可吸收生物材料在肌腱损伤重建中的防粘连作用

Anti-adhesion effect of absorbable biomaterials during tendon reconstruction

背景:运动性肌腱损伤后,重建肌腱粘连是肌腱损伤修复失败的主要原因,理想的防止肌腱粘连材料对肌腱损伤重建有重要作用。目的:分析可吸收医用防粘连材料在抑制运动性肌腱损伤重建后粘连的临床效果及性能特点。方法:应用计算机检索CNKI和Pub Med数据库1988至2015年有关半月板损伤修复和组织工程技术应用方面的文献,中文检索关键词为"肌腱修复、肌腱粘连、可吸收生物材料",英文检索关键词为"tendon Repair,tendon adhesion,absorbable biomaterials"。结果与结论:可吸收医用防粘连材料研究和临床应用均已取得显著成果。目前临床上可吸收医用防粘连材料主要有透明质酸、聚乳酸、胶原蛋白、纤维蛋白胶等,具有良好的生物相容性,能够在体内降解吸收,临床实施操作简单,能完全覆盖创伤表面,其作用机制主要有降低胶原纤维的产生、屏障隔离、加速止血、抗菌消炎等,可有效减少肌腱损伤重建后粘连,促进肌腱愈合。但他们又有各自的局限性,透明质酸在体内作用时间短,而且有免疫原性;聚乳酸最终分解物为乳酸小分子,可引起无菌性炎症;胶原蛋白、纤维蛋白胶的生物相容性、活性都存在着很多不足。

BACKGROUND： After sports tendon injury, tendon adhesion is the main reason for the failure to repair tendon injury. So, an ideal anti-adhesion material plays an important role in the tendon reconstruction. OBGECTIVE： To analyze the clinical effect and features of absorbable medical biomaterials in inhibiting tendon adhesion after repair of sports tendon injury. METHODS： CNKI and PubM ed database were retrieved by the first author using computer to search relevant articles about meniscal repair and tissue engineering technology published from 1988 to 2015. The key words were ＂tendon repair, tendon adhesion, absorbable biomaterials＂ in Chinese and English, respectively. RESULTS AND CONCLUSION： Basic and clinical studies on absorbable anti-adhesion materials have achieved remarkable results. Currently absorbable anti-adhesion materials include hyaluronic acid, polylactic acid, collagen and fibrin glue, which have good biocompatibility and can be absorbed and degraded in vivo. With simple clinical implementation, these materials can completely cover the wound surface. The main mechanisms are as follows： reducing the generation of collagen fibers, isolation barrier, accelerating hemostasis, antisepsis and anti-inflammation, thereby effectively reducing reconstructed tendon adhesion and promoting tendon healing. But they have their limitations： hyaluronic acid has short acting duration in vivo and immunogenicity; polylactic acid eventually is decomposed into small molecules that can cause aseptic inflammation; collagen and fibrin glue both have certain shortcomings in biocompatibility and activity.