腕掌部伤指浅腱段带蒂滑行移植修复鞘内屈肌腱缺损的研究

为给修复鞘内屈肌腱缺损提供一种带血供的滑膜腱移植体和方法，根据有关腕部屈肌腱的解剖文献［１～３］，对腕掌部浅腱段的血供来源、组织结构及生理功能进行了详细研究。结果证实腕部及掌部近侧段的浅腱位于滑液囊内，腱表面覆盖着脏层滑膜，称作滑膜腱。其血供主要来自腱系膜的血管。因此在腕上和鞘区同时切断同一浅腱后，该腱段的血液供应仍很丰富，且该腱的滑行距离由原来的２．５ｃｍ增大到５ｃｍ以上。经尸体摸拟试验证实，用该段腱带腱系膜血管蒂滑行移植修复鞘内５ｃｍ以内的屈肌腱缺根的方法是可行的。为确保临床的可靠应用，进一步用鸡足长趾屈肌腱制成鞘内屈肌腱缺损，分别进行踝跖部浅腱段带蒂滑行移植和游离移植的动物模型，对两种移植腱的愈合全过程连续进行大体、光镜、电镜组织学和最大抗张强度、滑行距离生物力学的对比观察和测定。结果表明：滑行移植腱的血液供应始终很丰富；其愈合速度比游离移植腱快约１４天；吻合处粘连轻而局限，呈膜状；愈合早期（３周）最大抗张强度、晚期（８周）滑行距离均明显优于游离移植腱。从而证明了血供在腱愈合过程中的重要作用。在上述研究的基础上，我们利用腕掌部伤指浅腱段带蒂滑行移植的方法，对７例９指鞘内屈肌腱缺损的病人（最长５ｃｍ）进?

STUDY ON SLIDING GRAFT OF WRIST AND PALM FDS WITH PEDICLE OF INJURED FINGER IN RERAIRING THE DEFECT OF ZONE Ⅱ FLEXOR TENDON

In order to provide a method and donor of synovial sheath tendon with bloodpedicle for repairing the defect of flexor tendon in zone 11,the study on blood supply ,tissuestructure and physiological functions of the FDS ,which lies at the region of the wrist andpalm,were systematicaly carried out. It was found that the FDS ,covered by the visceral syn-ovium is the synovial sheath tendon and its blood supply mainly comes from the mesotendonif the FDS was cut from the forearm and zone 11 ,the sliding excursion of it, still with adequate blood supply, can be increased from 2.5cm to more than 5.0cm. The experiment withthe fresh cadavers demonstrated that it was feasible to repair the defect of zone 11 flexor ten-don using the method of FDS sliding graft with mesotendon pedicle as the source of bloodsupply. In view of this ,the healing process of sliding grafts and the free grafts of the FDS inchickens was observed morphologically and by light and electronic microscopes,and the max-imum rupture strenth and the sliding excursion of the tendon anastomosis site were measured.The results showed that in the sliding graft tendon the blood supply was adequate ;thehealing time was 14 days less than that of the free graft tendon;the adhesion was light andlimited;and both the maximum rupture strength at the early healing stage and the sliding ex-cutsion at the advanced healing stage were superior to those of the free graft tendon. It ind-cates theimportance of the blood supply in the healing progress and the restoration of slidingfunctions of the tendon. On the basis of the above experimental results ,the tendon repair of 9fingers in 7 patients with the defects of zone 11 FDP were performed using the sliding FDSgraft of the injuried fingers. The follow-up presented that eight of the nine fingers(90%)were in excellent or good status evaluated by the TAM. In comparision with other operations,the choice of sliding graft has the following advantages :①The sliding graft itself is thesynovial sheath tendon with adequate blood supply,and its tissue structure as well as the nu-tritional ways are the same as those of the zone 11 tendons.②The sliding graft is the reuse ofthe injuried FDS of the wounded finger. Therefore,no other tendon is needed.③This operation is suitable to the primary and the delayed repair of the injured tendon and the repair canbe finished just one time.④The sliding bed of the graft was, maintained,which facilites therestoration of the sliding functions.⑤This operation is simple. applicable,with less scope ofwound and easier to be accepted.