Biomechanics Laboratory, Department of Orthopedic Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Clin Orthop Relat Res. 2012 Sep;470(9):2522-7. doi: 10.1007/s11999-012-2437-x.
Flexor tendon grafting is often required to reconstruct a failed tendon repair. Previous reports have demonstrated flexor grafts coated with lubricants such as carbodiimide derivatized hyaluronic acid (cd-HA) decrease adhesion formation and improve digit function. However, whether this surface modification would affect graft adhesion and cellularity is unknown.
QUESTIONS/PURPOSES: Adhesion score and the cellularity of the graft of untreated and cd-HA surface-modified autograft and allograft tendons were studied using a canine forepaw in vivo model.
The peroneus longus tendons (n = 6) and flexor digitorum profundus tendons (n = 8) were used as extrasynovial autograft and intrasynovial allograft, respectively. The flexor digitorum profundus (FDP) tendons in the second and fifth digits in each dog were reconstructed with one digit treated with cd-HA and the other treated with saline as a control. Six weeks after surgery, the grafted tendons were harvested for histological evaluation with hematoxylin and eosin staining. During dissection, the adhesions were observed and scored.
The adhesion score was greatest in the extrasynovial autograft without surface modification and the least in the intrasynovial allograft with surface modification. Autograft tendons had a higher cell density than the allografts regardless of surface treatment. Cd-HA graft treatment did not affect cellularity when compared with controls.
Our observations suggest surface modification of a tendon graft with cd-HA decreased the adhesion formation without altering the cellularity in either autologous or allograft tendon. We therefore presume this surface modification would not adversely affect graft healing.
修复失败的肌腱时，通常需要使用屈肌腱移植物。先前的报告表明，用诸如碳化二亚胺衍生透明质酸（cd-HA）等润滑剂涂覆的屈肌移植物可减少粘连形成并改善手指功能。但是，尚不清楚这种表面修饰是否会影响移植物的粘连和细胞活力。
问题/目的：使用犬前爪体内模型研究了未处理的和 cd-HA 表面修饰的自体和同种异体肌腱移植物的粘连评分和移植物的细胞活力。
使用腓肠肌长肌腱（n = 6）和屈趾深肌腱（n = 8）分别作为 extrasynovial 自体移植物和 intrasynovial 同种异体移植物。每只狗的第二和第五个手指的屈趾深肌腱（FDP）用一根手指用 cd-HA 处理，另一根用盐水处理作为对照进行重建。手术后 6 周，收获移植物进行苏木精和伊红染色的组织学评估。在解剖过程中，观察并评分粘连。
未经表面修饰的 extrasynovial 自体移植物的粘连评分最高，经过表面修饰的 intrasynovial 同种异体移植物的粘连评分最低。无论表面处理如何，自体移植物的细胞密度均高于同种异体移植物。与对照组相比，cd-HA 移植物处理并未影响细胞活力。
我们的观察结果表明，cd-HA 对肌腱移植物的表面修饰可减少粘连形成，而不会改变自体或同种异体肌腱的细胞活力。因此，我们推测这种表面修饰不会对移植物愈合产生不利影响。
