聚己内酯/聚乳酸薄膜防治肌腱粘连的实验研究

Experimental Study on Biodegradable PCL/PLA Membrane for Prevention of Tendon Adhesion

目的：将聚己内酯／聚乳酸薄膜［ｐｏｌｙ（ε－ｃａｐｒｏｌａｃｔｏｎｅ）／ｐｏｌｙｌａｃｔｉｃ－ａｃｉｄ，ＰＣＬ／ＰＬＡ薄膜］用于肌腱吻合部位，观察其防止肌腱粘连的情况。方法：将兔左后肢比目鱼肌腱做部分游离，横形切断其截面积的一半，再将其吻合。实验组于吻合部位放置厚度为４０～６０μｍ的ＰＣＬ／ＰＬＡ薄膜，对照组只行吻合术。石膏外固定３周。结果：大体观察：肌腱粘连形成的半定量评分结果经ｔ检验，实验组与对照组差异有非常显著性意义。ＰＣＬ／ＰＬＡ薄膜在体内可逐渐降解，２４周时全部降解吸收，局部无不良反应。光镜观察：实验组腱外部可见“假鞘样”结构形成，其纤维组织增生程度较轻，胶原纤维排列规则，表面光滑。而对照组无“假鞘样”结构形成，腱周组织与肌腱外表间有大量的纤维增生，排列紊乱。生物力学测试结果表明，实验组抗粘连阻力作功要明显小于对照组。结论：ＰＣＬ／ＰＬＡ薄膜具有可靠的物理屏障作用，防止肌腱粘连效果良好。

Objective:To determine the ability of a poly (ε-caprolactone)/polylactic-acid (PCL/PLA)membrane in the prevention of tendon adhesion. Methods: The tendon of the soleus muscle of the left hind leg of the rabbit was partially separated and a transverse incision was made over half of its cross section. The incised site was then an astomosed and covered up with PCL/PLA membrane. In the control group, no membrane was used at the anastomosis site. Plaster cast fixation was used for 3 weeks after surgery. Gross and histologic observations and biomechanic test were performed to evaluate the degrees of tendon adhesion. Results: Gross and histologic studies showed PCL/PLA membrane significantly reduced the formation of the tendon adhesion and was biodegradable in vivo. According to the biomechanic test, the resistance to antiadhesion effect shown in the PCL/PLA group was much less than that seen in the control group. Conclusion: The PCL/PLA membrane is a reliable and effective material to reduce tendon adhesion.