-DL-lactide （PDLLA） resorbable film on reducing the muscle adhesion of knee joint. METHODS： The experiment was accomplished in the animal laboratory in the Third People＇s Hospital Affiliated to College of Medicine, Shanghai Jiao Tong University between March and August in 2006. Thirty New Zealand adult male rabbits were randomly separated into treatment group and control group, each containing 15 animals. In the treatment group, the lamellar muscles and most of the synovium at femoral rectal muscle close to the whirbone were removed through a medial incision of left knee joint in rabbits, and then were impaired. An anti-adhesion PDLLA resorbable film with suitable size （0.8 cm × 1.2 cm） was placed at the impaired part. After that, the rabbit knee joint was fixed at 90° with cast for three weeks, the observation persisted until eight weeks later when all the rabbits were sacrificed under anesthesia. In the control group, the anti-adhesion membrane was not placed. Before impairment, three weeks and eight weeks after impairment, the passive flexion angles of knee joint were tested. The local adhesion of knee joint, pathological changes of tissue surrounding the muscle, and the absorption of anti-adhesion membrane were all detected eight weeks later. RESULTS： 1.Eight weeks later, the severe adhesion of tissue nearby the knee joint was detectable in the control group, showing dense fibrils and limitations on passive activity of knee joint. In the treatment group, the adhesion was lighter and no stiffness was found.2.Major thick and dense collagen fibers formed in the control group 8 weeks later, and the adhesion occurred in the cortical bone or muscular tissue. While the collagen fibers arrayed loosely and rarely in the treatment group, without the presence of compact adhesion.3.Three and eight weeks after impairment, the flexion angles in the treatment group was significantly less than those in the control group （P 〈 0.01）. And the angles in both groups were also significantly reduced 8 weeks later compared with 3 weeks later （P 〈 0.01）. CONCLUSION： The application of PDLLA anti-adhesion resorbable film can make some effects on reducing adhesion and preventing stiffness of joint after impairment of muscle.