大隐静脉修复鞘管防止屈肌腱粘连的实验研究与临床应用

目的：观察大隐静脉修复鞘管防止屈肌腱粘连的效果和临床应用的可行性。方法：将３０只鸡的双足中趾造成相同的肌腱和腱鞘损伤，一侧用大隐静脉修复鞘管为实验趾；一侧不修复鞘管直接缝合切口为对照趾。随机分组，分别在术后１、２、４、６和１２周进行双侧趾的屈曲功能、大体解剖和光镜观察。结果：实验趾的屈曲功能明显优于对照趾。大体解剖见用大隐静脉修复的鞘管近似正常鞘管结构，可完全阻止肌腱粘连，不影响肌腱愈合。对照趾肌腱与周围组织粘连紧密，影响肌腱滑动。光镜下见移植的静脉外膜与周围组织愈合好，内膜光滑与肌腱无粘连。临床应用２１例３３指，平均随访１８个月，优良率达９０％以上。结论：大隐静脉修复鞘管是防止屈肌腱粘连较有效的方法。

EXPERIMENTAL STUDY AND CLINICAL APPLICATION OF REPAIRING SHEATH TUBE WITH GREAT SAPHENOUS VEIN TO PREVENT THE ADHESION OF FLEXOR DIGTORIUM TENDON

Objective:To observe the effect and the clinical feasibility of repairing sheath,tube with great saphenous vein to prevent the adhesion of flexor tendon.Methods:The double claw midtoe of 30 roosters are caused the same injury of tendon and tendon sheath,and then,The side of repairing sheath tube with great saphenous vein is considered as experimental toe and the other side of norepairing sheath tube but suturing directely as control toe are randomly divided into group.the flexing and extending function of both side is observed by anatomy and microscope after 1,2,4,6 and 12 weeks of postoperation separately.Results:The flexing and extending function of experimental toe is superior obviously to that of control toe.By anatomical observation,the repairing sheath tube with great saphenous vein is similar to the nomal structure of sheath tube,which can prevent completely the adhesion of tendon and not influence the cure of tendon, the tendon of control toe adhere seriously with peripheral tissue and influence the excursion of tendon.By microscopical observation:the exterior membrance of grafting veins cure well and the interior membrane has not adhesion with tendon.The tendon of control toe is on the contrary.33 fingers of 21 cases are used clinicaly,traced average 18 months,fine rate is more than 90% by American TAM evaluation.Conclusion:The repairing sheath tube with great saphenous vein to prevent the adhesion of flexor tendon is the most effective method.