Gelberman R H, Seiler J G, Rosenberg A E, Heyman P, Amiel D
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston 02114.
Scand J Plast Reconstr Surg Hand Surg. 1992;26(3):257-64. doi: 10.3109/02844319209015268.
Intercalary intrasynovial and extrasynovial flexor tendon graft donors were placed within the synovial sheaths of the medial and lateral forepaw digits of 22 dogs and treated with early controlled passive mobilization. Specimens were studied by light and transmission electron microscopy at 10 and 21 days. Early repair in the extrasynovial tendons occurred by an ingrowth of connective tissue from the digital sheath. Adhesions obliterated the gliding surface and occupied the space between the tendon's gliding surface and surrounding tissues. There was no epitenon response noted in the extrasynovial tendon grafts. While there was considerable new collagen fibril formation within the repair site at the ultrastructural level, there was a lack of longitudinal remodeling. In contrast, the intrasynovial tendon grafts showed early healing, with minimal adhesion formation, by a proliferation and migration of cells from the epitenon. These cells showed greater cellular activity and collagen production at 10 and 21 days compared to cells in extrasynovial tendons at the same intervals. The findings of this study suggest that the use of intrasynovial autogenous tendon graft donors, coupled with early controlled motion, stimulates an intrinsic repair process in both the tendon stump and autogeneous tendon graft. These findings differ significantly from the experimental findings in which extrasynovial, paratenon-covered grafts are used.
将间插式滑膜内和滑膜外屈肌腱移植供体置于22只犬前爪内侧和外侧趾的滑膜鞘内，并进行早期控制性被动活动治疗。在第10天和第21天通过光镜和透射电镜对标本进行研究。滑膜外肌腱的早期修复是通过来自指鞘的结缔组织向内生长实现的。粘连使滑动表面消失，并占据了肌腱滑动表面与周围组织之间的空间。滑膜外肌腱移植未观察到腱外膜反应。虽然在超微结构水平上修复部位有相当多的新胶原纤维形成，但缺乏纵向重塑。相比之下，滑膜内肌腱移植显示早期愈合，粘连形成最少，通过腱外膜细胞的增殖和迁移实现。与同期滑膜外肌腱中的细胞相比，这些细胞在第10天和第21天表现出更强的细胞活性和胶原蛋白产生。本研究结果表明，使用滑膜内自体肌腱移植供体并结合早期控制性活动，可刺激肌腱残端和自体肌腱移植的内在修复过程。这些结果与使用滑膜外、腱旁组织覆盖的移植的实验结果有显著差异。
