可吸收膜联合口服塞来昔布防止兔肌腱粘连的实验研究

Experimental study on absorbable membrane in combination with oral celecoxib for prevention of tendon adhesion in rabbit

[目的]观察聚乳酸聚乙二醇共聚物[poly（1-lacticacid）-polyethylene goycol，PELA]可吸收膜与口服塞来昔布联合应用对预防兔肌腱粘连、降低局部炎症的有效性。[方法]成年雌性新西兰大白兔36只，体重2．0～2．5kg，随机分为三组。制备双后足第3趾屈肌腱损伤模型：A组原位缝合作为对照，B组采用防粘连膜包裹肌腱损伤区，C组应用防粘连膜并术后口服塞来昔布[10mr／（kg·d）]。术后3周行大体及组织学观察、肌腱功能评价和生物力学测定。[结果]3周后，肉眼下：A组腱周大量致密粘连组织，锐性分离困难；B组中度粘连，锐性分离见肌腱表面“假鞘”覆盖；C组仅少量粘连，“假鞘”薄，钝性可完全分离。镜下，C组断端愈合良好，腱周粘连少，局部炎细胞少于其他组。肌腱屈曲总角度：C组优于B组，A组最差，组间差异均有统计学意义（P〈0．05）。生物力学测定示三组最大抗拉力无明显差异。[结论]PELA可吸收膜联合口服塞来昔布能有效防止肌腱粘连，抑制局部炎症，为防止肌腱粘连提供了一种新方法。

[ Objective ] To investigate the effect of poly （ l-lactic acid） -polyethylene goycol （PELA） absorbable membrane combined with oral celecoxib in preventing tendon adhesion and decreasing local inflammation. [ Method] Thirty-six adult female New Zealand rabbits（weighing 2.0- 2.5 kg） were randomly divided into 3 groups. Flexor digitorumprofundus tendon transection and in-situ tenorraphymodel was made in the third digit of beth hindpaws. As a control group, the repaired tendons in group A were not treated. The tendons in group B were wrapped with absorbable membrane. In group C,the absorbable membrane were used with a combination of oral Celecoxib[ 10mg/（ kg · day） ]. Three weeks later, macroscopic and microscopic observation, functional recovery evaluation and biomechanical test were performed. [ Result ] 3 weeks after the operation, dense tissue adhesion was seen in group A. Sharp dissection of the tendon from the surrounding tissue was difficult. In group B, there was moderate fibrotic adhesion. The tendon was covered by a pseudosheath. In Group C,the pseudosheath was thinner and tendons could be easily released bluntly. Histological examination of group C showed healed tendons and less inflammation cells than other groups. Total active motion of the tendonin group C was better than in group B,while in group A being the worst （P 〈 0.05 ）. The results of biomechanical test showed no difference in three groups. [ Conclusion] The combination of PELA absorbable membrane and oral celecoxib could prevent tendon adhesion and reduce local inflammation,thus offer a new method for the prevention of tendon adhesion.