高分子化合物及药物薄膜屏障在预防肌腱损伤中的应用

Application of macromolecular compound and drug biological barrier in preventing tendon adhesion

目的:探讨几丁搪、可吸收性防粘连膜、透明质酸3种高分子生物屏障材料对肌腱损伤导致的肌腱粘连的预防机制和作用原理。方法:以肌腱粘连,高分子生物屏障,几丁搪,可吸收性防粘连膜,透明质酸为检索词,检索中国期刊全文数据库(1999-01/2009-06),以tendon adhesion,high polymer biology barrier,several Ding keeps out,absorb ability antiseize continually membrane,hyaluric acid为检索词,检索Pubmed数据库(1999-01/2009-06),文献检索语种限制为中文和英文。以肌腱愈合质量和肌腱周围的炎性反应为评价指标,纳入几丁搪、可吸收性防粘连膜、透明质酸3种高分子生物屏障材料对肌腱损伤导致的肌腱粘连的预防机制和作用原理的研究,排除其他生物材料的研究。结果:计算机初检得到223篇文献,根据纳入排除标准,对几丁搪、可吸收性防粘连膜、透明质酸3种高分子生物屏障材料对肌腱损伤导致的肌腱粘连的预防机制、作用原理进行分析。肌腱粘连是肌腱损伤后常见的并发症,其防治一直是医学界普遍关注的问题。肌腱愈合有内源性和外源性两种途径,而周围组织的粘连和肌腱瘢痕的形成与外源性愈合又有不可分割的关系,因此如果能促进内源性愈合,尽量避免外源性愈合,就可以较好地解决这个问题。目前国内外学者倍加推崇的是高分子化合物及药物薄膜屏障在防止肌腱粘连中的应用。结论:高分子生物屏障材料一方面通过薄膜的屏障作用防止或减轻粘连,另一方面通过药物的药理作用影响肌腱愈合的内源性和外源性机制(主要加速内源性愈合),达到减轻粘连的目的。

OBJECTIVE： To explore the mechanisms of chitosan, absorbable membrane, and hyaluric acid in preventing adhesion following tendon injury. METHODS： The Chinese Journal Full-text Database, as well as Pubmed database, were retrieved with key words of tendon adhesion, high polymer biological barrier, several Ding keeps out, absorbability antiseize continually membrane, and hyaluric acid. The quality, as well as inflammatory reaction surrounding tensions were served as evaluate indexes, accordingly, the English and Chinese papers regarding mechanisms of chitosan, absorbable membrane, and hyaluric acid in preventing tendon adhesion were included. Studies concerning other biomaterials were excluded. RESULTS： A total of 223 papers were obtained by initial search with computer. According to inclusion criteria, the related papers were analyzed. Adhesion formation associated with tendon surgery is a widespread problem. Tendon healing was classically considered to occur through extrinsic and intrinsic healing, in which the extrinsic healing was closely associated with the formation of adhesion or scar, so if we can accelerate proliferation of granulation tissue, inhibit the extrinsic healing of the tendon, the purpose of preventing tendon adhesion formation could be achieved. As a result, macromolecular compound and drug biology barrier were widely used. CONCLUSION： High polymer biological barrier can relieve tendon adhesion by its barrier function and pharmacologic action to regulate healing mechanisms.