人羊膜修复腱鞘缺损的实验研究  

EXPERIMENTAL STUDY ON HUMAN AMNIOTIC MEMBRANE FOR REPAIRING TENDON SHEATH DEFECT

作　　者：高鸣[1] 赵红芳[1] 田德虎[1] 于昆仑[1] 白江博[1] 董瑞一[1] 张国辉[1] 

机构地区：[1]河北医科大学第三医院手外科石家庄,050031

出　　处：《中国修复重建外科杂志》2013年第3期335-339,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨人羊膜修复鸡足趾腱鞘缺损后防止肌腱粘连的可行性和有效性。方法取行剖腹产术产妇自愿捐赠的胎盘,制备大小为1.5 cm×1.0 cm的羊膜片。3～6月龄健康雄性来亨鸡40只,体重(1.86±0.04)kg,取双足第3趾制备肌腱、腱鞘损伤模型。"8"字缝合修复肌腱后,右足采用羊膜片修复缺损腱鞘(A组),左足缺损腱鞘不作处理(B组)。术后1、2、4、6周各取10只实验动物行大体及组织学观察,并按照Tang等肌腱粘连大体观察分级标准进行分级,生物力学试验测定肌腱滑移度及总屈趾角度。结果术后实验动物均存活至实验完成,切口均愈合良好。随术后时间延长,大体及组织学观察显示两组均有假鞘(新生腱鞘)形成,但A组假鞘较B组成熟、光滑。术后1、6周A组肌腱粘连分级均明显优于B组,差异有统计学意义(P<0.05)。生物力学试验测定示,术后1、2周两组肌腱滑移度比较,差异均无统计学意义(P>0.05),4、6周时A组肌腱滑移度均较B组长(P<0.05)。术后1、2、4、6周A组总屈趾角度均小于B组,差异有统计学意义(P<0.05)。结论采用人羊膜修复鸡腱鞘缺损能有效预防肌腱粘连,利于肌腱滑动功能的恢复。Objective To investigate the feasibility and effect of human amniotic membrane in prevention of tendon adhension after tendon sheat defect repair. Methods The amniotic membrane in size of 1.5 cm x1.0 cm was harvested from human placenta which was voluntary donated from maternal after cesarean. Forty healthy male Leghorn chicken （aged 3-6 months） were selected, weighing （1.86 ＋ 0.04） kg. The model of flexor digitorum profundus tendon and tendon sheath defects was established at the third toe. After repair of the flexor digitorum profundus tendon, the human amniotic membrane was used to repair the tendon sheath defect in the right foot （group A）, but tendon sheath defect was not repaired in the left foot （group B）. At 1, 2, 4, and 6 weeks after operation, the gross and histological observations were done; the degree of tendon adhesions was graded according to Tang＇s tendon adhesion general observation grading standards; and the biomechanical properties （tendon slip length and total flexion angle） were tested. Results All animals survived after operation and incisions healed. Gross and histological observations showed that the new tendon sheath formed with time passing after operation in groups A and B; new tendon sheath was more maturer and smoother in group A than in group B. The degree of tendon adhesions in group A was significantly less than that in group B （P 〈 0.05） at I and 6 weeks after operation. The biomechanical test results showed there was no significant difference in the tendon slip length between 2 groups at 1 and 2 weeks after operation （P 〉 0.05）, but the tendon slip length of group A was significantly longer than that of group B at 4 and 6 weeks after operation （P 〈 0.05）. The total flexion angle of group A was significantly smaller than that of group B at 1, 2, 4, and 6 weeks after operation （P 〈 0.05）. Conclusion It is effective in the prevention of tendon adhesion to use the amniotic membrane for repairing the tendon sheath defect, which is benefi

关 键 词：羊膜 腱鞘修复 肌腱粘连 鸡 

分 类 号：R687.2[医药卫生—骨科学]