Siddiqi N A, Hamada Y, Yamaguchi T, Toshima T
Department of Orthopaedic Surgery, Yamanashi University School of Medicine, Japan.
Nihon Seikeigeka Gakkai Zasshi. 1991 Aug;65(8):561-70.
The formation of adhesions around the lacerated flexor tendons in zone II was studied in chickens after using an artificial tendon sheath made of hydroxyapatite (HAp). The flexor sheath was excised between the proximal and distal pulleys in zone II to create a window in the fibro-osseous tunnel. After suturing the severed profundus tendon, an HAp sheath was placed around the suture site followed by 3 weeks of immobilization. The results were compared with controls in which no HAp sheaths were used after the operation. Adhesion formation was assessed both biomechanically and histologically. The mobility of the tendons was better in the HAp group at all the periods studied. HAp sheath was not firmly adherent to either the granulation tissue or the surface of the tendon. Histology at 3 as well as 6 weeks in HAp groups revealed epitenon-like structure on the tendon surface including the tenorrhaphy site and a wide space around the tendon after the HAp sheath was removed. The outer margins of this space was lined by a layer of fibrocyte-like cells and collagen fibers thereby resembling new formed tendon sheath. In the cases of control, marked peritendinous adhesions were observed.
在鸡身上使用由羟基磷灰石（HAp）制成的人工腱鞘后，对II区屈指肌腱撕裂处周围粘连的形成情况进行了研究。在II区的近端和远端滑车之间切除屈肌腱鞘，在纤维骨性隧道中制造一个窗口。缝合离断的指深屈肌腱后，在缝合部位周围放置HAp腱鞘，然后固定3周。将结果与术后未使用HAp腱鞘的对照组进行比较。通过生物力学和组织学方法评估粘连形成情况。在所有研究时间段内，HAp组肌腱的活动度均较好。HAp腱鞘与肉芽组织或肌腱表面均未紧密粘连。HAp组在3周和6周时的组织学检查显示，肌腱表面包括肌腱缝合部位有类腱外膜结构，去除HAp腱鞘后肌腱周围有较宽的间隙。该间隙的外缘由一层纤维细胞样细胞和胶原纤维排列，从而类似于新形成的腱鞘。在对照组中，观察到明显的腱周粘连。
