TGF-β_1抗体复合生物蛋白胶预防鞘管区术后粘连的实验研究  

PREVENTING EFFECT OF TGF-β_1 ANTIBODY COMPOUNDED WITH FIBRIN GLUE ON POSTOPERATIVE ADHESIONS OF FLEXOR TENDON

作　　者：张志敏[1] 刘建[1] 孟国林[1] 吴尧平[1] 

机构地区：[1]第四军医大学附属西京医院骨科,西安710032

出　　处：《中国修复重建外科杂志》2008年第3期349-353,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：山东省卫生计划资助项目(2003CA1CFB1)~~

摘　　要：目的研究TGF-β1抗体(TGF-β1 antibody,TGF-β1Ab)复合生物蛋白胶(fibringlue,FG)预防鞘管区屈肌腱粘连的作用和对肌腱愈合的影响。方法 72只成年雄性来亨鸡制备左足第3、4趾趾深屈肌腱横断模型。按鞘管区给药随机分为4组:A组0.2mLTGF-β1Ab、B组0.2 mL FG、C组0.2mLTGF-β1Ab及FG复合液、D组0.2 mL生理盐水,仅术中注入1次。术后1、3及8周, 每组各取6 只鸡第4 趾行大体及组织学观察;3、8周第3 趾行生物力学测定。 结果术后1周各组肌腱粘连程度评分无明显差异(P> 0.05);3及8 周C组与A、B及D组比较差异有统计学意义(P < 0.05)。组织学观察,术后3、8周A、B及D组胶原纤维排列紊乱,C组胶原纤维排列整齐。术后3周,各组肌腱滑动距离比值分别为0.45 ± 0.05、0.40 ± 0.10、0.79 ± 0.09、0.25 ± 0.07;模拟主动屈曲度比值分别为0.61 ± 0.02、0.67 ± 0.03、0.91 ± 0.03、0.53 ± 0.04;屈曲功分别为(18.00 ± 0.77)、(17.80 ± 1.13)、(27.60 ± 1.73)、(15.60 ± 1.27)o/N。C组3项指标与A、B及D组比较差异均有统计学意义(P < 0.05);各组最大抗断裂载荷分别为(14.2 ± 1.9)、(15.2 ± 2.2)、(16.0 ± 2.2)、(14.7 ± 2.7)N,各组间差异均无统计学意义(P > 0.05)。术后8周,各组肌腱滑动距离比值分别为0.45 ± 0.07、0.43 ± 0.08、0.80 ± 0.09、0.29 ± 0.05;模拟主动屈曲度比值分别为0.61 ± 0.02、0.63 ± 0.03、0.92 ± 0.03、0.53 ± 0.03;屈曲功分别为(18.30 ± 0.84)、(18.60 ± 0.80)、(27.90 ± 1.24)、(15.30 ± 0.75)o/N。C组3项指标与A、B及D组比较差异均有统计学意义(P < 0.05) ;各组最大抗断裂载荷分别为(51.9 ± 3.0)、(51.4 ± 1.4)、(53.3 ± 1.3)、(52.3 ± 2.2)N,各组间差异均无统计学意义(P > 0.05)。结论TGF-β1Ab复合FG可以有效预防术后肌腱粘连,不影响肌腱的正常愈合。Objective To explore the preventing effects of TGF-β1 antibody （TGF-β1Ab） compounded with fibrin glue （FG） on postoperative adhesions of flexor tendon. Methods Seventy-two Leghorn chickens were randomly divided into 4 groups （groups A, B, C and D）, 18 chickens for each group, and the long flexor tendons of the 3rd and 4th toes in zone Ⅱ of all chickens were transversed and sutured with the 4-strand cruciate repair technique to make defect models. In group A, 0.2 mL TGF-β1 Ab was applied at repair site. In group B, 0.2 mL FG was applied at repair site. In group C, 0.2 mL TGF-β1Ab and FG was applied at repair site. In group D, 0.2 mL normal sodium was applied at repair site. At 1, 3 and 8 weeks after operation, the tendons of 6 chickens in each group were harvested for morphological and histological evaluation. Six specimens of each group were obtained for biomechanical test at 3 and 8 weeks. Results The gross observation showed that the differences in grading of tendon adhesion were not significant among 4 groups at I week after operation （P 〉 0.05）, but the differences were significant between groups A, B, D and group C at 3 and 8 weeks after operation （P 〈 0.05）. Histological observation showed that collagen fibers arranged irregularly in groups A, B and D, but arranged regularly in group C at 3 and 8 weeks after operation. At 3 weeks after operation the gliding excursion ratio of the tendon in groups A, B, C and D were 0.45 ± 0.05, 0.40 ± 0.10, 0.79 ±0.09 and 0.25 ± 0.07 respectively ; the simulated active flexion ratio were 0.61 ± 0.02, 0.67 ± 0.03, 0.91 ±0.03 and 0.53 ± 0.04 respectively; the work of flexion were（18.00± 0.77）, （17.80±1.13）, （27.60 ±1.73） and （15.60 ± 1.27）°/N respectively. There were significant differences between group C and other three groups （P 〈 0.05）. The tendon anastomosis breaking strength were （14.2 ± 1.9）, （15.2 ± 2.2）, （16.0 ± 2.2） and （14.7 ±2.7） N, showing no significant differences among 4 group

关 键 词：肌腱损伤 肌腱粘连TGF-β1抗体 生物蛋白胶 鸡 

分 类 号：R687.2[医药卫生—骨科学]