几丁聚糖影响肌腱愈合的实验研究及临床应用

目的　研究几丁聚糖对肌腱愈合的影响。　方法　以24只新西兰兔为实验动物，实验组于Ⅱ区将屈趾深肌腱切断并吻合后，腱鞘内注入几丁聚糖0.1ml，对照组不注入。术后3，4周后对其局部肌腱行大体标本观察、生物力学测试、光镜和透射电镜观察。临床Ⅱ区屈指肌腱断裂病人40例,Ⅰ组20例肌腱吻合后腱鞘内注入几丁聚糖0.2ml，Ⅱ组不注入，随访检查其握力，计算屈指肌腱总主动活动度(TAM)。　结果　（1）大体标本观察实验组肌腱较对照组愈合好，粘连轻。生物力学测试结果表明，两组比较差异具有显著性意义（P<0.05）。（2）组织学检查光镜和电镜示两组3，4周比较差异有显著性意义(P<0.05)。(3)临床应用中的握力及屈指TAMⅠ组握力为健侧的58%～96%，平均83.3%；Ⅱ组为49%～86%，平均72.6%。Ⅰ组TAM优9例，良7例，差1例；Ⅱ组优5例，良7例，可5例，差3例。两组比较差异有非常显著性意义（P<0.01)。　结论　几丁聚糖具有预防肌腱粘连的作用，且能促进肌腱愈合。

Experimental study and clinical application of effect of chitosan on wound healing of muscle tendons

Objective To investigate the effect of chitosan on wound healing of muscle tendons and clinical application. Methods The flexor tendons of the second and third toes of the hind legs in 24 rabbits were cut off and anastomosed, then chitosan was injected into the tendon sheaths and the broken parts of 12 rabbits as the experimental group. The rest 12 rabbits were injected no chitosan as the control group. The legs of all the rabbits were immobilized with plaster. Six animals in each group were sacrificed and the toes were observed after 3 weeks of immobilization, and the rest 12 were dealt with after 4 weeks of immobilization. All the tendons were observed with naked eyes, under a light microscope and under a transmission electron microscope, respectively. The biomechanics of the tendons were also measured. In clinical application, chitosan was injected into the tendon sheaths and the broken parts of 20 patients with broken flexor tendons, and other 20 patients with broken flexor tendons received no chitosan. Then they were followed up, and their grip strength was measured and the total active movement (TAM) was calculated. Results Gross specimen observation showed tendon's healing in the experimental group was better than that of the control group. Biomechanical tests showed significant difference between the experimental group and the control group ( P <0.05). The observation under light and transmission electron microscopes showed significant difference between the experimental group and the control group. The grip strength and TAM of the hands in clinical practice showed significant difference between the experimental group and the controls ( P <0.01). Conclusions It suggests that chitosan can prevent or reduce the adhesions between tendons and improve the wound healing of tendons.