负载布洛芬的生物可吸收膜预防鸡肌腱粘连的实验研究

An experimental study of ibuprofen-loaded nanofiber absorbable membrane for prevention of tendon adhesion in chicken

目的探讨负载布洛芬的生物可吸收膜预防鸡肌腱粘连的疗效及降低局部炎性反应的有效性。方法成年雌性Leghorn鸡54只，随机分成3组，每组18只。制备左、右爪第3趾趾深屈肌腱横断模型，A组为肌腱横形切断后原位缝合，B组为不载药纳米纤维修复组，C组为使用载布洛芬的纳米纤维可吸收膜修复组。术后2,4、6周每组各取6只鸡第3趾行大体及组织学观测、肌腱的功能评价及生物力学测定。结果6周后，A组：致密粘连组织存留，锐性分离困难，肌腱已愈合，组织结构仍能辨认；B组：肌腱与周围组织有中度纤维束粘连，有透明的膜状物质覆盖其表面；C组：假鞘结构与周围组织颜色一致、假鞘变薄，钝性分离仍可完成松解。组织学观测显示c组肌腱断端腱细胞及胶原纤维渐多且排列整齐。假鞘中含有少量血管和炎性细胞，但较B组明显少。各组肌腱屈曲总角度评定组间相比，C组优于B组，A组最差，组间比较差异均有统计学意义（P〈0．05）；生物力学测定B组和C组均优于A组，B组和C组间差异无统计学意义（P〉0．05）。结论负载布洛芬的生物可吸收膜可以有效防治肌腱粘连，同时抑制局部炎性反应，为预防肌腱粘连提供一种新的方法。

Objective To investigate the effect of ibuprofen-loaded nanofiber absorbable membrane for preventing tendon adhesion and decreasing local inflammation. Methods In the experiment, 54 adult female leghorn chickens were randomly divided into 3 groups, with 18 chickens each. Flexor digitorum profundus tendon transection and in-situ tenorraphy model was created in the third digit of both paws. The repaired tendons were not treated in group A which served as control. In group B, the repaired tendons were wrapped with nanofiber absorbable membrane without ibuprofen, while in group C the tendons were wrapped ibuprofen-loaded nanofiber absorbable membrane. At 2, 4 and 6 weeks postoperatively, macroscopic and microscopic observation of the repair site, functional recovery evaluation and biomechanical test were performed. Results Six weeks after the tendon repair, dense tissue adhesion of the tendon was seen in group A. Sharp dissection of the tendon from the surrounding tissues was di^cult. Tendon healing was achieved with recognizable tissue structures. In Group B there was moderate fibrotic adhesion around the tendon, which was covered by a transparent membranous structure. In Group C, the pseudosheath formed around the tendon was thin and was identical in color with the surrounding tissues. The tendons could be easily dissected out bluntly. Histological examination showed increase amount of and well aligned tenocytes and collagen fibers at the tendon repair site in group C. There were much less vessels and inflammation cells in the pseudosheath in group C than in group B. Total active motion of the tendons was significantly better in group C than in group B, while group A being the worst （ P 〈 0.05）. Biomechanical test results of group C and group B, while not different between these two groups, were significantly better than those of group A. Conclusion Ibuprofen-loaded nanollber absorbable membrane could prevent tendon adhesion and reduce inflammation reaction at the repair site. It offers a new method for prevention of tendon adhesion.