脱细胞羊膜与医用膜修复腱鞘缺损防治肌腱粘连的比较

Acellular amniotic membrane versus medical membrane to prevent tendon adhesion in tendon sheath repair

背景:实验证实生物膜可用于腱鞘缺损的重建,抑制肌腱外源性愈合,为肌腱滑动提供良好的基床,减轻肌腱粘连。目的:比较脱细胞羊膜与医用膜修复腱鞘缺损中防治肌腱粘连的作用。方法:于66只来亨鸡双足第Ⅲ趾制备肌腱损伤、腱鞘缺损模型,随机分为3组,每组22只,羊膜组采用脱细胞羊膜修复腱鞘缺损,医用膜组采用可吸收医用膜修复腱鞘缺损,对照组不修复腱鞘。术后2,4,8,12周取各组标本,进行大体、组织学及生物力学检测。结果与结论:(1)大体观察:术后12周,羊膜组、医用膜组腱鞘完整,肌腱愈合良好,无粘连;对照组肌腱粘连严重。(2)组织学:术后8周,羊膜组假鞘中滑膜细胞数最多,基质内粗面内质网高度扩张,分泌旺盛,医用膜组次之,对照组滑膜细胞数最少,分布杂乱,基质内扩张空泡较前两组弱。术后12周羊膜组、医用膜组成纤维细胞层状整齐排列,结构致密;对照组腱鞘组织结构疏松,成纤维细胞分布絮乱。(3)生物力学:羊膜组、医用膜组肌腱滑动距离、总屈趾角度均大于对照组(P<0.05),前两组间比较差异无显著性意义。术后12周,3组间最大拉伸断裂强度比较差异无显著性意义。(4)结果表明,脱细胞羊膜与医用膜重建腱鞘缺损均能明显屏障肌腱外源性愈合,防治肌腱粘连。

BACKGROUND： Experiments have demonstrated that biological membranes can be used to reconstruct the tendon sheath and inhibit exogenous healing of the tendon. Therefore, these membranes provide a good bed for tendon gliding and reduce tendon adhesion. OBJECTIVE： To compare the effects of acellular amniotic membrane and medical membrane against tendon adhesion during the repair of tendon sheath defects. METHODS： Toes III from the bipeds of 66 leghorns were chosen to prepare tendon injury and tendon sheath defect models, which were randomly divided into three groups（n=22 per group）. Amnion group were repaired with acellular amniotic membrane, medical membrane group with absorbable membrane, and control group had no treatment on tendon sheath defects. Gross, histological and biomechanical tests of each group were performed at 2, 4, 8, 12 weeks after surgery. RESULTS AND CONCLUSION： At 12 weeks after surgery, in the amniotic membrane and medical membrane groups, the tendon sheath formed completely, and the tendon healed well, with no adhesion, but in the control group, there was serious tendon adhesion. At 8 weeks after surgery, the number of synovial cells in the false sheath was highest in the amniotic membrane group sequentially followed by the medical membrane group and control group. In the amniotic membrane group, the rough endoplasmic reticulum expanded highly and secreted exuberantly in the matrix, while in the control group, the synovial cells presented with messy arrangement, and expanded vacuoles in the matrix were weaker than those in the other two groups. At 12 weeks after surgery, fibroblasts were arrayed tidily in layer with dense structure in the medical membrane and amniotic membrane groups; but in the control group, fibroblasts were distributed disorderly with loose structure. Tendon sliding distance and total flexor toe angle in the amniotic membrane and medical film groups were significantly larger than those in the control group（P〈0.05）, but there was no significant difference between the medical membrane and amniotic membrane groups. Additionally, the maximum tensile fracture strength had no significant difference among three groups at 12 weeks after surgery. These results indicate that both amniotic membrane and medical membrane can markedly protect the tendon from exogenous healing and adhesion.