Zhao Chunfeng, Sun Yu-Long, Amadio Peter C, Tanaka Toshikazu, Ettema Anke M, An Kai-Nan
Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA.
J Bone Joint Surg Am. 2006 Oct;88(10):2181-91. doi: 10.2106/JBJS.E.00871.
Clinical and experimental studies have demonstrated that restrictive adhesions and poor digital motion are common complications after extrasynovial tendon grafting in an intrasynovial environment. The purpose of this study was to test the hypothesis that surface modification of an extrasynovial tendon with use of a carbodiimide-derivatized hyaluronic acid-gelatin polymer (cd-HA) improves gliding ability and digital function after tendon grafting in a canine model in vivo.
The peroneus longus tendons from both hindpaws of twenty-four dogs were harvested and transplanted to replace the flexor digitorum profundus tendons in the second and fifth digits of one forepaw. Prior to grafting, one of the peroneus longus tendons was coated with cd-HA, which consists of 1% hyaluronic acid, 10% gelatin, 0.25% 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC), and 0.25% N-hydroxysuccinimide (NHS), while the other was immersed in saline solution only. Eight dogs were killed at one, three, and six weeks. Digital normalized work of flexion, tendon gliding resistance, and hyaluronic acid quantification (with the hyaluronic acid-binding-protein staining technique) were the outcome measures.
The normalized work of flexion of the tendons treated with cd-HA was significantly lower than that of the saline-solution-treated controls at each time-point (p < 0.05). The gliding resistance of the cd-HA group was significantly lower than that of the saline-solution group at three and six weeks (p < 0.05). The ratio between the intensity of staining of the cd-HA-treated tendons with that of the saline-solution-treated controls was significantly greater at time-0 than at three or six weeks (p < 0.05), but there was no significant difference between time-0 and one-week values.
Treating the surface of an extrasynovial tendon autograft with a carbodiimide-derivatized hyaluronic acid-gelatin polymer decreases digital work of flexion and tendon gliding resistance in this flexor tendon graft model in vivo.
cd-HA gelatin may provide surgeons with a new and useful method to improve the quality of tendon graft surgery.
临床和实验研究表明，在滑膜内环境中进行滑膜外肌腱移植后，限制性粘连和手指活动不佳是常见的并发症。本研究的目的是验证以下假设：在犬体内模型中，使用碳二亚胺衍生化的透明质酸 - 明胶聚合物（cd - HA）对滑膜外肌腱进行表面修饰，可改善肌腱移植后的滑动能力和手指功能。
从24只犬的双后爪获取腓骨长肌腱，并移植以替代一只前爪第二和第五指的指深屈肌腱。在移植前，将其中一条腓骨长肌腱用cd - HA包被，cd - HA由1%透明质酸、10%明胶、0.25% 1 - 乙基 - 3 -（3 - 二甲基氨基丙基）碳二亚胺盐酸盐（EDC）和0.25% N - 羟基琥珀酰亚胺（NHS）组成，而另一条仅浸入盐溶液中。在1周、3周和6周时处死8只犬。手指屈曲的标准化功、肌腱滑动阻力和透明质酸定量（采用透明质酸结合蛋白染色技术）为观察指标。
在每个时间点，用cd - HA处理的肌腱的屈曲标准化功均显著低于用盐溶液处理的对照组（p < 0.05）。在3周和6周时，cd - HA组的滑动阻力显著低于盐溶液组（p < 0.05）。在时间0时，cd - HA处理的肌腱与盐溶液处理的对照组的染色强度之比显著大于3周或6周时（p < 0.05），但在时间0和1周的值之间无显著差异。
在该体内屈肌腱移植模型中，用碳二亚胺衍生化的透明质酸 - 明胶聚合物处理滑膜外自体肌腱表面可降低手指屈曲功和肌腱滑动阻力。
cd - HA明胶可为外科医生提供一种新的有用方法来提高肌腱移植手术的质量。
