肌腱在可降解聚碳酸酯套管内愈合情况的实验观察

Observation of the tendon healing in the degradable polycarbonate tubes

目的了解可降解聚碳酸酯套管套接肌腱的效果。方法采用两种可降解聚碳酸酯材料聚(2熏2二甲基三亚甲基碳酸酯-共-ε-己内酯)眼P(DMTC-CL)演及聚(2熏2二甲基三亚甲基碳酸酯-共-ε-己内酯-共-丙交酯)眼P(DMTC-CL-LA)演,分别制成肌腱套管A、B。将24只成年雄性纯种三黄鸡随机分为A、B组:A组Ⅱ、Ⅲ趾以A管修复趾深屈肌腱,B组Ⅱ、Ⅲ趾以B管修复趾深屈肌腱,两组Ⅳ趾以尼龙线修复肌腱作为自身对照。分别观察术后1周、2周、3周、30d、45d、60d修复肌腱的形态学变化。结果B管术后2周即开始降解,术后3周肌腱初步愈合,但肌腱粘连明显;A管术后60d仍未见明显降解,术后30d肌腱初步愈合,但愈合质量较差,粘连轻;对照趾术后3周肌腱初步愈合,肌腱粘连明显。结论穴1雪肌腱在相对密闭的套管内可以最终达到愈合,但愈合的速度及质量均受到一定的影响。穴2雪套管可以有效阻止肌腱吻合口与周围组织的粘连。穴3雪套管的通透性及降解速度对肌腱的愈合及粘连均有明显影响。

Objective To observe the healing process and adherence formation in the lacerated tendons repaired with degradable and diffusible polycarbonate tubes. Methods Two types of degradable and diffusible polycarbonate tubes: tube A made of poly(2,2-dimethyl trimethylene carbonate-co-ε-caprolactone) and tube B made of poly(2,2-dimethyl trimethylene carbonate-co-ε-caprolactone-co lactide) were used as tendon repair materials. Twenty-four male adult purebred Sanhuang chicken were randomized into two groups: the flexor digitorium profoundus tendons of the second and third digits in group A were repaired with tubes A and those in group B were repaired with tubes B. The flexor digitorium profoundus tendons of the fourth digits in both groups were repaired with ″8″ -shaped stitch suturing method and used as control. The animals in both groups were sacrificed at 7, 14, 21, 30, 45 and 60 day intervals after operation. The operated claws were cut down for macroscopic examination and microscopic observation. Results In group B the tubes became incomplete for degradation at 14d after operation and the lacerated tendon started to heal at 21d, but obvious adhesion was formed. In group A the tubes were still intact at 60d after operation and the lacerated tendon ends were initially healed with little adhesion formation at the 30d, but the quality of healing was inferior to that in the group B and control. In the control group the lacerated tendon ends were initially joined but the adhesion was very obvious. Conclusions (1) The tendon in the closed tubes can healed finally, but the heal process is reduced in quantity and quality. (2) The tubes could effectively prevent adhesion formation. (3) The permeability and the degradation rate of tubes may affect the healing process and adherence formation.