深低温冷藏并戊二醛化同种异体肌腱移植修复手部肌腱缺损的特点评价

背景采用不同方法处理的异体肌腱移植修复手外伤肌腱缺损,已成为近年手部组织工程研究的重点.目的探讨经深低温冰箱冷藏及戊二醛处理的同种异体肌腱移植修复手部肌腱缺损的特点.设计自身前后对照观察.单位惠州市中心人民医院骨科病房.对象选择1997-01/2001-08在惠州市中心人民医院骨科二病区住院的男性手外伤肌腱缺损患者15例(17条肌腱),年龄20～35岁.其中伸指肌腱缺损8条,屈指肌腱缺损9条;缺损肌腱长3～9 cm.方法应用从健康青壮年意外死亡者志愿贡献或外伤断肢后无再植条件废弃肢体经无菌操作条件取出的手指屈肌腱(本人或家属均知情同意),经-80℃深低温冰箱保存,术前应用3.5 g/L戊二醛溶液浸泡后按显微外科缝合肌腱的方法将异体肌腱移植于手部肌腱缺损处.随访时按国际手外科联合会制定的总活动度法评定疗效,分为优、良、可、差4级.主要观察指标手指总主动活动度和排斥反应.结果15例患者(17条肌腱)均进入结果分析.随访8个月,手指肌腱总活动度优级4条,良级6条,可级4条,差级3条,总有效率82.36%(14/17).全部病例没有使用激素及免疫抑制剂,均没有发生急性免疫排斥反应,移植的肌腱无断裂.结论异体肌腱经-80℃深低温保存及术前应用戊二醛处理,可以降低移植后的抗原反应,增加移植肌腱的强度和韧性,避免可能发生的传染病的感染,是代替自体肌腱移植的良好方法之一,但移植后存在着肌腱粘连的并发症尚需解决.

Evaluation of deep-frozen glutaraldehyde-treated tendon allograft for repairing hand tendon defect

BACKGROUND: Different pretreatments of the tendon allograft for repairing hand tendon defect due to traumatic injuries have received much attention in the study of tissue engineering for hand surgeries.OBJECTIVE:To explore the characteristics of deep-frozen glutaraldehyde-treated tendon allograft for repairing hand tendon defect.DESIGN: A self-controlled study.SETTING:Ward of Orthopedic Department, Huizhou People's Central Hospital.PARTICIPANTS:Fifteen patients (aged 20-35 years) with 17 defected tendons were hospitalized in the Department of Orthopedics of Huizhou People's Central Hospital between January 1997 and August 2001. Among the 17 defected tendons, 8 were extensor tendons and 9 flexor tendons,with the length of defects varying from 2 to 9 cm.METHODS:The allogenic tendon grafts were obtained from young donors died in accidents or non-replantable amputated limbs due to traumatic injuries with informed consent obtained from the donors or their family members. These grafts were stored at -80 ℃ and immersed in 3.5 g/L glutaraldehyde solution before transplantation. Surgical operation was conducted following standard microsurgical procedures. According to the assessment criteria for total rang of motion (ROM) recommended by International Hand Surgery Association, the outcome of the surgically repaired hands was graded as excellent, good, acceptable and poor.MAIN OUTCOME MEASURES:Total ROM of the digits and graft rejection.RESULTS:None of the 15 patients was lost for analysis. The follow-up lasted for 8 months, during which 4 transplanted tendons had excellent, 6good, 4 acceptable and 3 poor functions, with a total effective rate of 82.36% (14/17). Neither cortical hormone nor immunosuppressants were used in these cases and no acute graft rejection or rupture of the tendons occurred.CONCLUSION: The antigenicity of the tendon allografts can be lowered after deep freezing of the grafts at -80 ℃ with preoperative glutaraldehyde treatment, which also increases the strength and tenacity of the tendons and decreases the risk for infection. The treated grafts provide a good alternative for autologous tendon graft but the complication of tendon adhesion still awaits to be tackled.