无线结巩膜层间Z字缝合法的病理及力学分析

目的对一种新式缝合固定技术即无线结的巩膜层间Z字缝合法的安全性及力学参数进行分析。方法将日本大耳白兔50只随机分为A、B、C、D、E组,每组10只,其中A、B、C、D组右眼为实验眼,分别给予1针、2针、3针、4针的巩膜层间Z字缝合,使用微型测力计测其拉力,比较各组间拉力的差异;E组右眼均给予巩膜层间Z字缝合(3针),于术后1 d、7 d、14 d、30 d、45 d每次处死2只,取其巩膜组织进行病理切片HE染色,观察巩膜缝线处愈合状态。结果 A、B、C、D四组拉力逐渐增大,两两比较,差异均有统计学意义(均为P<0.001),且3针巩膜层间Z字缝合平均拉力(0.242 3±0.024 2) N,大于人工晶状体最大悬吊力(0.058 3 N),足以稳固人工晶状体。E组HE染色结果显示,术后1 d缝线周围有少量炎性细胞,术后7 d巩膜组织有大量炎性细胞,术后14 d炎性细胞向缝线处聚集成簇,术后30 d炎性细胞仅局限于缝线处,术后45 d缝线周围形成纤维结缔组织包裹,几乎不见炎性细胞。结论巩膜层间Z字缝合3针足以稳固晶状体;病理切片HE染色结果提示,缝线在远期不会引起炎症反应。

Pathological and mechanical analysis of knotless transscleral Z-suture

Objective　 To evaluate the safety and mechanical parameters of a new suture scleral fixation technology, knotless transscleral Z-suture. Methods　Fifty Japanese white rabbits were randomly divided into group A, B, C, D and E, 10 rabbits in each group. Right eyes of rabbits in group A, B, C and D were taken as experimental eyes, and respectively received 1, 2, 3 and 4 stitches of transscleral Z-suture. The tension was measured using a miniature dynamometer, and compared between groups. Right eyes of rabbits in group E received 3 stitches of transscleral Z-suture, and two rabbits were killed on the 1 day, 7 days, 14 days, 30 days and 45 days after surgery, respectively. The scleral tissues were stained with HE to observe the healing state of scleral suture. Results　The tension in group A, B, C and D gradually increased, and statistical differences were observed by pairwise comparison (all P<0.001). Mean tension of transscleral Z-suture with 3 stitches was (0.242 3±0.024 2) N, which was greater than maximum suspension force of IOL (0.058 3 N), and was enough to stabilize IOL.HE staining of scleral tissues in group E showed that a small number of inflammatory cells were clustered around the suture on the 1 day after surgery; a large number of inflammatory cells were observed 7 days after surgery; inflammatory cells were clustered toward the stitches 14 days after surgery, and only confined around the stitches 30 days after surgery; fibrous connective tissues were formed around the stitches and inflammatory cells were almost absent 45 days after surgery. Conclusion　The tension of 3-stitch transscleral Z-suture is sufficient to stabilize the lens. HE staining indicates no inflammation by sutures in the long term.