化学处理的冻干异体肌腱移植的实验研究

目的：用化学及冷冻干燥方法处理鸡趾屈深肌腱，选择性地去除其腱细胞成分而不破坏其胶原纤维，以建立一种能显著降低肌腱抗原性，而不明显损伤肌腱强度的异体肌腱处理技术。方法：用１∶１三氯甲烷／甲醇（ＣＭ）混合液及含碘乙酸、乙二胺四乙酸、叠氮钠的转移液浸泡肌腱后，－４℃下真空冷冻干燥。用ＣＭ处理的冻干肌腱作同种异体移植，同时以新鲜异体及自体肌腱移植作对照。结果：羟脯氨酸含量测定、生物力学分析、大体、显微及超微观察显示：ＣＭ处理的异体移植肌腱与自体移植腱结果相似，而未处理异体移植肌腱则被排斥。ＣＭ处理的异体移植腱形成完全由细胶原原纤维（直径３３．３ｎｍ）组成的新生移植腱，而对照组自体移植腱含少量原粗大胶原原纤维（直径３１７．０ｎｍ）。结论：化学处理的冻干异体肌腱是一种良好的自体组织替代材料     

腱鞘内肌腱与异体腱鞘内肌腱移植

目的：探讨异体腱鞘内肌腱替代自体腱鞘内肌腱作为移植材料的可行性。方法：取新西兰大白兔的趾深屈肌腱，经深低温保存４周～３个月，移植至同种异体第３趾深屈肌腱缺损处。同侧第４趾深屈肌腱用自体腱鞘内肌腱移植作对照。术后３～１２周作生物力学和组织学测定。结果：组织学发现，两组移植肌腱均无粘连或仅有轻度粘连。趾间关节活动度、肌腱缝合处抗破裂力，经统计学处理，两组间差异无显著意义（Ｐ＞０．０５）。结论：异体腱鞘内肌腱可作为肌腱移植材料     

自体和异体滑膜内、外肌腱移植的实验研究

目的　比较自体和异体滑膜内肌腱 (intrasynovial tendon,IT )及滑膜外肌腱 (extrasynovialtendon,ET)作鞘管内移植后两者愈合过程和粘连的异同。方法　应用兔新鲜自体和深低温冻存的异体趾深屈肌腱 (IT)、腓骨长肌腱 (ET) ,分别移植于兔左后肢第二趾 (IT)、四趾 (ET)鞘管内修复趾深屈肌腱缺损。自体、异体组各 2 1只兔。术后 10天、3、6周取两组移植腱及对侧正常腱作组织学观察 ;术后 4、8周取材作生物力学测定。结果　两组 IT移植后粘连轻 ,而两组 ET移植后粘连明显 ,滑动功能差于 IT移植(F =14.10 ,P <0 .0 1)。术后 8周时异体移植腱的最大抗断裂载荷值低于自体移植腱 (F =10 .11,P <0 .0 1)。结论　鞘管内自体或异体肌腱移植后均有供腱的组织特异性 ,两者 IT移植后滑动功能均优于 ET组。异体肌腱 (IT、ET)移植后的愈合过程慢于自体移植组。     

95%乙醇浸泡异体肌腱移植的临床应用

多条肌腱缺损的修复，由于可供移植的自体肌腱来源有限，一直是临床治疗中的难题。张友乐等［１］报道临床应用超低温冷冻处理的异体肌腱移植获得成功。但此法在基层医院中应用仍受到一定的限制。我们在实验研究成功的基础上［２］，临床应用经９５％乙醇浸泡的异体肌腱修...     

同种异体肌腱移植与肌腱库的建立

目的：为临床应用异体肌腱移植提供实验依据以及介绍肌腱库的建立。方法：用经深低温冷冻、冷冻干燥、不加处理的同种异体肌腱和自体肌健移植，修复ＳＤ大鼠跟腱缺损。术后３、８周行免疫原性和生物力学测定、形态学组织学观察。结果：经深低温冷冻与冷冻干燥处理的异体肌腱，有明显降低组织抗原性的作用，并保留了腱组织的生物学特性。结论：深低温冷冻保存的异体肌腱可应用于临床，近期疗效较为满意［１］。     

带腱鞘异体肌腱移植的实验研究

目的：探讨深低温冷冻带腱鞘异体肌腱移植的可行性,为屈指肌腱II区腿鞘和肌腱缺损重建提供新的修复材料。方法：将60只北京双A鸡随机分为两组,A组为异体移植,B组为自体移植,每组再分两个亚组,AI全鞘异体肌腱移植,A2部分鞘（滑车A2－A4）异体肌腱移植;B1全鞘自体肌腿移植;B2部分（滑车A2－A4）自体肌腱移植,异体材料采用深低温处理,移植术后进行组织形态学,移植免疫学及肌腱滑动功能检测。结果：A1组和B1组移植术后局部组织反应重,腱鞘形成生物屏障,影响肌腱的营养同腱变性,纤维化,部分坏死,A2组与B2组肌腱愈合良好,组织修复能力强,腱鞘与肌腱间可分离,带部分腱鞘异体肌腱经深低温处理后,其组织抗原性明显降低,组织修复能力同自体移植,愈合后腱鞘与肌腱间隙存在,移植鞘与正常肌腱组织结构相同,结论：带部分腱鞘异体肌腱经深低温处理后可以作为修复腱鞘和肌腱缺损的材料。     

同种异体肌腱移植的临床应用

目的观察临床应用经深低温冷冻保存的同种异体肌腱移植,修复肌腱缺损的效果。方法１９９６年１０月至１９９８年１月,将经深低温冷冻保存的同种异体肌腱４０根,修复手部屈肌腱缺损２６例,术后均不用免疫抑制剂。结果术后切口均Ⅰ期愈合,未见有急性排斥反应发生。术后半年因肌腱粘连,均行肌腱松解术。术中发现异体肌腱的质地、颜色、光泽、粘连程度、腱断端愈合程度与以往自体肌腱移植无明显差异。结论经深温冷冻保存的同种异体肌腱,是修复肌腱缺损的良好材料,抗原性低,近期疗效满意。     

异体动脉移植的实验研究与临床应用

目的通过实验及临床应用结果，证实经深低温冷冻处理的动脉是一种修复动脉缺损的新材料。方法将５０只北京大耳白兔随机分为４组：Ａ组：提供修复的异体股动脉组；Ｂ组：深低温冷冻异体动脉移植组；Ｃ组：未经处理的异体动脉移植组；Ｄ组：自体动脉移植组。术后进行组织免疫学、组织形态学、血管通畅率等观察。结果经深低温冷冻处理动脉组，其血管组织抗原性明显下降，组织生物活性依然存在，血管内皮细胞修复能力较强，移植通畅率与自体动脉移植组相同。临床应用其修复上肢尺、桡动脉缺损９例，移植血管平均长度１２ｃｍ。术后随访４～２６个月，平均１８个月。９例移植血管均无排斥反应，伤口Ⅰ期愈合。经远红外线及超声波检测，血管通畅率为１００％。结论异体动脉经深低温冷冻处理后，可用于临床作为修复肢体血管缺损的生物性材料。     

反复冻融及超深低温处理的异体肌腱移植实验研究

为比较有创与无创冷冻方法处理的肌腱异体移植的效果，探索不同冷冻处理技术对肌腱免疫源性的影响及获得成功的异体移植的条件，采用有创反复冻融及无创超深低温（－１９６℃）冻存技术分别处理肌腱，液氮下保存３个月后异体移植，以自体肌腱移植作对照。腱细胞活力测定显示，反复冻融处理的肌腱细胞全部失活，而超深低温处理的肌腱细胞活力为（９２．５±３．４）％。组织学观察显示，反复冻融及超深低温处理的异体移植肌腱均产生了不同程度炎性细胞浸润，且腱周粘连均较自体移植肌腱重。主动屈曲功能测定、羟脯氨酸含量测定及生物力学性能测定显示，反复冻融与超深低温组无显著性差异（Ｐ＞０．０５），且后两项指标显著较自体移植肌腱差。认为：①反复冻融及超深低温处理的肌腱异体移植获得一定成功，两者无显著性意义。②既要保留肌腱细胞的活性，又要去除肌腱中的抗原呈递细胞，可能是冷冻处理的肌腱异体移植获得成功的关键。③损伤了肌腱细胞成分，降低了肌腱抗原性，不等于能获得成功的异体移植     

人造血管内置自体肌肉匀浆诱导肌腱再生的研究

目的观察自体肌肉匀浆在诱导肌腱再生方面的作用，探讨人造血管作为支架构建肌腱再生空间和作为腱鞘代用品防止肌腱粘连的效果。方法将32只新西兰大白兔造成双侧跟腱缺损模型，一侧用人造血管内置自体肌肉匀浆桥接（A组），另一侧用自体跟腱移植（对照B组）或缺损旷置（对照C组），术后第3、5、7、9周分别通过肉眼、光镜、电镜和生物力学测试，观察分析肌腱再生修复的情况。结果A组，人造血管中胶原纤维腱化，排列较有序，腱周粘连轻微，生物力学拉力测试强度逐步增强。B组，自体移植肌腱愈合较好，腱周存在粘连，生物力学拉力测试强度较好。C组，肌腱以结缔组织粘连愈合为主，腱周粘连严重，生物力学拉力测试强度较差。肌腱组织学愈合示A组和B组差异无统计学意义（P〉0．05），A组与C组在第3周差异无统计学意义，第5周以后A组优于C组；各组成纤维细胞计数显示各周A组与B组和C组差异均有统计学意义（P〈0．05）；在大体观和病理学评价腱周粘连A组明显优于B、C组；生物力学测试显示在第3、5、7周B组抗张强度优于A组，在第9周时A、B两组抗张强度差异无统计学意义（P〉0．05）。第5、7、9周A组抗张强度优于C组。结论人造血管内置自体肌肉匀浆桥接肌腱缺损后能有效诱导肌腱再生修复；人造血管能够较好地预防肌腱腱周的粘连。     

同种异体肌腱移植修复腕部类风湿指伸肌腱自发性断裂

目的 探讨应用同种异体肌腱移植修复腕部类风湿指伸肌腱自发性断裂的临床效果.方法 对6例腕部类风湿指伸肌腱自发性断裂的患者,在切除肌腱和关节滑膜的同时,均采用同种异体肌腱移植修复断裂缺损的肌腱.结果 术后随访6个月至4年,未见肌腱粘连和再次断裂,根据中华医学会手外科学会上肢部分功能评定试用标准评定,优良率达92%.结论 应用同种异体肌腱移植修复腕部类风湿指伸肌腱自发性断裂,是一种操作简便、损伤小、疗效可靠的良好方法.     

自体脂肪颗粒纯化移植预防肌腱粘连的临床研究

目的探讨预防术后肌腱粘连更为有效的方法和材料。方法2003年1月至2005年1月间,我们对符合研究条件的70例82条指屈肌腱断裂伤,分别采用单纯缝合术和缝合后自体脂肪颗粒纯化移植两种方法治疗,进行对比研究。结果随访2~16个月,平均6.5个月,用TAM系统评定法来判定肌腱缝合后的功能恢复情况。采用自体脂肪颗粒纯化移植治疗组46条肌腱,优22条,良18条,中6条,差0条,优良率86.96%;单纯肌腱缝合治疗组36条肌腱,优6条,良14条,中12条,差4条,优良率55.56%。两组差异有统计学意义(P<0.001)。结论纯化脂肪颗粒是预防肌腱粘连的理想材料,有良好的生物相容性。具有促进肌腱愈合、防止或减轻术后粘连、改善肌腱滑动的作用。     

早期控制被动活动对游离肌腱移植的影响

用兔进行游离肌腱移植术后早期拉制被动活动和固定的对比研究,包括移植腱的营养与成活,腱的愈合机制,粘连和吻合处抗破裂力量。结果表明:早期控制被动活动对腱的成活及愈合方式无影响,但可使腱周粘连疏松、腱表面血管纵形排列,有利于肌腱滑动,可促进胶原合成和增加吻合处抗破裂力量。     

透明质酸钠在同种异体肌腱移植中的临床应用

目的 探讨透明质酸钠（Sodium hyaluronate Product,SHP)在同种异体肌腱移植后防止肌腱粘连的作用。方法 对23例37指屈肌腱损伤，行异体屈肌腱移植后，均匀涂SHP2mL-4mL，修复腱鞘，术后72小时开始手指功能锻炼。另选20例35指屈肌腱损伤，用同样方法治疗，术中不用SHP作对照。结果 两组经过平均1年8个月的随访，按TAM（Total active movement,TAM)标准评定疗效，SHP组37指，疗效优良33指，优良率89．2％，显高于对照组的62．9％（P＜0．05）。结论 透明质酸钠能防止或减轻异体肌腱移植后肌腱粘连，促进肌腱愈合。     

Rotator cuff defect healing: A biomechanical and histologic analysis in an animal model

Rotator cuff tears are one of the most common causes of pain and disability in the upper extremity. With the use of an animal model, we studied the healing response of a controlled defect in the normal supraspinatus tendon and in a tendon with a reduced intrinsic healing capacity. In 36 Sprague-Dawley rats, defects (2 mm × 2 mm) were created in the supraspinatus tendons bilaterally. To model a tendon with an intrinsically reduced capacity to heal, the tissue adjacent to the defect area in the left shoulder was treated with in situ freezing. The contralateral tendon was not frozen. After 3 (n = 12), 6(n = 12), and 12(n = 12) weeks, animals were killed and underwent histologic (n = 4 from each group) and biomechanical (n = 8 from each group) evaluation. An additional group of untreated animals served as a normal control group. On histologic evaluation 78% of tendons had persistent defects (defined as incomplete closure of the defect site). Over time, the tissue from both groups demonstrated an improved histologic grade but did not reach normal levels, even at 12 weeks. No histologic differences were found between defect healing in normal tendons and in those treated with in situ freezing. On biomechanical evaluation there were also no significant differences between treatment groups. Over time, an improvement occurred in tissue properties, indicating that some healing of the defects had occurred. However, these tissue properties remained an order of magnitude lower than those of normal control tendons. These findings indicate that there is an active but inadequate repair response to the defect in the rat supraspinatus tendon, which is not significantly worsened by in situ freezing of the tissue around the defect. This model has applications     

Prevention of tendon adhesions by the reconstruction of the tendon sheath with solvent dehydrated bovine pericard: An experimental study

BACKGROUND: The achievement of the kinetic functions of a finger in full range of motion after the injury and the repair of the flexor tendon has been a challenging issue in hand surgery. Several current studies emphasize the importance of the tendon sheath for the healing of the tendon and for the prevention of the adhesive bands and advise primary repair or reconstruction of them. Various biological and synthetic materials have been used for this purpose with different rates of success. METHODS: In this experimental study, the sheaths of flexor tendons of chicken toe were excised and three groups were observed: group 1, primary sheath not repaired; group 2, sheath repair with autogenous fascia; and group 3, sheath reconstruction with solvent dehydrated bovine pericardium (SDBP). RESULTS: Histopathologic evaluations were performed on the 3rd and 12th weeks to determine the outcome of the repair methods regarding the gliding surfaces of the tendons, adhesion rates, and inflammatory reactions, which are the main issues on the healing of the tendon. The results indicated less formation of adhesions in group 3 compared with groups 1 and 2 (p = 0.001). CONCLUSION: The results showed that SDBP can be used for the reconstruction of the sheaths successively for the prevention of the adhesive bands in flexor tendon surgery.     

Bridge tendon graft in no man‘s land:an experimental study in chickens

Objective:To investigate the morphological characteristics of the bridge tendon grafting in no man‘s land to reconstruct the tendon defect and the effect of passive mobilization on it.Methods:A 2 cm defect was made in bilateral flexor digitorum profundus tendons of the middle chicken toes,and was then transplanted to the opposite site to serve as a segmental autograft tendon.Postoperatively,passive mobilization of the left and right middle toes began at 5 and 21 d separately.Specimens were studied by light,scanning and transmission electron microscopy at 5,10,21 and 35d.Results:Early repair of the tendon-graft of the left middle toes was made by proliferation and ingrowth of the epitenon cells intermingled with newly-formed collagen fibers.a gliding surface formed at 10 and 21 d.The tendon graft itself played an active role in the repair.In contrast,adhesions obliterated the surface and occupied the space between the tendon graft and surrounding tissues in the right middle toes.Conclusions:It indicates that the use of the segmental bridge tendon graft in no man‘s land coupled with early passive motion stimulates an intrisic repair process in both the tendon stump and the autogenous tendon graft and results in a functional healing.