应用胶原膜缓解大鼠跟腱损伤修复中肌腱粘连的实验研究

发布时间：2018-08-12 12:39

【摘要】：目的 肌腱粘连是肌腱手术后最常见的致残原因之一。预防肌腱粘连是肌腱修复手术后面临的一个重大挑战。本实验旨在利用大鼠跟腱损伤模型，研究在手术修复损伤肌腱中应用胶原膜包裹受损肌腱对肌腱愈合强度、愈合质量以及预防肌腱粘连发生的作用，探讨其临床运用的可行性。 方法 切断60只雄性Sprague-Dawley大鼠（250±18克）双侧后肢跟腱共120条，改良Kessler’s法进行手术缝合。按随机对照原则分为空白对照组（G1，切开皮肤分离软组织但未切断肌腱，n=40）、手术组（G2，肌腱切断后单纯缝合，n=40）、胶原膜治疗组（G3，肌腱切断，手术缝合并包裹胶原膜，n=40）。每组随机分为2组，分别于术后四周及八周处死大鼠，取得肌腱，进行大体观察评价、生物力学评价、组织学切片HE染色及免疫组织化学方法染色分析。 结果 大体观察评价分析显示胶原膜治疗组比手术组肌腱粘连程度显著降低。 生物力学测试结果显示：术后4周，手术组与胶原膜治疗组肌腱平均最大张力比对照组降低（p0.05），但胶原膜治疗组相比手术组增高（p 0.05）。术后8周，胶原膜治疗组的最大张力相比手术组增高（p 0.05），胶原膜治疗组的最大张力与对照组无显著性差别（p0.05）。 HE染色组织学观察结果：术后4周，手术组见瘢痕组织。胶原膜治疗组肌腱胶原纤维束排列不规则，但更密集，且线性排列方式优于手术组。术后8周与术后4周相比，手术组和胶原膜治疗组的修复更成熟，胶原蛋白基质更密集，胶原纤维束规则排列，总胶原基质的面积更宽。术后8周，，胶原膜治疗组的胶原基质总面积超过手术组。术后8周在手术组部分区域发现有骨化形成。 Ⅰ型胶原、Ⅱ型胶原的免疫组织化学染色结果显示：术后8周胶原膜治疗组和手术组Ⅰ型胶原的表达均略强于相应组术后四周；术后4周和8周，胶原膜治疗组分别都比相应手术组有显著强表达的Ⅰ型胶原蛋白（p 0.05）。 手术组在术后4周或8周都可观察到Ⅱ型胶原的棕色染色，但在术后8周时较多。术后4周和8周的Ⅱ型胶原表达，胶原膜治疗组均比手术组弱（p0.05）。 结论 用胶原膜包裹损伤肌腱相比于无包裹的损伤肌腱愈合更好，粘连程度降低。
[Abstract]:Objective tendon adhesion is one of the most common causes of injury after tendon surgery. Preventing tendon adhesion is a major challenge after tendon repair. The purpose of this study was to study the effect of collagen membrane on tendon healing strength, healing quality and prevention of tendon adhesion, and to explore the feasibility of clinical application of collagen-coated tendon in the repair of tendon injury in rats using the model of Achilles tendon injury in order to study the effect of collagen-coated tendon on tendon healing strength, healing quality and prevention of tendon adhesion. Methods 120 Achilles tendons of 60 male Sprague-Dawley rats (250 卤18 g) were amputated and sutured by modified Kessler's method. According to the principle of random control, they were divided into blank control group (G1), operation group (G2), collagen membrane treatment group (G3, tendon amputation, surgical suture and encapsulation of collagen membrane). Each group was randomly divided into two groups. The rats were killed at four and eight weeks after operation. The tendons were obtained, the gross observation and evaluation, biomechanical evaluation, HE staining of histological sections and immunohistochemical staining were carried out. Results the gross observation and evaluation showed that the degree of tendon adhesion in collagen membrane group was significantly lower than that in operation group. The results of biomechanical test showed that the mean maximum tension of tendon in the operation group and collagen membrane treatment group was lower than that in the control group (p0.05), but the collagen membrane treatment group was higher than that in the operation group (p0.05). At 8 weeks after operation, the maximal tension of collagen membrane treatment group was higher than that of the operation group (p 0. 05). There was no significant difference between the collagen membrane treatment group and the control group (p0. 05). HE staining histological observation: at 4 weeks after operation, scar tissue was found in the operation group. The collagenous fibers in the collagen membrane group were irregular, but more dense, and the linear arrangement was better than that in the operation group. After 8 weeks compared with 4 weeks after operation, the repair of the operation group and collagen membrane treatment group was more mature, collagen matrix was more dense, collagen fiber bundle arranged regularly, the area of total collagen matrix was wider. At 8 weeks after operation, the total area of collagen matrix in the collagen membrane treatment group was larger than that in the operation group. 8 weeks after operation, ossification was found in some areas of the operation group. The immunohistochemical staining results of type 鈪

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