第三趾趾深屈肌腱Ⅱ区损伤模型肌腱粘连的功能锻炼  

Functional exercise for tendon adhesion in a model of deep flexor tendon II injury of the third toe

作　　者：程杰 王继宏[2] 张沛[3] Cheng Jie;Wang Jihong;Zhang Pei(Department of Trauma Area C,the Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,Inner Mongolia Autonomous Region,China;Department of Hand and Foot Microsurgery Area B,the Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,Inner Mongolia Autonomous Region,China;Department of Spinal Surgery Area A,the Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古医科大学第二附属医院创伤外科中心C区,内蒙古自治区呼和浩特市010030 [2]内蒙古医科大学第二附属医院手足显微外科中心B区,内蒙古自治区呼和浩特市010030 [3]内蒙古医科大学第二附属医院脊柱外科中心A区,内蒙古自治区呼和浩特市010030

出　　处：《中国组织工程研究》2024年第8期1161-1167,共7页Chinese Journal of Tissue Engineering Research

基　　金：内蒙古医科大学科技百万工程联合项目(YKD2018KJBW(LH)012),项目负责人:程杰;内蒙古自治区高等学校科学研究项目(NJZY22673),项目负责人:程杰。

摘　　要：背景:前期研究显示,改良津下缝合法可用于修复鸡肌腱损伤,由于未进行修复后的功能锻炼,使得肌腱出现较明显的粘连,体现了肌腱修复术后进行功能锻炼的重要性。目的:探讨预防改良津下缝合法修复鸡屈趾肌腱断裂模型肌腱粘连被动功能锻炼的方案。方法:取10月龄三黄鸡100只,建立右足第三趾Ⅱ区趾深屈肌腱断裂模型后,采用随机数字表法分为5组,每组20只:A组术后石膏固定3周,并且每天给予1次的被动功能锻炼,连续3周;B组术后石膏固定3周,并且每天给予2次的被动功能锻炼,连续3周;C组术后石膏固定3周,并且每天给予3次的被动功能锻炼,连续3周;D组术后石膏固定3周;E组不进行石膏固定也不进行被动功能锻炼。3周后,观察鸡爪的大体形态、肌腱吻合端的形态及腱周粘连程度,检测第三趾屈趾深肌腱滑移距离和所有关节的屈曲角度、肌腱吻合端病理形态和羟脯氨酸含量。结果与结论:①E组肌腱在术后6 d左右完全断裂,从实验中剔除;B、C组鸡爪有较好的抓握形态,D组鸡爪几乎无抓握形态,A组鸡爪抓握形态差于B、C组;②B、C组肌腱吻合端膨大不明显,质地和正常腱性组织差别不大,相对于C组,B组肌腱粘连程度相对轻;D组肌腱吻合端膨大明显,质地较硬,腱周组织瘢痕明显,粘连程度重;A组的表现介于B、C组和D组之间;③B、C组鸡第三趾屈趾深肌腱滑移距离和所有关节的屈曲角度均优于A、D组(P<0.05),B组鸡肌腱中羟脯氨酸含量高于A、C、D组(P<0.05);④苏木精-伊红与天狼星红染色显示,A、C、B组肌腱胶原纤维排列逐渐有方向性,鲜红粗大的Ⅰ型胶原纤维逐渐增多,绿色细小的Ⅲ型胶原纤维逐渐减少;E组肌腱胶原纤维排列方向性差,Ⅰ型和Ⅲ型胶原纤维交叉分布;⑤结果表明,改良津下缝合法修复鸡屈趾肌腱断裂模型术后,每天2次充分的被动功能锻炼既能有效减轻肌腱粘连又能减�BACKGROUND:Previous studies have shown that the modified Tsuge suture method can be used to repair chicken tendon injuries.However,the lack of postrepair functional exercise leads to obvious tendon adhesions.Therefore,a functional exercise after tendon repair is very important.OBJECTIVE:To explore a scheme for passive functional exercise against tendon adhesion in a chicken model of flexor toe tendon rupture following repair using the modified Tsuge suture method.METHODS:A total of 100 Sanhuang chickens,10 months of age,were taken to make animal models of deep flexor tendon II rupture of the third toe of the right foot.Animal models were randomized into five groups(n=20 per group):groups A,B,C and D were given plaster immobilization for 3 weeks after surgery,and were simultaneously given passive functional exercise 1,2,3,and 0 times a day for 3 weeks,respectively;group E had neither plaster immobilization nor passive functional exercise after surgery.The gross morphology of the chicken claw,the morphology of the tendon anastomosis end and the degree of peritendinous adhesion were observed.The slipping distance of the deep flexor tendon of the third toe,the flexion angles of all joints,the pathological morphology of the tendon at the anastomotic end and the hydroxyproline content were measured.RESULTS AND CONCLUSION:The tendon of group E was completely ruptured around 6 day after surgery and was removed from the experiment.The chicken claws in groups B and C had better grasping morphology,group D had almost no grasping morphology,and group A had worse grasping morphology than groups B and C.In groups B and C,the tendon anastomosis end was not obviously expanded,with the texture similar to that of normal tendon tissue.Compared with group C,tendon adhesion was relatively mild in group B.In group D,the tendon anastomosis end was obviously expanded,with the hard texture,obvious peritendinous scar and serious adhesion.Expansion at the tendon anastomosis end was more obvious than groups B and C but less severe than grou

关 键 词：腱损伤 动物实验 肌腱粘连 被动功能锻炼 趾深屈肌腱 石膏固定 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学] R686.1