【摘要】：背景:羊膜獨有的結構可阻止某些物質通過,能保證包裹內組織正常營養(yǎng)供應,而且具有抗粘連、組織相容性好、炎性反應輕、纖維包裹少及可降解等特性。目的:比較新鮮羊膜及脫細胞羊膜修復腱鞘缺損,預防肌腱粘連和促進肌腱愈合的作用。方法:取60只雄性來亨雞,制作雙足第三足趾制備肌腱及腱鞘損傷模型,隨機分為3組修復,新鮮羊膜組采用新鮮人羊膜修復腱鞘缺損,脫細胞羊膜組采用人脫細胞羊膜修復腱鞘缺損,對照組不做腱鞘修復。修復后進行第三足趾組織學觀察及生物力學測試。結果與結論:①組織學觀察:修復后2周,3組均存在充血水腫及炎癥反應,新鮮羊膜組最輕,對照組最嚴重,3組水腫及炎癥反應隨時間延長逐漸減輕。修復12周,各組假鞘較修復后4周明顯成熟,新鮮羊膜組及脫細胞羊膜組假鞘表面細胞致密層狀排列整齊,表面光滑;對照組假鞘表面細胞排列紊亂,結構松散,可見表面纖維組織突出假鞘表面;②生物力學測試:脫細胞羊膜組、新鮮羊膜組修復后4,8,12周的肌腱滑動距離均大于對照組(P0.05),前2組間比較差異無顯著性意義;脫細胞羊膜組、新鮮羊膜組修復后4,8周的肌腱最大拉伸斷裂強度高于對照組(P0.05),且新鮮羊膜組高于脫細胞羊膜組(P0.05),3組修復后12周的肌腱最大拉伸斷裂強度無差異;③結果表明:新鮮羊膜和脫細胞羊膜均可用于重建腱鞘缺損,預防肌腱粘連,新鮮羊膜在促進早期肌腱愈合方面優(yōu)于脫細胞羊膜。
[Abstract]:Background: the unique structure of amniotic membrane can prevent certain substances from passing through and can guarantee the normal nutrition supply of the surrounding tissue. It also has the characteristics of anti-adhesion, good histocompatibility, light inflammatory reaction, less fiber encapsulation and degradability. Aim: to compare the effects of fresh amniotic membrane and acellular amniotic membrane in repairing tendon sheath defect, preventing tendon adhesion and promoting tendon healing. Methods: 60 male Leghorn chickens were used to make the injury model of tendon and tendon sheath in the third toe of the foot. The fresh amniotic membrane was used to repair the defect of tendon sheath in the fresh amniotic membrane group. Human acellular amniotic membrane was used to repair the defect of tendon sheath in the acellular amniotic membrane group, while the control group was not repaired with tendon sheath. Histological observation and biomechanical test of the third toe were performed after repair. Results and conclusion: 1 histological observation: 2 weeks after repair, there were hyperemia edema and inflammation in all the three groups, the fresh amniotic membrane group was the lightest, the control group was the most serious, and the edema and inflammatory reaction in the three groups gradually decreased with the time prolonging. After 12 weeks of repair, the pseudosheath of each group was obviously mature compared with that of the 4th week after repair. The surface of the false sheath in fresh amniotic membrane group and acellular amniotic membrane group was arranged neatly and neatly, and the surface was smooth. In the control group, the surface cells of the pseudosheath were disordered and the structure was loose, and the fibrous tissue of the surface could protrude the surface of the false sheath. 2Biomechanical test: the tendon gliding distance in the acellular amniotic membrane group and fresh amniotic membrane group at 12 weeks after repair was higher than that in the control group (P0.05), but there was no significant difference between the first two groups. In the acellular amniotic membrane group, the maximum tensile breaking strength of the tendon in the fresh amniotic membrane group was higher than that in the control group at 4 weeks after repair (P0.05), and that in the fresh amniotic membrane group was higher than that in the acellular amniotic membrane group (P0.05). There was no difference in maximum tensile strength of tendon 12 weeks after repair in the three groups. The results showed that fresh amniotic membrane and acellular amniotic membrane could be used to reconstruct tendon sheath defect and prevent tendon adhesion. Fresh amniotic membrane was superior to acellular amniotic membrane in promoting early tendon healing.
【作者單位】： 河北醫(yī)科大學第三醫(yī)院手外科河北省骨科生物力學重點實驗室;
【基金】：河北省醫(yī)學科學研究重點課題計劃(ZL20140210)~~
【分類號】：R318.08;R687

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