同种异体肌腱移植修复跟腱断裂  

Tendon allograft transplantation repairs Achilles tendon rupture

作　　者：唐恒涛[1] 王闯建[1] 严旭[1] 张春霖[1] 

机构地区：[1]郑州大学第一附属医院骨科,河南省郑州市450052

出　　处：《中国组织工程研究》2013年第31期5626-5632,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:对于跟腱断裂,临床传统修复方法是应用踝周自体肌腱移位修复,自体肌腱取材有限,供区损伤,以牺牲正常的动力和稳定结构为代价;而同种异体肌腱移植具有来源丰富,取材方便,不破坏宿主正常结构,保持其原有生物结构特性等优点。目的:评价同种异体肌腱移植修复跟腱断裂的临床效果。方法:2008年8月至2011年6月收治30例急性、陈旧性跟腱断裂患者,4例陈旧损伤有2-5cm不等缺损,应用同种异体肌腱移植修复缺损,移植后短腿石膏固定患肢,4周后拆除石膏行功能锻炼。按Arner-lindholm疗效评定标准评价临床治疗结果。结果与结论:住院时间平均12.5d。移植后25例获得随访,随访1-3年,未见再断裂病例。按Arner-lindholm评定标准,25例中优20例,良3例,可2例,优良率为92%。患者踝关节功能恢复正常,3例跟腱与邻近组织粘连,影响踝关节背伸,足部蹬力无明显下降。2例考虑排异反应,经对症处理痊愈。1例出现少许皮缘坏死、切口感染,扩创换药,行邻近转移皮瓣覆盖后痊愈。所有患者出院时切口均愈合。结果显示,同种异体肌腱移植修复跟腱断裂效果满意,是一种值得推荐的治疗选择。但远期疗效需要进一步观察。BACKGROUND： For the treatment of Achilles tendon rupture, peripheral ankle autologous tendon displacement is the traditional method in clinic, while the source of autologous tendon is limited, has damage to the donor site and has to pay with the normal power and stable structure. Allogenic tendon has the advantages of rich sources, easy to obtain, no damage to the normal structure of the host, and can maintain its original biological structure. OBJECTIVE： To evaluate the clinical effect of tendon allograft transplantation on the repair of Achilles tendon rupture. METHODS： Thirty cases of acute and old Achilles tendon rupture and four cases of chronic rupture with 2-5 cm deficiency were treated from August 2008 to June 2011. The cases were treated with tendon allograft transplantation, and short leg cast was used to fix the limb after transplantation. Functional exercises were commenced at 4 weeks after cast removal. The clinical treatment results were evaluated by Arner-lindholm criteria. RESULTS AND CONCLUSION： The mean hospital stay was about 12.5 days. Twenty-five cases were followed-up for 1-3 years after transplantation and no rupture recurred. According to Arner-lindholm criteria, excellent was in 25 cases, good in 3 cases, fair in 2 cases, and the excellent and good rate was 92%. Ankle joint function was recovered to the normal level. Three cases had adhesion between Achilles tendon and adjacent tissue that had impact on the ankle dorsiflexion, and there was no significance decrease in foot pedal force. Two cases had rejection that healed after symptomatic treatment. One case had less flap margin necrosis and incision infection that healed after dressing and adjacent flap coverage. Incisions of all patients were healed at discharge. The results show that tendon allograft transplantation has satisfactory effect for reaping the Achilles tendon rupture which is a recommended treatment option. But the long-term effect needs further observation.

关 键 词：器官移植 组织移植 跟腱断裂 同种异体 肌腱 修复 缝合 韧带 缺损 

分 类 号：R318[医药卫生—生物医学工程]