自体肌腱在眼睑原位重建中的应用  

Eyelid reconstruction in situ using autologous tendon

作　　者：郑梁 余文 杨帆[1] 赵相宜 Zheng Liang;Yu Wen;Yang Fan;Zhao Xiangyi(Taihe Hospital Affiliated to Hubei University of Medicine,Shiyan 442000,Hubei Province,China;Department of Anesthesiology,Second Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi Province,China;School of Basic Medical Sciences,Hubei University of Medicine,Shiyan 442000,Hubei Province,China)

机构地区：[1]湖北医药学院附属太和医院,湖北省十堰市442000 [2]南昌大学第二附属医院麻醉科,江西省南昌市330006 [3]湖北医药学院基础医学院,湖北省十堰市442000

出　　处：《中国组织工程研究》2023年第12期1837-1841,共5页Chinese Journal of Tissue Engineering Research

基　　金：湖北省卫生与计划生育委员会指导项目(WJ2017F076),项目负责人:郑梁。

摘　　要：背景:寻找合适的睑板替代物是眼睑重建的关键,目前所用材料均存在不足之处。根据自体肌腱的生物特性,其具有作为睑板替代物的潜力。目的:观察应用自体肌腱行兔下眼睑原位重建术后的效果及组织转归。方法:取13只成年日本大耳白兔,制备双侧下眼睑缺损模型,一侧眼用自体肌腱行眼睑原位重建手术,另一侧用同种异体巩膜行眼睑原位重建手术,术每天观察移植物情况。术后4周,取双侧睑板复合体,分别进行生物力学测试、苏木精-伊红染色,观察纤维血管化和复合体转归情况。结果与结论:①术后兔双侧眼睑切口有轻微红肿、结膜充血,5 d左右消退;植入4周后切口愈合良好,植入物无明显排斥反应,无植片暴露,眼睑无闭合障碍,角膜完整,眼球活动度良好;②苏木精-伊红染色显示,肌腱组移植物边界清楚,周边由睑板腺体细胞包绕,移植物中央可见呈条索状平行排列的胶原纤维结构,肌腱边界处部分纤维结构不清,移植体周围可见散在分布的新生毛细血管,周围未见明显的炎症细胞浸润;异体巩膜组异体巩膜被胶原纤维替代,细胞排列紊乱;③肌腱组和异体巩膜组眼睑的最大载荷分别为(10.521±3.497),(9.450±4.032)N,最大载荷时的拉伸位移分别为(6.110±0.347),(4.590±0.732)mm,杨氏弹性模量分别为(5.562±1.156),(2.575±0.978)MPa,组间比较差异均有显著性意义(P<0.05);④结果表明,自体肌腱与睑板具有较好的组织相容性,可达到进行眼睑原位重建的物理特征及效果。BACKGROUND:Finding a tarsal substitute is the key to eyelid reconstruction,but current materials exist insufficiency.According to the biological characteristics of autologous tendon,it has the potential as a tarsal substitute.OBJECTIVE:To observe the effect and histopathological changes of autologous tendon as a tarsal substitute transplanted for eyelid reconstruction in rabbits.METHODS:Eyelid defect models on the lower eyelids of 13 healthy New Zealand white rabbits were prepared.The eyelid reconstruction in situ was performed autologous tendon in the right lower eyelids(tendon group)and allogeneic sclera material(sclera group)on the upper eyelids of fellow eyes.The changes of eyelids were observed every day after operation.After 4 weeks,bilateral meibomian complexes were taken for biomechanical test and hematoxylin-eosin staining to observe vascularization and complex outcome.RESULTS AND CONCLUSION:(1)After operation,the bilateral eyelid incision of the rabbit had slight redness,swelling and conjunctival hyperemia,which subsided in approximately 5 days.The incision healed well at 4 weeks after implantation.There was no obvious rejection of the implant,graft exposure,or eyelid closure obstacle.The cornea was intact.Eye movement was good.(2)Hematoxylin-eosin staining exhibited that the graft in the tendon group had a clear border,and the periphery was surrounded by meibomian gland cells.Collagen fibers in the center of the graft were seen in a cord-like parallel arrangement.Part of the fibrous structure at the border of the tendon was unclear.New capillaries were scattered around the graft,and there was no obvious inflammatory cell infiltration around the graft.In the allogeneic sclera group,the allogeneic sclera was replaced by collagen fibers,and the cells were disorderly arranged.(3)The maximum load of the eyelid was(10.521±3.497)and(9.450±4.032)N in the tendon group and allogeneic sclera group,respectively.The tensile displacement at the maximum load was(6.110±0.347)and(4.590±0.732)mm in the tendon group

关 键 词：眼睑重建 自体肌腱 异体巩膜 组织工程 原位重建 兔 动物模型 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R628