大鼠跟腱断裂缝合中3种肌腱缝合方法的生物力学和组织学比较

背景：治疗手部伸肌腱断裂的手术缝合方法很多，临床效果不一，而且如何解决术后肌腱粘连，仍是临床难题。 目的：比较跟腱断裂缝合中3种肌腱缝合方法的生物力学性质和组织学差异。 设计、时间及地点：对比观察动物实验，于2008-04/06在哈尔滨医科大学附属第一临床医院中心实验室完成。 材料：取45只Wistar大鼠，随机分为3组，Tang法组、改良Kessler法组、Bunnell法组。 方法：无菌条件下，“S”形切开后肢后外侧跟腱处,潜行分离皮下组织,锐性横断跟腱，3组动物于切断后24 h，1周，3周分别以Tang法、改良Kessler 法、Bunnell法缝合肌腱。每只大鼠的双后肢跟腱为实验组,右后肢跟腱作生物力学测试，左后肢跟腱作组织学检测。 主要观察指标：肌腱断裂抗张强度及组织学变化。 结果：Tang法、Kessler法和Bunnell法断裂抗张强度在24 h、1周、3周3个时间段都呈现同样的趋势，即早期断裂抗张强度都有减弱，后期强度逐渐增加。同时，术后及术后早期Tang法缝合肌腱的断裂抗张强度均明显高于其他两种方法，3周时，断裂抗张强度3种方法相近。组织学检测示，术后1周，Tang法、Kessler法和Bunnell法苏木精-伊红染色病理切片表现明显不同，Tang法较其他两种方法肉芽组织中新生血管比较多，血管腔扩张完整，有大量肉芽组织形成，炎症细胞浸润少。 结论：Tang法缝合的肌腱断端血运良好，愈合快，断裂抗张强度较大，较其他两种方法更适用于早期功能锻炼。

Comparison of biomechanical and histological roperties of three tendon suturing methods in suturing tendon ruptures of rats

BACKGROUND: There are many kinds of suturing methods for curing hand extensor tendon rupture. But different methods present different clinical effects and the adhesion of tendon following operation is still a clinical difficulty. OBJECTIVE: To make a comparative study on the biomechanical properties and histological differences of 3 tendon suturing methods. DESIGN, TIME AND SETTING: A comparative observational animal experiment was completed in the Centralab of the First Clinical Collage of Harbin Medical University from April to June 2008. MATERIALS: A total of 45 Wistar rats were randomly divided into 3 groups, namely, Tang method group, upgraded Kessler method group and Bunnell method group. METHODS: Under germ free condition, posterolateral achilles tendons of hide limbs of rats were cut open in S shape and their subcutaneous tissues were separated. Then, sharp transsection was performed to the achilles tendons of rats. At hour 24, week 1 and week 3 postoperatively, tendons of rats in the three groups were sutured with their corresponding methods, namely Tang method, upgraded Kessler method and Bunnell method. The sampling objects were the hind limbs of each rat, with the right ones undergoing biomechanical test and the left ones undergoing histological detection. MAIN OUTCOME MEASURES: The tensile strength (TS) and the histological change of the tendon rupture. RESULTS: At hour 24, week 1 and week 3, the TS of the three groups changed in the same direction, regardless of the tendon suturing method used, i.e. the TS of each group weakened during the early period and strengthened gradually during the later period. However, the tendon sutured by Tang method presented greater TS than the other two groups at hour 24 and week 1 postoperatively. At week 3, there is no difference of significance in TS among the three groups. In addition, the histological detection with HE staining showed pathological sections of great difference to the three groups at week 1 postoperatively, i.e. more granulation tissues formed in the group sutured with Tang method than in the other two groups, with more new vessels, less inflammatory cells and completely-expanded lumen of blood vessels in these granulation tissues. CONCLUSION: The Tang tendon suturing method results in faster healing and greater TS to the broken ends of tendons than the other two. Accordingly, it is more suitable for early functional exercise.