磷酸果糖抑制肌腱胶原产生和趾屈指肌腱吻合后的粘连

背景：有实验证实外源性6-磷酸果糖能降低肌腱细胞Ⅰ型胶原的产生量,减轻肌腱术后粘连的形成。 目的：观察6-磷酸果糖对肌腱术后粘连形成的影响。 方法：取72只兔行中趾屈指肌腱切断吻合,随机分成实验组与对照组(n=36),分别于腱鞘内注入6-磷酸果糖与生理盐水,术后4,8周后行肌腱粘连检测、生物力学测定、组织学观察和扫描电镜观察;术后1,2,4,8周采用原位杂交方法测定肌腱转化生长因子β1和Ⅰ型胶原mRNA的表达。 结果与结论：术后4,8周,与对照组比较,实验组肌腱缝合处光滑,屈趾肌腱滑动距离较长,肌腱滑动受限较轻(P < 0.05),但两组最大抗断裂载荷差异无显著性意义(P > 0.05);扫描电镜和组织学观察结果显示,对照组胶原纤维排列紊乱,实验组胶原纤维排列整齐。实验组转化生长因子β1和Ⅰ型胶原mRNA表达水平均低于对照组(P < 0.05)。证实6-磷酸果糖能有效抑制转化生长因子β1在肌腱损伤修复中的作用,减轻粘连形成。

Mannose-6-phosphate effects on collagen production and adhesion formation of the flexor tendon

BACKGROUND:It has been confirmed that exogenous mannose-6-phosphate can inhibit type Ⅰ collagen production in tendon cells and prevent tendon adhesion after repair of flexor tendon injury. OBJECTIVE:To investigate the preventive effect of mannose-6-phosphate on adhesion formation following flexor tendon repair. METHODS:Seventy-two adult New Zealand White rabbit forepaws underwent sharp transection of the middle digit flexor digitorum profundus and immediate repair, and then were randomly divided into experimental (injected with mannose-6-phosphate) and control (injected with normal saline) groups. Tendons were harvested at 4 and 8 weeks postoperatively, and biomechanics testing, histological evaluation and scanning electron microscope observation were conducted. In situ hybridization method was performed to determine the mRNA expression of transforming growth factor beta 1 and type Ⅰ collagen. RESULTS AND CONCLUSION:At 4 and 8 weeks after operation, the suture line was smooth, the gliding excursion ratio of the flexor tendon was higher, and the tendon sliding was constrained less in the experimental group as compared with the control group (P < 0.05). However, there was no significant difference in the tensile strength of tendon anastomosis between the two groups (P > 0.05). Scanning electron microscope and histological observation showed that collagen fibers arranged irregularly in the control group, but arranged regularly in the experimental group. The in situ hybridization examination revealed that transforming growth factor beta 1 and type Ⅰ collagen mRNA expression in the experimental group was lower than that in the control group (P < 0.05). These findings indicate that mannose-6-phosphate can inhibit the function of the transforming growth factor beta 1 effectively in the flexor tendon repair and prevent adhesion formation.