光化学组织粘合技术联合羊膜修复手部肌腱损伤的研究

Study of a novel technique combined photochemical tissue bonding and amniotic membrane for improving healing of hand tendon injury

目的:应用光化学组织粘合技术(PTB)联合羊膜的方法修复手部肌腱损伤并评价其疗效。方法:60只苏北草鸡用于制作趾深屈肌腱断伤模型,一侧第3趾深屈肌腱(随机左右)用传统Kessler缝合方法修复,对侧第3趾深屈肌腱用PTB联合羊膜的方法进行修复。术后不同时间点进行伸屈活动度测定,观察肌腱愈合情况,评估粘连程度,检测炎症细胞浸润,检测抗张力强度。结果:PTB联合羊膜修复组中羊膜同损伤肌腱贴合紧密,在术后14 d关节活动度(P<0.01)和肌腱粘连程度(P<0.05)均明显优于缝合组;术后7、14 d时炎症细胞浸润数量较缝合组明显减少(P<0.01);抗张性与缝合组相比,在各时间点差异均无明显统计学意义(P>0.05)。结论:PTB联合羊膜的方法可使损伤肌腱获得良好的抗张性,减少炎症反应和瘢痕粘连等并发症,促进运动功能的恢复。该方法无技术难点及明显禁忌,可较快转化为临床治疗手段。

Objective： In this study a new approach combined photochemical tissue bonding （PTB） and human amniotic membrane （HAM） was utilized to repair hand ＂tendon rupture and its efficacy was to be evaluated. Methods ： A total 60 Subei chickens underwent surgical transection of the third flexor digitorum profundus （FDP） tendons were repaired by：（a） SR, standard Kessler suture for one side （random left or right） ;（b） HAM/PTB, PTB combined with human amniotic membrane for the other side. And then the total active motion, gross appearance, extent of adhesion formation, biomechanieal properties, and inflammation cells of the repaired tendon were evaluated at different post-operative days. Results： PTB strongly bonded the HAM with the FDP tendon surface. There was no significant difference for the tensile property in both treatments at all postoperative time points（P 〉 0.05 ）. The joint activities （ P 〈 0.01 ） and adhesion formation levels （ P 〈 0.05 ） were significantly better in the HAM/PTB group compared to that in the SR group on days 14. Histology revealed drastically reduced numbers of inflammatory cells in the HAM/PTB group than in the SR on days 7 and 14 after surgery（P 〈 0.01 ）.Conclusion： PTB sealing of HAM around the tendon repair site provides considerable benefits for hand tendon repair by eliminating technical difficulties and obvious contraindications. Thus this procedure has great potential to become a new surgical approach for repairing hand tendon damage.