修复运动性肌腱断裂防粘连材料的应用

Application of anti-adhesion materials for exercise-induced tendon rupture

背景:随着肌腱外源性愈合学说和内源性愈合学说的建立,如何抑制外源性愈合,促进内源性愈合成为解决肌腱粘连的关键。而腱周局部防粘连屏障物的运用是近年来研究的热点。目的:综述防粘连材料在修复运动性肌腱断裂过程中的应用进展。方法:应用计算机检索1990-01/2010-12PubMed数据库及维普数据库有关生物材料防治肌腱粘连的研究进展、防粘连材料的临床应用及效果方面的相关文献,英文检索词"tendon adhesion,absorbability antiseize continually membrane,Anti-adhesion membrane",中文检索词"肌腱断裂,肌腱粘连,防粘连膜,生物材料,运动损伤"。检索文献量总计127篇。最终纳入符合标准的文献25篇。结果与结论:目前肌腱防粘连材料的研究已经取得显著成果,但所研究的材料利弊各异。诸如生物膜替代腱鞘,虽有效地阻止了外源性愈合,但因阻隔了营养物质的渗透,不利于肌腱愈合;药物薄膜具有屏障隔离的作用,减轻外源性愈合从而达到防止或减轻粘连的目的,局部组织对药物薄膜排斥性小,临床应用前景较好;可吸收材料可以在体内降解、吸收,不需二次手术取出,生物相容性良好,但其组织黏附性、机械强度和存留时间有待进一步研究;不可吸收材料因通透性能相对较差常需二次手术取出,使其临床应用受限;有些材料具有毒副作用和严重的炎性反应,临床上已经基本不再使用。在防粘连材料真正成为一种治疗肌腱无粘连愈合和功能重建之前,以上问题都是亟待研究和解决的。

BACKGROUND： With the establishment of exogenous and endogenous healing theory of the tendon, how to suppress exogenous healing and promote endogenous healing is the key for treatment of tendon adhesion. The anti-adhesion barrier surrounding the tendon is the focus in recent years. OBJECTIVE： To review the progress of anti-adhesion materials in repair of exercise-induced tendon rupture. METHODS： A computer search of PubMed and VIP databases for anti-adhesion biomaterials articles published from January 1990 to December 2010 were retrieved by using key words of ＂tendon adhesion, absorbability antiseize continually membrane, anti-adhesion membrane＂ in English and ＂tendon rupture, tendon adhesion, anti-adhesion membrane, biomaterial, sports injury＂ in Chinese. Finally, 25 articles were included. RESULTS AND CONCLUSION： Studies about the current anti-adhesion materials for the tendon have achieved remarkable results; however, there are different advantages and disadvantages of different materials. For example, biomembranes instead of tendon sheath inhibit exogenous healing, but they also block the penetration of nutrients, which is not conductive to tendon healing; drug films with barrier isolation reduce exogenous healing to prevent tendon adhesion, which has good prospects for clinical application; absorbable materials have good biocompatibility, but their adhesive force, mechanical strength and retention time need to be further studied; second operation is used to remove nonabsorbable materials due to poor permeability, which have not been used in clinic; some materials with toxic side effects and severe inflammatory reaction have been basically no longer used clinically. These issues should be studied and solved before anti-adhesion materials are really applied in the treatment of tendon adhesion and functional reconstruction.