肌腱粘连的机制及干预研究进展

Research progress in the mechanism and intervention of tendon adhesion

肌腱粘连是肌腱损伤修复术后常见的并发症,其治疗棘手,是当前临床上亟待攻克的难题之一。近年来,随着医学科学的不断更新与发展,肌腱愈合机制研究不断深入,为术后肌腱粘连的防治与功能恢复提供了理论依据。防治肌腱粘连的关键在于抑制外源性愈合和炎症反应以及促进内源性愈合。肌腱粘连的发生主要与转化生长因子-β(transforming growth factor-β,TGF-β)、碱性成纤维细胞生长因子、血管内皮生长因子等细胞因子有关,另外TGF-β/Smad信号转导通路也较为重要。临床上改进缝合方法及早期康复活动对肌腱粘连的防治具有关键作用,其原理与力学载荷对细胞行为的影响相关;材料联合药物是当前防治肌腱粘连的研究热点,现有的防粘连膜主要发挥物理屏障作用,负载药物后通过抑制炎症反应、调控细胞增殖代谢、抗氧化应激、抑制TGF-β等途径可以实现高效抑制粘连。该文就近年来肌腱粘连的机制以及防治手段中手术、康复、材料、药物等方面的研究进展作一综述,以期促进基础研究的转化应用,为临床防治肌腱粘连提供参考。

As one of the clinical challenges,tendon adhesion is a common complication after the repair of tendon injuries and difficult to treat.In recent years,with the continuous updating and development of medical science,research into the mechanism of tendon healing has been advanced,which provides a theoretical basis for the prevention and treatment of tendon adhesion and functional recovery after surgery.The key to prevent tendon adhesion is to inhibit exogenous healing and inflammatory reaction and to promote endogenous healing.The occurrence of tendon adhesion is mainly related to transforming growth factor-β(TGF-β),basic fibroblast growth factor,vascular endothelial growth factor and other cytokines.Additionally,TGF-β/Smad signal transduction pathway is of significance.Clinically,improvement of suturing methods and early rehabilitation activities play an important role in the prevention and treatment of tendon adhesion,the principle of which is related to the effect of mechanical loading on cell behavior.The combination of materials and drugs is the current research hotspot in the prevention and treatment of tendon adhesion.The existing anti-adhesion membrane mainly acts as physical barrier,and the drug-loaded membrane can efficiently inhibit adhesion by inhibiting inflammatory responses,regulating cell proliferation and metabolism,reducing oxidative stress,and inhibiting TGF-β.This article presents a review of recent research progress in the mechanisms of tendon adhesion and interventions in the areas of surgery,rehabilitation,materials and drugs,in order to promote the transformation and application of basic research,which may provide reference significance for clinical prevention and treatment of tendon adhesion.