猪小肠粘膜下层修复鸡腱鞘的实验研究

An experimental study of tendon sheath repair with porcine small intestine submucosa

目的 评估猪小肠粘膜下层预防肌腱粘连的效果.方法 取成年雄性来亨鸡54只,随机分成3组,每组18只.切除鸡右足第3趾Ⅱ区的腱鞘1.0 cm,采用猪小肠粘膜下层修复为实验组（B组）,腱鞘缺损原位修复为对照组（A组）,不修复为腱鞘缺损组（C组）.术后4周,3组均行关节总活动度（total active motion,TAM）测定、肌腱滑移距离（tendon sliding distance,TSD）测定、HE染色组织学观察、Nyska法粘连度评定、腱鞘滑膜细胞免疫组织化学S-P法染色观察、腱鞘滑膜细胞计数,从而评价猪小肠粘膜下层预防肌腱粘连的效果.结果 术后4周,TAM测定：A组为143.33±20.93,B组为142.72±16.16,C组为105.78±8.97;TSD测定：A组为1.12±0.12,B组为1.11±0.11,C组为0.99±0.11;Nyska法粘连度评分：A组为0.50＋ 0.51,B组为0.72＋0.57,C组为1.89＋ 0.76;滑膜细胞计数：A组为119.33±33.55,B组为91.50±21.88,C组为33.17±22.41.A、B两组与C组比较差异均有统计学意义（P＜0.05）,B组与A组比较差异无统计学意义（P＞0.05）.HE染色组织学观察可见A、B两组肌腱与腱鞘之间的空隙较C组明显.免疫组织化学S-P法染色观察可见A、B组大量滑膜细胞,明显多于C组.结论 猪小肠粘膜下层修复缺损的腱鞘能有效预防肌腱粘连.

Objective To assess the effectiveness of tendon adhesion prevention using small intestine submucosa （SIS）.Methods Fifty-four adult male Leghorn chickens were randomly divided into three groups,with 18 each.A piece of tendon sheath measuring 1.0 cm was excised in zone Ⅱ of flexor tendon of the right 3rd toe.According to group assignment,the tendon sheath was repaired by in situ reattachment of the excised sheath （control group,A）,by SIS （experimental group,B）,or left unrepaired （tendon sheath defect group,C）.After four weeks,animals in all three groups were subject to total active motion （TAM） measurement,tendon gliding distance （TGD） measurement,histological observation with HE staining,Nyska adhesion assessment,SP immunohistochemical staining of tendon sheath synovial cells,and tendon sheath synovial cell count.These parameters were compared among the groups to evaluate the effect of SIS in preventing tendon adhesion.Results Four weeks postoperatively,TAM was 143.33 ± 20.93 degrees in group A,142.72 ± 16.16 degrees in group B,and 105.78 ± 8.97 degrees in group C.TGD was 1.12 ± 0.12 cm in group A,1.11 ± 0.11 cm in group B,and 0.99 ± 0.11 cm in group C.Nyska＇s adhesion score was 0.50 ± 0.51 in group A,0.72 ± 0.57 in group B,and 1.89 ± 0.76 in group C.Synovial cell count was 119.33 ± 33.55 in group A,91.50 ± 21.88 in group B,and 33.17 ± 22.41 in group C.The differences between group A and group C and between group B and group C were significant （P ＜ 0.05）.Between group B and group A,the difference was not statistically significant （P ＞ 0.05）.HE staining showed more visible gap between the tendon and tendon sheath in groups A and B than in group C.Immunohistochemical staining revealed significantly higher number of synovial cells in groups A and B comparing to group C.Conclution Repairing tendon sheath defect with SIS can effectively prevent tendon adhesion.