异种小肠黏膜下层浓度水平对跟腱断裂修复的影响

背景：用猪的小肠黏膜下层重建各种组织结构是目前研究的热点,但是对于匀浆可注射形式的小肠黏膜下层的相关研究很少。 目的：观察不同浓度水平的匀浆可注射形式的异种小肠黏膜下层在修复和构建跟腱组织时是否对修复和重建结果产生影响。 设计、时间及地点：随机对照动物实验，于2006-09/2008-12在河北医科大学第三医院骨科研究所(河北省骨科研究所)完成。 材料：45只国产公山羊，1.0~2.0岁，体质量35~47 kg。小肠黏膜下层均来自同一只猪，去抗原处理后用均浆机打浆制备小肠黏膜下层悬液。 方法：切断45只山羊右后肢跟腱，随机分为25%，50%，100%浓度组，分别注射25%，50%，100%浓度的猪的小肠黏膜下层 2 mL于山羊的断裂跟腱处。注射前观察一般状况及注射侧肢体的情况，于2，4，6周各取5只切取修复后的跟腱。 主要观察指标：①生物力学测试。②踝关节后凸角。③组织学分析结果。 结果：各时间点25%浓度组生物力学测试值均大于50%浓度组和100%浓度组 (P < 0.01)。各组踝关节后凸角注射前左侧后肢、右侧后肢和注射后右侧后肢的差别无显著性意义(P > 0.5)。 4周和6周，25%浓度组几乎全为成纤维细胞，修复跟腱与正常的跟腱几近相同，100%和50%为大量的成纤维细胞，尚存浸润的炎细胞。 结论：结果表明可以在浓度水平调控匀浆形式的小肠黏膜下层在跟腱修复中的作用，以达到最佳浓度效果。

Effects of various heterogenic small intestinal submucosa formulations on the repair of Achilles tendon rupture

BACKGROUND: It is prevalent to construct many sorts of engineered tissues using the porcine small intestinal submucosa (SIS) as biomaterials. However, studies of injectable SIS are few. OBJECTIVE: To investigate the effects of different injectable SIS formulations on tendon repair. DESIGN, TIME AND SETTING: A randomized controlled animal experiment was performed at the Orthopedics Institute of Hebei Medical University from September 2006 to December 2008. MATERIALS: Forty-five domestic male goats, 1.0-2.0 years old, weighing 35-47 kg, were enrolled in the study. Porcine SIS was obtained from a pig, and then prepared for SIS suspension with a homogenate machine. METHODS: Following Achilles tendons were cut down, the goats were randomly divided into three groups, 25%, 50%, and 100% injectable SIS groups. Then, 25%, 50%, and 100% injectable SIS homogenate was injected into the spot of Achilles tendon rupture. General and limbs condition of goats were observed prior to injection. The tendons were harvested at weeks 2, 4, and 6 after SIS injection. MAIN OUTCOME MEASURES: The biomechanical test, kyphotic angle of ankle joint, as well as the results of histological examination. RESULTS: The biomechanical measurement value of the 25% group was greater than that of the 50% and 100% groups at each time point (P < 0.01). There was no great difference of kyphotic angle between both hind limbs prior to injection and right side of hind limb after injection (P > 0.05). Almost all cells were fibroblasts in the 25% group at 4 and 6 weeks after injection, and the repairing Achilles tendon was the same with normal tendon. Plenty of fibroblasts with few inflammatory cells could be found the 50% and 100% groups. CONCLUSION: Injectable SIS formulations can be regulated to obtain the optimal concentration for repairing Achilles tendon rupture.