显微外科技术修复肌腱的实验研究——(三)屈趾肌腱游离移植与转移的比较研究

COMPARATIVE STUDY ON HEALING BETWEEN THE FREE TENDON GRAFT AND TENDON TRANSFER IN THE RECONSTRUCTION OF FLEXOR TENDON IN ZONE Ⅱ

36只新西兰大白兔双前爪,行腱鞘区第2趾肌腱转移、第4趾游离肌腱移植,术后1、3、7、14、21、28天。对两种术式肌腱及缝合处行大体、组织学、血供、生化检查。结果显示肌腱随术后时限延长,粘连逐渐加重,胶原纤维于术后21天可见,肌腱愈合以外源形式为主;游离移植肌腱有部分退变。肌腱的再血管化能力低。转移肌腱组织的羟脯氨酸及氨基已糖均较正常肌腱低,较游离移植肌腱高。本实验表明:腱鞘区肌腱缺损,进行游离肌腱移植与肌腱转移对肌腱愈合均有影响,在组织学及生化方面,尤以游离肌腱移植为甚。这与腱鞘区肌腱的营养特性以及游离移植肌腱的营养更加贫乏有关。

In order to understand the influence of the free tendon graft and the tendon transfer on their blood supply, histological and biochemical changes during healing following repair of the damaged tendon after the alteration of the nourishing environment, an experiment was carried on 36 New Zealand white rabbits. In the front paws of the rabbits, the free tendon graft was sutured in the tendon defect of flexor of the fourth toe and the flexor tendon of the third toe was transferred to the second toe to reconstruct the tendon loss. The rabbits were examined at the interval of 1,3,7,14,21 and 28 days after operation. The results showed that as the prolongation of the postoperative time, the adhesion around the tendon became more and more dense. The synthesis of the collagen fibers began at 21 days after operation, and the healing of the tendon following repair mainly came from the surroundings. A few of the specimens in the free tendon grafts showed some degenerative changes and with low revascularization potential. In the biochemical assessments, the contents of hydroxyproline and hexosamine in the transferred tendons were higher than those in the free tendon grafts, however, were still lower than the contents in the normal tendons. Winding up the results of this study, it appeared that in the repair of tendon in Zone Ⅱ, either free tendon graft or tendon transfer would have influence on the healing of tendon repair, and the free tendon graft would result in more interference with healing as the histological and biochemical changes were concerned.