bFGF复合膜对同种异体肌腱移植的作用的实验研究

目的　用bFGF复合膜 ,包裹在腱移植处 ,探讨腱内部再生是否快于腱周结缔组织增生 ,从而达到防止或减轻腱粘连的目的。方法　用 - 80℃冰箱冷存 10天的同种异体跟腱缝接 30只兔左肢跟腱缺损 2 .0cm处 ,分两组 :A组在腱移植处包裹bFGF复合非降解膜 (药膜 )为实验组 ,B组在腱移植处包裹无药的非解降解膜 (无药膜 )为对照组 ,术后不同时间 ,切取腱移植部位 ,常规制成光、电镜标本 ,再行镜下观察 ,图像分析仪测定和腱周粘连定量测定。结果　包药膜腱移植段内部的成纤维细胞和胶原纤维明显较无药膜的多 (<0 0 1) ,包无药膜腱周结缔组织的成纤维细胞和胶原纤维明显较包膜的多 (<0 0 1) ,包药膜腱移植段内部的成纤维细胞和胶原纤维明显较腱周结缔组织的多 (<0 1) ,无药膜的明显较腱周的少 (<0 0 1)。结论　bFGF复合膜有增强腱内部再生和减轻或防止腱粘连的作用     

玻璃化冷冻保存组织工程肌腱植入大鼠体内的组织学变化

背景：应用玻璃化冷冻方法保存组织工程肌腱具有可行性和应用前景,有待进一步研究。 目的：探讨应用玻璃化冷冻保存组织工程肌腱体内植入对大鼠跟腱缺损修复的影响。 方法：选用成年SD大鼠64只,于大鼠跟腱中段制备5 mm肌腱缺损模型,随机摸球法均分为2组,分别植入玻璃化冷冻保存组织工程肌腱和新鲜非冷冻保存组织工程肌腱。植入后2,4,6,8周,观察植入肌腱材料及周围组织的大体形态和组织学变化。 结果与结论：两组肌腱材料体内植入后的大体形态和组织学反应无明显差异。植入后2,4周,植入的肌腱材料发生降解,材料中间及周围有大量炎性细胞浸润和纤维结缔组织增生。植入后6,8周,大量新生胶原纤维组织长入并替代降解的植入材料,形态和排列方式趋近于正常肌腱组织,大鼠跟腱缺损基本修复。结果表明玻璃化冷冻保存组织工程肌腱体内植入可修复大鼠跟腱缺损。     

可吸收表皮生长因子复合膜防止肌腱粘连的研究

背景：采用液态分子生物材料作为屏障预防肌腱粘连发生,存在药物降解快、流失量大、屏障作用不理想等问题,因此研究者们越来越多的倾向于膜态屏障材料的研制开发。同时发现肌腱损伤后,腱细胞在多种内源性的生长因子作用下增殖分化,促进了肌腱的内源性愈合,但究竟哪一种因子是肌腱愈合的特异性因子,也是学者们研究的焦点之一。 目的：观察表皮生长因子复合胶原膜在预防鞘管区肌腱粘连、促进肌腱内源性愈合中的作用。 方法：将30只10月龄雄性leghorn公鸡随机分为3组,每组10只。将每只鸡的左足第三趾造成挤压撕脱伤模型,用改良Kessler缝合法缝接。断端分别包裹复合有表皮生长因子的胶原膜、单纯的胶原膜以及断端不加任何处理。术后4周,对标本进行大体观察、生物力学测试、光镜、电镜等观察。 结果与结论：表皮生长因子胶原膜组肌腱粘连程度较轻,腱缝合段内的胶原纤维数量多,以粗大的Ⅰ型胶原为主;成纤维细胞数量少,腱细胞成熟。单纯胶原膜组肌腱粘连较轻,但腱缝合段内的胶原纤维数量少,排列稀疏,以纤细的Ⅲ型胶原为主;空白对照组肌腱与周围组织粘连重,腱缝合段内的胶原纤维数量较多,排列紊乱,Ⅰ、Ⅲ型胶原交错排列。结果表明表皮生长因子来促进肌腱的内源性愈合,可降解胶原膜修复腱鞘可阻止肌腱的外源性愈合,从而达到防止肌腱粘连的目的。     

医用防肌腱粘连膜的研究进展

肌腱粘连是指肌腱损伤修复过程中周围组织的增生和侵入。早在1918年，BunneH就提出肌腱愈合的过程就是粘连形成的过程。在手外科领域中，肌腱问题占很大比例，损伤肌腱修复术后极易导致粘连，一定的粘连有利于断端获得血管输送血液的营养，同时还使肌腱周围增生结缔组织膜的成纤维细胞接触肌腱而发挥修复作用。但粘连过多又使修复后的肌腱功能受到限制，严重影响手的各种运动功能。因此，防止粘连成了手部肌腱外科的一个中心问题。     

壳聚糖/PLGA乳化膜预防鸡趾屈肌腱粘连的实验研究

目的研究壳聚糖／PLGA乳化膜预防鸡趾鞘管区屈肌腱粘连的效果。方法雌性成年种禽45只，随机分成3组．每组15只。A组为对照组，B组为PLGA膜组，C组为壳聚糖／PLGA乳化膜组。将左足三、四趾趾浅屈肌腱切除，横断趾深屈肌腱，作改良Kessler法缝合．B、C两组分别局部包裹PLGA膜及壳聚糖／PLGA乳化膜。术后2、4、6周取材，分别行大体观察、组织学检查和生物力学测定。结果组织学检查显示：3组肌腱愈合进程无明显差异，B组局部白细胞浸润较其他两组明显。两实验组缝合处粘连评分及将肌腱牵出鞘管所需最大力量与对照组相比差异有显著统计学意义（P〈0．05）。结论局部应用PLGA膜及壳聚糖／PLGA乳化膜均能减轻肌腱术后粘连，前者局部炎症反应较明显，而后者无明显炎症反应发生．因而壳聚糖／PLGA乳化膜是一种较理想的预防肌腱粘连的可降解材料。     

骨形态发生蛋白12基因和间充质干细胞修复肌腱损伤

肌腱损伤愈合中，存在着由腱细胞分裂、增殖，修补肌腱断裂、缺损部位的内源性愈合和由腱外膜细胞增殖而参与的外源性愈合的双重愈合机制。然而(肌)腱细胞的增殖较周围结缔组织缓慢。调控腱细胞的增殖，使肌腱的内在愈合机制在愈合过程中占优势，在促进肌腱愈合和防止肌腱术后粘连等方面均有十分重要的作用。     

聚-DL-乳酸可吸收医用膜防止鸡肌腱粘连的实验研究

目的探讨鸡肌腱断裂修补后,聚-DL-乳酸可吸收膜预防肌腱粘连的可行性及其有效性。方法将100只实验用鸡随机分为2组,A组为实验组,B组为对照组,各50只。对每只鸡的左足趾总深屈肌腱进行断裂修补。A组修补后放置可吸收膜,B组修补后不放置可吸收膜。修补术后3周、6周、2月、3月、5月分别进行大体观察、组织形态学、生物力学及功能恢复的测定。同时进行2组间比较的统计学分析。结果死亡20只鸡,可吸收膜组和对照组各10只,80只进入实验结果统计中。肉眼下可吸收膜组同周围组织粘连较少,光镜下可吸收膜组未见明显坏死组织,与周围纤维组织粘连较少,胶原纤维排列整齐。电镜下可吸收膜组3月后以未成熟的成纤维细胞增生为主,对照组以成熟的成纤维细胞增生为主。生物力学结果无明显差异,3月后可吸收膜组的屈趾功能明显优于对照组。结论聚-DL-乳酸可吸收医用膜具有防止肌腱粘连的效果。     

植入人胎羊膜预防损伤肌腱粘连的实验研究

目的：了解肌腱端端吻合要中植入人胎羊膜后周围的形态学改变以及愈合状况。方法：切断鸡双足爪肌腱后行常规吻合术，左侧值入人胎羊膜，石侧作为对照，分别于手术后２、３、４、６、８周时取材对标本进行光镜和扫描电镜观察。结果：２周时羊膜周围组织充血、水肿并有少量为细胞及异物巨细胞，以后逐渐减少、消失，６￣８周时肌腱愈合并与周围组织无粘连。结论：损伤的肌腱周围植入人胎羊膜能有效地预防粘连。     

脱细胞羊膜预防生物衍生肌腱修复鸡屈趾肌腱Ⅱ区缺损修复后的粘连

背景：羊膜有预防肌腱修复后粘连的作用,但存在一定的免疫排斥反应。 目的：探讨脱细胞羊膜对生物衍生肌腱修复鸡屈趾深肌腱Ⅱ区缺损修复后肌腱粘连的预防作用。 方法：分别以罗曼鸡右爪的第2,3,4趾将实验分成生物衍生肌腱组,生物衍生肌腱+脱细胞羊膜组以及自体肌腱组,建立屈趾深肌腱Ⅱ区1 cm缺损模型。以生物衍生肌腱桥接第2,3趾缺损,以自体肌腱桥接第4趾的肌腱缺损,在第3趾的生物衍生肌腱和上下吻合口周围包裹完整的脱细胞羊膜。 结果与结论：生物衍生肌腱组与自体肌腱组移植物为外源性愈合,生物衍生肌腱+脱细胞羊膜组羊膜有效地防止了成纤维细胞向修复区域内浸润,形成内源性愈合。肌腱粘连程度生物衍生肌腱+脱细胞羊膜组优于生物衍生肌腱组和自体肌腱组,生物衍生肌腱组和自体肌腱组相似,移植物周围的炎症反应生物衍生肌腱+脱细胞羊膜组>生物衍生肌腱组>自体肌腱组。证实脱细胞羊膜能通过机械性阻挡周围肉芽组织向修复区域内生长而防止外源性愈合造成的肌腱粘连。     

消旋聚乳酸/ 羟基磷灰石复合材料成骨性的体内实验研究

 目的 探讨消旋聚乳酸/羟基磷灰石（PDLLA/HA）复合材料在动物体内的生物相容性和成骨性。 方法 将 66 只日本大耳兔随机为 3 组，每组 22 只。其中 2 组分别于股骨髁间植入 PDLLA/HA 复合材料圆柱棒（PDLLA/HA 组）和 PDLLA 圆柱棒（PDLLA 组），1 组仅手术而不植入材料作为对照组。术后 3、6 周植入部位摄 X 线片观察植入材料的变化及其与周围组织的结合情况；术后 3、6、12、24 周每组各处死 5 只兔，进行植入部位大体解剖学观察和组织病理学观察。 结果 术后 X 线观察显示 PDLLA/HA 组植入材料显影良好，与周围组织有明显界限；而 PDLLA 组可以看到明显的孔道。大体解剖学和组织病理学观察显示 PDLLA/HA 组术后早期局部炎症反应明显轻于 PDLLA 组，材料与周围组织结合紧密，膜外有少许新骨生成；6 周时膜外新骨增多；12 周时复合螺钉周围有少量新生骨小梁形成，边缘附有大量的成骨细胞；24 周时可见纤维组织长入材料，材料色、形、质与周围结缔组织相近。而 PDLLA 组材料降解明显，12 周后已不能维持棒体形状。 结论 PDLLA/HA 复合材料具有良好的生物相容性和体内成骨性。     

Weft-knitted silk-poly(lactide-co-glycolide) mesh scaffold combined with collagen matrix and seeded with mesenchymal stem cells for rabbit Achilles tendon repair

Abstract

Natural silk fibroin fiber scaffolds have excellent mechanical properties, but degrade slowly. In this study, we used poly(lactide-co-glycolide) (PLGA, 10:90) fibers to adjust the overall degradation rate of the scaffolds and filled them with collagen to reserve space for cell growth. Silk fibroin-PLGA (36:64) mesh scaffolds were prepared using weft-knitting, filled with type I collagen, and incubated with rabbit autologous bone marrow-derived mesenchymal stem cells (MSCs). These scaffold–cells composites were implanted into rabbit Achilles tendon defects. At 16 weeks after implantation, morphological and histological observations showed formation of tendon-like tissues that expressed type I collagen mRNA and a uniformly dense distribution of collagen fibers. The maximum load of the regenerated Achilles tendon was 58.32% of normal Achilles tendon, which was significantly higher than control group without MSCs. These findings suggest that it is feasible to construct tissue engineered tendon using weft-knitted silk fibroin-PLGA fiber mesh/collagen matrix seeded with MSCs for rabbit Achilles tendon defect repair.     

局部注射骨髓间充质干细胞和曲安奈德治疗兔跟腱炎的效果对比

景：应用长效糖皮质激素局部封闭治疗跟腱炎在学术界一直很有争议。 目的：对跟腱炎模型兔跟腱局部分别注射兔骨髓间充质干细胞和长效糖皮质激素曲安奈德,动态观察相关指标,观察骨髓间充质干细胞和曲安奈德对跟腱炎的组织结构和力学性能的影响。 方法：将60只单侧跟腱炎新西兰大白兔模型随机等分4组,取其中2组分别于患侧跟腱局部注射骨髓间充质干细胞和曲安奈德1次;剩余2组则分别注射2次,注射间隔2周。 结果与结论：相比1次曲安奈德组,局部注射骨髓间充质干细胞1次和2次的跟腱炎模型兔跟腱腱束整齐、致密,断裂少,成纤维细胞增多,跟腱组织羟脯氨酸含量、跟腱最大负荷拉力均增加(P < 0.05),2次注射的治疗效果更明显(P < 0.05)。说明局部重复注射骨髓间充质干细胞移植治疗跟腱炎的效果优于长效糖皮质激素曲安奈德。     

A novel biodegradable PCL film for tendon reconstruction: Achilles tendon defect model in rats

This study aims to investigate applicability of poly(epsilon-caprolactone) (PCL) biodegradable films for repair of gaps in Achilles tendons in a rat model, also comparing surgical repair versus no repair approaches. PCL was synthesized with tailor-made properties, then, PCL films were prepared by solvent casting. Seventy-five outbred Sprague-Dawley rats were randomly allocated into five groups: (i) sham operated (skin incision only); (ii) no repair (complete division of the Achilles tendon and plantaris tendon without repair); (iii) Achilles repair (with a modified Kessler type suture); and (iv) plasty of Achilles tendon defects with the biodegradable PCL films, and (v) animals subjected to 1 cm mid-substance defect with no repair. Functional performance was determined from the measurements of hindpaw prints utilizing the Achilles functional index. The animals were killed 8 weeks after surgery and histological and biomechanical evaluations were made. All groups subjected to Achilles tendon division had a significant functional impairment that gradually improved so that by day 28 there were no functional impairments in any group whereas animals with a defect remained impaired. The magnitude of the biomechanical and morphological changes at postoperative 8 weeks were similar for no repair group (conservative), Achilles repair group and tendonplasty group (biodegradable PCL film group). The initial rate of functional recovery was significantly different for primary suture, Achilles repair group and PCL film group (p>0.01). But, at the 28th day, functional recovery was quite similar to the other groups. In summary, our results suggest that the PCL film can be an alternative biomaterial for tendon replacement.     

异种生物型防肌腱粘连膜的兔实验研究

目的研究不同异种生物型膜预防新西兰大白兔趾伸肌腱粘连的效果.方法成年新西兰大门兔54只,不分性别,随机分A、B、C组,每组18只,A组为正常对照组,B组为超薄膜组,C组为薄膜组.将新两兰大白兔左足第三趾伸肌腱切开,再缝合,B、C两组分别局部包裹超薄膜及薄膜.手术后2、4、6周取材,分别行大体观察、组织学检杳和炎性反应评估.结果组织学检查显示,两组肌腱愈合进程无明显差异.B组肌腱内未见明显炎性反应,外保护膜薄而均匀,炎性反应较轻.C组肌腱炎性反应较重,外保护膜出现水肿与纤维素样变性.结论局部应用超薄膜及薄膜均能减轻肌腱术后粘连,前者局部炎性反应较轻,而后者见明显炎性反应.超薄膜是一种较理想的预防肌腱粘连的可降解材料.     

A Novel Application of Biosynthetic Tissue-Engineered Tridimensional Implant on Large Tendon Defects: A Comprehensive,Detailed, In Vivo Investigation with Significant Clinical Value

This study was designed to investigate the effect of a biosynthetic implant on tendon healing in vivo. Fifty white New Zealand male rabbits were randomly divided into two groups, namely treated (n = 25) and control (n = 25) groups. A large gap was created in the Achilles tendon and was maintained by Kessler pattern. In the treated group, the implant was inserted in the injured area. No implant was used in the control group. Contrast radiography, hematology, and clinical examination were conducted during the course of the experiment. The animals were euthanized at 60 days post injury (DPI) and their Achilles tendons were subjected to the gross, histopathologic, and biomechanical analyses and the hydroxyproline content of these tendons was also evaluated. Another five treated animals, as a pilot group, were used to define the inflammatory reaction at 10 DPI. Severe inflammatory reaction was initiated by the partially degraded implant, at 10 DPI. However, at 60 DPI, the inflammation subsided, the implant was mostly removed but a few small remnants were still present in the injured area. The newly formed tendon, properly aligned along the longitudinal axis of the Achilles tendon replaced the collagen implant. In the control tendons, a loose areolar connective tissue which tightly adhered to the peri-tendinous tissue was the only regenerated structure in the injured area. At this stage, the treated tendons showed significantly higher ultimate strength (p = 0.001), yield strength (p = 0.001), and stiffness (p = 0.001) compared with the control ones. Application of the biosynthetic implant was a safe and effective option in managing the large tendon defects and could be considered as a substitute for autografts in clinical practice.     

Addition of nitric oxide via nitroflurbiprofen enhances the material properties of early healing of young rat Achilles tendons

OBJECTIVE AND DESIGN: To determine if the addition of nitric oxide (NO) via nitroflurbiprofen (NO-flurbiprofen) would enhance rat Achilles tendon healing. MATERIALS AND METHODS: Sixty-five male Sprague-Dawley rats were randomly divided into NO-flurbiprofen, flurbiprofen and vehicle groups, given drugs or vehicle subcutaneously, and their right Achilles tendon divided. Histological assessment was carried out at day 5, 10, and 15 post-operation. Healing tendon biomechanical properties and hydroxyproline content were measured at day 10. RESULTS: The healing Achilles tendon from the NO-flurbiprofen and flurbiprofen groups showed a better organization of extracellular collagenous matrix than that from the vehicle group. Flurbiprofen and NO-flurbiprofen decreased healing tendon cross-sectional area by 30% and 20%. This reduction was accompanied by a decreased failure load in the flurbiprofen group, but not the NO-flurbiprofen group. NO-flubiprofen prevented the reduction of body weight gain observed in the flubiprofen group. CONCLUSION: Both flurbiprofen and NO-flurbiprofen promoted better collagen reorganization during tendon healing. NO-flurbiprofen further improved tendon healing by increasing tendon stress and reducing the side effects (body weight loss) of flurbiprofen. The enhanced tendon healing by NO-flurbiprofen is likely due to the release of NO from the compound.     

跟腱复合组织缺损的显微外科修复

目的 :探讨跟腱复合组织缺损的显微外科治疗。方法 :应用膝降血管大收肌腱、骨、皮复合组织瓣移植一期修复跟腱伴皮肤和跟骨缺损。结果 :施术 3侧 ,取得满意效果。结论 :该术式可修复不同类型的跟腱复合组织缺损 ,并具有操作简便、易行和供区损伤小等特点。