局部联合应用透明质酸钠及5-氟尿嘧啶对兔肌腱粘连及愈合的影响  

Effect of locally combined use of sodium hyaluronate and 5-fluorouracil on the tendon adhesion and healing in rabbits

作　　者：张波[1] 付凯[2] 郑宪友[2] 韩清銮[1] 张磊[1] 陈磊[1] 张光辉[1] 栗威[1] 

机构地区：[1]济宁医学院附属医院手足外科,272029 [2]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华实验外科杂志》2017年第8期1371-1373,共3页Chinese Journal of Experimental Surgery

基　　金：山东省自然科学基金（ZR2009CL010）;济宁市科技局资助项目（[2010]85号）

摘　　要：目的 探讨局部联合应用透明质酸钠（SH）及5-氟尿嘧啶（5-Fu）对肌腱粘连及愈合的作用.方法 将90只成年新西兰大白兔,体重2.0~2.5kg,雌雄各半,采用随机数字表的方法分为3组（n=30）：SH组、5-Fu组及SH＋5-Fu组.按照自身对照的原则,显露兔双后腿肌腱,常规手术制备肌腱损伤模型,实验组右后腿肌腱损伤处分别应用SH、5-Fu及联合应用SH及5-Fu,左后腿肌腱应用生理盐水作为对照组.分别于术后第1、3、6 周取兔肌腱常规进行大体及组织学观察,分别观察肌腱粘连程度及成纤维细胞的变化;术后6周电镜下观察成纤维细胞、胶原纤维生长.结果术后第1、3、6 周,SH组、5-Fu组及SH＋5-Fu组肌腱粘连程度较对照组均明显减轻（P值分别为0.048、0.044、0.001;0.036、0.045、0.005;0.035、0.016、0.001）;SH＋5-Fu组较SH组、5-Fu组肌腱粘连程度均明显减轻（P值分别为0.047、0.019、0.032;0.014、0.019、0.034）;SH＋5-Fu组肌腱内成纤维细胞数（1周：153.20±13.26;3周：192.30±10.94;6周：195.60±12.93） 较对照组（1周：64.30±5.60;3周：91.60±8.36;6周：92.90±7.61）、SH组（1周：94.00±10.67;3周：133.10±10.72;6周：134.80±8.51）及5-Fu组（1周：100.30±10.38;3周：139.60±10.27;6周：141.20±10.97）均明显升高（P值分别为0.018、0.001、0.001）;SH＋5-Fu组腱周成纤维细胞数（1周：103.40±8.34;3周：84.40±9.05;6周：80.00±10.57） 较对照组（1周：210.80±12.94;3周：189.50±15.07;6周：184.40±15.61）、SH组（1周：140.30±13.84;3周：121.40±13.75;6周：115.40±14.36）、5-Fu组（1周：147.50±8.15;3周：127.20±8.64;6周：121.50±7.56）均明显减少（P值分别为0.005、0.007、0.019）;术后第6周,电镜下观察SH＋5-Fu组较SH组、5-Fu组及对照组肌腱细胞及胶原纤维排列较规则,结构较规则,周期性横纹明显.结论 局部联合应用SH及5-Fu可以明显促进肌腱内成纤维细胞增殖和胶原纤维合成,减少腱周�Objective To assess the effect of locally combined use of sodium hyaluronate （SH） and 5-fluorouracil （5-Fu） on the tendon adhesion and healing.Methods Ninety mature New Zealand white rabbits （weighing 2.0-2.5 kg,half males and half females） were randomly divided into 3 groups （n=30 each）： SH group,5-Fu group and SH＋5-Fu group.A tendon injury model was established in the hind legs.In experimental groups,the injured tendons of the right hind legs were given SH （SH group）,5-Fu （5-Fu group） and combined use of SH and 5-Fu （SH＋5-Fu group） respectively.The injured tendons of the left hind legs were given same volume of normal saline in the control group.The gross and histological changes were examined to observe the adhesion degree and the fibroblast cells at 1st,3rd and 6th week,respectively.Under the electron microscope,the fibroblast cells and collagenous fibers were observed at 6th week.Results At 1st,3rd and 6th week,as compared with the control group,the grading of adhesion in the SH group,the 5-Fu group and the SH＋5-Fu group was significantly decreased,respectively （P=0.048,0.044,0.001;0.036,0.045,0.005;0.035,0.016,0.001）,and the grading of adhesion in the SH＋5-Fu group was significantly slighter than that in the SH group and 5-Fu group （P=0.047,0.019,0.032;0.014,0.019,0.034）.The number of fibroblasts in the tendon parenchyma in the SH＋5-Fu group （at 1st week： 153.20±13.26;at 3rd week： 192.30±10.94;at 6th week： 195.60±12.93） was significantly greater than in the control group （at 1st week： 64.30±5.60;at 3rd week： 91.60±8.36;at 6th week： 92.90±7.61）,the SH group （at 1st week： 94.00±10.67;at 3rd week： 133.10±10.72;at 6th week： 134.80±8.51） and the 5-Fu group （at 1st week： 100.30±10.38;at 3rd week： 139.60±10.27;at 6th week： 141.20±10.97,P=0.018,0.001,0.001）,respectively.The number of fibroblast cells in the tendon sheath and epitenon in the SH＋5-Fu group （at 1st week： 103.40±8.34;at 3rd week： 84.40±9.05;at

关 键 词：透明质酸钠 5-氟尿嘧啶 肌腱粘连 肌腱愈合 肌腱损伤 

分 类 号：R686.1[医药卫生—骨科学]