修复腱旁组织防止趾伸肌腱粘连的实验研究

An Experimental Study of the Prevention of Extensor Tendinous Adhesion by Repairing Paratenon

以鸡趾伸肌腱为模型，比较两种手术方法的疗效。Ａ组：仅修复趾伸肌腱；Ｂ组：同时修复腱旁组织。术后３周和６周测定其伸趾功能、滑动度和粘连面积，同时观察肌腱的大体形态和组织学形态。结果表明：术后３周Ａ组粘连广泛，腱愈合不良；Ｂ组修复腱形成“梭形体”状，其粘连面积明显减小，与Ａ组相比差异有非常显著性意义（Ｐ＜０．０１）。术后６周，上述各项测定指标Ｂ组均较优越，与Ａ组相比差异有显著性意义（Ｐ＜０．０５～０．０１），Ｂ组粘连基本消失，较Ａ组其纤维排列有序、愈合好。在临床上，对伸肌腱断裂特别是指背部，手术时应同时修复腱旁组织，以期获得良好的功能。

?Toes of chickens were used as model for the comparison of the results of repair by two different operative methods. In group A, extensor tendon was repaired under operation microscope. In group B, the surrounding paratenon was also repaired after microsurgcally suturing extensor tendon. The extension function, tendon sliding degree, tendon adhesive extent, gross and histological morphology of the operated toes were respectively observed at 3 and 6 weeks postoperatively. At 3 weeks after operation, the results showed that the adhesion was extensive and healing was poor in group A, while an apparently smooth and regular “fusiform structure' was formed at the tendinous anastomotic stoma in group B. The adhesive extent in group B is significantly less than that in group A (P<0.01). At 6 weeks after operation, all of the three indices above in group B was significantly better than that in group A (P<0.05 ～0.01). In group B, the adhesive scar had disappeared and the structure of paratenon and tendon had recovered almost completely. The arrangement of collagenous fiber and fiber cells was better in group B than that in group A. In clinical practice, we should repair both extensor tendon and paratenon simultaneously, especially on the dorsum of finger, so as to achieve better function.