同种异体肌腱修复肌腱缺损的远期疗效观察  

LONG-TERM EFFECTIVENESS OF TENDON ALLOGRAFT FOR REPAIRING TENDON DEFECT

作　　者：唐林俊 陈浩贤 崔太安 程国良[2] 方光荣[2] 丁小珩[2] 

机构地区：[1]成都现代医院手显微外科,成都610041 [2]解放军第401 医院手外科

出　　处：《中国修复重建外科杂志》2011年第3期341-343,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结同种异体肌腱修复肌腱缺损的远期临床疗效。方法 1996年10月-1999年9月,采用经脱氧鸟苷培养冷冻保存与超深低温处理的同种异体肌腱移植修复肌腱缺损24例。男19例,女5例;年龄12～46岁,平均25.9岁。2～5指指总伸肌腱缺损7例,示指伸肌腱缺损7例;2～5指指深屈肌腱缺损3例,环指指深屈肌腱缺损1例;2～5趾趾长伸肌腱缺损3例;长伸肌腱缺损2例;肩胛带离断再植术后肩内收不能1例。肌腱缺损范围5～15 cm。受伤至手术时间为2 h～3个月,平均1.3个月。结果术后切口均Ⅰ期愈合,无深部感染及传染性疾病发生。患者均获随访,随访时间10～12年,平均10.8年。与对侧相同或相近关节比较,术后10年随访时1例4条移植肌腱有6～10°屈曲功能丢失,术后10.6年行屈肌腱松解,术中见同种异体肌腱色泽、弹性正常,直径较原肌腱减少约1/3,有轻度到中度粘连,松解术后功能改善明显;余患者关节伸屈功能良好。根据中华手外科学会手功能评价标准评定临床效果,获优12例,良6例,差6例,优良率达75%。结论脱氧鸟苷培养冷冻处理与超深低温处理的同种异体肌腱均可安全用于临床,其修复肌腱缺损的远期效果较好。Objective To observe the long-term effectiveness of tendon allograft to repair tendon defect. Methods Between October 1996 and September 1999, 24 patients with tendon defect were treated with tendon allograft which was cultured with deoxyguanosine and preserved at low-temperature or ultra-deep-low-temperature. There were 19 males and 5 females, aged from 12 to 46 years with an average of 25.9 years. These patients included 7 cases of total extensor tendon defect of 2nd-5th fingers, 7 cases of index finger extensor tendon defect, 3 cases of deep flexor tendon defect of 2nd- 5th fingers, 1 case of ring finger deep flexor tendon defect, 3 cases of long extensor tendon defect of 2nd-5th toes, 2 cases of long extensor hallucis tendon defect, and 1 case of shoulder adduction missing. The sizes of tendon defect ranged from 5 to 15 cm. The mean time from injury to operation was 1.3 months （range, 2 hours to 3 months）. Results Incisions healed by first intention. No deep infection, infectious diseases, and obvious immune rejection occurred. All patients were followed up from 10 to 12 years with an average of 10.8 years. When compared with contralateral sides, at 10 years of follow-up, 1 patient lost 6-10° flexion function; after 10.6 years, flexion tendon releasing was performed; allografted tendon had normal color and elasticity with decreased diameter and with mild and moderate adherence; and after releasing, function was improved. According to Hand Surgery Association assessment standard, the results were excellent in 12 cases, good in 6, and poor in 6; the excellent and good rate was 75%. Conclusion Tendon allograft which is cultured with deoxyguanosine and preserved at low-temperature or ultra-deep-low-temperature is safe to use in cl inical, which has good long-term effectiveness in treating tendon defect.

关 键 词：同种异体肌腱移植 肌腱缺损 脱氧鸟苷 超深低温 冷冻保存 

分 类 号：R687.2[医药卫生—骨科学]