肌腱缝合后鞘内置入法预防Ⅱ区屈肌腱粘连的实验研究

目的 探讨一种屈肌腱修复新方法即腱缝合后鞘内置入法，并观察其在鸡Ⅱ区屈肌腱损伤修复中的疗效，揭示其预防屈肌腱术后粘连机理，为临床应用提供依据。方法 选用健康白色纯种Leghorn鸡40只，以第三趾趾深屈肌腱屈曲型损伤为实验模型，随机分组，左右足配对设计，一侧为实验组，用腱缝合后鞘内置入法修复肌腱；另一侧为对照组，切开腱鞘修复肌腱，缝合腱鞘。分别于术后1、2、4、8周进行大体观察、组织学观察、生物力学测定。结果 1周后大体观察、肌腱滑动距离，实验组与对照组间无显著性统计学意义。2、4、8周后大体观察粘连情况、肌腱滑动距离、各是关节屈曲角度、组织学观察结果，两组间有显著性差异，4周后腱及鞘缝合口间距与肌腱粘连带宽度比，两组间均有显著性差异。结论 腱缝合后鞘内置入法在Ⅱ区屈肌腱修复中能有效减轻肌腱术后粘连，尤其是致密粘连的形成，在提高肌腱术后功能上优于单纯腱鞘闭合，可以适用于临床。

The preventive effect of suturing site intra-sheath embedding tenorrhaphy on flexor tendon adhesion in zone Ⅱ:an experimental study

Objective To study the effect of a new flexor tendon repairing methods-suturing site intrasheath embedding tenorrhaphy,disclosing the mechanism of method in preventing adhesion of postoperative flexor tenson, and providing theoretical basis for clinical application.Methods 40 white leghorn chickren were used as animal model, with randomized, self-controlled study. Mor-phalogical examination of the extent and quality of adhesion, biomechanical tests for measuring gliding excursions and total phalangopakngeal moving angle of the repaired tendons, and histologi-cal observations of the repaired sheaths and tendons were performed postoperation at increasing time intervals (1,2,4 and 8 weeks) .Results All the results of experimental groups were superior to those of the control groups, except the quality of adhesion and gliding excursions of the repaired tendons in the first week; meanwhile, before 8 weeks all the samples have adhesion more or less. Conclusion The experimental results demonstrate that it is an optimal method in preventing adhesion, especially to the formation of compact adhesion, and it is better than closing sheath merely in promoting function of postoperative flexor tendon.