几丁糖预防屈肌腱粘连的临床效果

Clinical effect of chitosan on prevention of flexor tendon adhesion

目的 :观察几丁糖 (chitosan)预防肌腱粘连的临床效果。方法 :对Ⅱ区肌腱损伤 48例 72条肌腱断裂行一期修复 ,术中采用改良Kessler法缝合肌腱 ,在肌腱鞘管内注入 2 %医用几丁糖 0 5～ 1 0ml,缝合皮肤。术后 2 4h开始功能锻炼 ,3周后作全程屈伸运动功能锻炼。同期 32例 44条肌腱用同样方法修复 ,但不使用几丁糖作为对照组。结果 :两组病例经过平均 5个月的随访 ,按手指总主动活动度 (TAM)标准评定疗效 ,几丁糖组随访 6 4条肌腱 ,疗效优良者 5 5条 ,优良率为 85 94% ,显著高于对照组的 6 8 18% (χ2 =4 90 ;P <0 0 5 )。结论 :几丁糖具有预防或减轻肌腱粘连的作用 ,是一种较为理想的预防肌腱粘连的生物材料。

Objective:To observe the clinical effect of chitosan on the prevention of flexor tendon adhesion in tendon sheath. Methods:Forty-eight patients with tendon injury in area Ⅱ, who had 72 tendinous ruptures, were primarily repaired by the modified Kessler's tendinosuture. Chitosan(2%,0 5-1 0 ml) was injected into the sheath harboring the ruptured tendon and the skin was sutured. The function training of the operated fingers began 24 hours after the operation and its thorough flexion and extension would commence 3 weeks later. The other 32 patients with 44 tendinous ruptures repaired with the same method without using any chitosan served as controls. Results:All the patients in both groups were followed up for 5 months (mean). According to the total active movement (TAM) standards, 55 of 64 tendons in chitosan group had good outcome (85 94%). It was significantly higher than that in the control group (68 18%;χ 2=4 90; P <0 05).Conclusion:Chitosan is effective in preventing or reducing tendon adhesions. It is a kind of ideal biological material in preventing tendon adhesions.