分米波与透明质酸钠预防屈肌腱粘连的比较研究

EFFECTS OF DECIMETER WAVE AND SODIUM HYALURONATE PRODUCT ON POSTOPERATIVE ADHESIONS IN FLEXOR TENDON

目的比较分米波与透明质酸钠防治肌腱粘连和促进肌腱愈合的作用。方法取6月龄雄性白色来亨鸡96只,体重(2.24±0.07)kg。于左足第Ⅲ、Ⅳ趾制备肌腱损伤模型,随机分为3组(n=32):分米波照射组(A组),模型制备后第1～21天行分米波照射,频率915MHz,功率8W,辐射距离10cm,每日1次,每次10min;透明质酸钠组(B组),模型制备后即刻予1.2%透明质酸钠0.5mL均匀涂于肌腱缝合处;对照组(C组)未作处理。术后观察动物一般情况;术后14、28d,行大体、透射电镜及组织学观察;于7、10、14、18、21、28d取材,行生物力学测试。结果各组动物术后切口愈合良好,无感染及死亡。大体和组织学观察示A、B组腱周有较疏松粘连,C组腱周广泛粘连;透射电镜观察示A、B组胶原纤维较C组排列规则。生物力学测试示术后各时间点最大拉伸断裂强度、最大延伸率、拉断肌腱粘连带功耗A、B组均优于C组(P<0.05)。术后14、18d最大拉伸断裂强度、术后18、21d最大延伸率以及术后18、21、28d拉断肌腱粘连带功耗,A组均优于B组(P<0.05),余时间点两组间比较差异均无统计学意义(P>0.05)。结论分米波和透明质酸钠均能有效促进肌腱愈合,预防肌腱粘连,且分米波操作简便、作用持久。

Objective To compare the effect of decimeter wave with sodium hyaluronate product （SHP） on preventing and treating peritendinous adhesion and promoting tendon healing. Methods Totally 96 healthy male white 6-month-old Leghorn chickens weighing （2.24 ± 0.07） kg were randomized into group A （ decimeter wave therapy group, n=32）, in which decimeter wave therapy was applied 1 to 21 days after operation at a frequency of 915 MHz, a power of 8 W, radiation distance of 10 cm, for 10 minutes once per day; group B （SHP group, n=32）, in which 5 mL and 1.2% SHP was applied; and group C （control group, n=32）, in which injury received no treatment. The Ⅲ and Ⅳ toes of left feet of all chickens were made into tendon injury model. The general condition of animal was observed after operation; gross and histological observations were made 7, 10, 14, 18, 21 and 28 days after operation, and the biomechanical analysis was done 14 and 28 days after operation. Results Operative incision healed well, no infection and death occurred. Peritendinous adhesions in groups A, B were looser, and tendon healing was better than that of group C 14 and 28 days after operation. More fibroblasts with active metabolism and more collagen formation in groups A, B than that in group C. The Pmax of group A was better than that of group B 14 and 28 days after operation （P 〈 0.05）; the δmax of group A was better than that of group B 18 and 21 days after operation （P 〈 0.05）, and the W0 of group A was better than that of group B 18, 21 and 28 days after operation （P 〈 0.05）. There was no significant difference between group A and group B at the other time points. Conclusion Topical decimeter wave therapy and application of SHP after flexor tendon repair can promote intrinsic healing, meanwhile they can prevent the adhesion of tendon and reduce extrinsic healing： Decimeter wave therapy can improve the qualities of tendon＇s wound healing.