自体和异体滑膜内、外肌腱移植的实验研究

目的　比较自体和异体滑膜内肌腱 (intrasynovial tendon,IT )及滑膜外肌腱 (extrasynovialtendon,ET)作鞘管内移植后两者愈合过程和粘连的异同。方法　应用兔新鲜自体和深低温冻存的异体趾深屈肌腱 (IT)、腓骨长肌腱 (ET) ,分别移植于兔左后肢第二趾 (IT)、四趾 (ET)鞘管内修复趾深屈肌腱缺损。自体、异体组各 2 1只兔。术后 10天、3、6周取两组移植腱及对侧正常腱作组织学观察 ;术后 4、8周取材作生物力学测定。结果　两组 IT移植后粘连轻 ,而两组 ET移植后粘连明显 ,滑动功能差于 IT移植(F =14.10 ,P <0 .0 1)。术后 8周时异体移植腱的最大抗断裂载荷值低于自体移植腱 (F =10 .11,P <0 .0 1)。结论　鞘管内自体或异体肌腱移植后均有供腱的组织特异性 ,两者 IT移植后滑动功能均优于 ET组。异体肌腱 (IT、ET)移植后的愈合过程慢于自体移植组。

An experimental study on autogenous and allogeneic intrasynovial and extrasynovial tendon grafts

Objective To compare the healing process and adhesion formation in autogenous and allogeneic intrasynovial tendon (IT) grafts and extrasynovial tendon (ET) grafts. Methods The fresh autografts and deep freeze preserved allografts from the flexor digitorum profundus tendon (IT) and the long peroneal tendon (ET) were grafted intrathecally to repair the defect of flexor digitorum profundus tendon of the 2nd (IT) and the 4th (ET) toe in rabbits. Histological and ultrastructural observations were performed at 10 days, 3 and 6 weeks postoperatively. Biomechanical testing of the tendons was carried out in 8 weeks. Results Slight adhesion was observed in the intrasynovial autografts and allografts. There was dense adhesion with the tendon sheath and the flexor digitorum superficialis tendon in the extrasynovial autografts and allografts. Excursion of the extrasynovial autografts and allografts was inferior to that of the intrasynovial ones ( F =14.10, P < 0.01 ). By eight weeks, the maximum tensile load of the allografts was less than that of the autografts ( F = 10.11, P < 0.01 ). Conclusions The healing process of the intrathecally grafted tendons is donor tissue specific in both autografts and allografts. The intrasynovial origin tendon grafts demonstrate significantly improved excursion function. The healing process of the allografts is slower than that of the autografts.