Rochester, Minn.; and Providence, R.I. From the Biomechanics & Tendon and Soft Tissue Biology Laboratories, Mayo Clinic; and Brown University.
Plast Reconstr Surg. 2014 May;133(5):628e-637e. doi: 10.1097/PRS.0000000000000102.
Using allograft is an attractive alternative for flexor tendon reconstruction because of the lack of donor-site morbidity, and better matching to the intrasynovial environment. The purpose of this study was to use biological lubricant molecules to modify the graft surface to decrease adhesions and improve digit function.
Twenty-eight flexor digitorum profundus tendons from the second and fifth digits of 14 dogs were lacerated and repaired to create a model with repair failure and scar digit for tendon reconstruction. Six weeks after the initial operation, the tendons were reconstructed with flexor digitorum profundus allograft tendons obtained from canine cadavers. One graft tendon in each dog was treated with saline as a control and the other was treated with carbodiimide-derivatized hyaluronic acid and gelatin plus lubricin. Six weeks postoperatively, digit function, graft mechanics, and biology were analyzed.
Allograft tendons treated with carbodiimide-derivatized hyaluronic acid-lubricin had decreased adhesions at the proximal tendon/graft repair and within the flexor sheath, improved digit function, and increased graft gliding ability. The treatment also reduced the strength at the distal tendon-to-bone repair, but the distal attachment rupture rate was similar for both graft types. Histologic evaluation showed that viable cells migrated to the allograft, but these were limited to the tendon surface.
Carbodiimide-derivatized hyaluronic acid-lubricin treatment of tendon allograft improves digit functional outcomes after flexor tendon reconstruction. However, delayed bone-to-tendon healing should be a caution. Furthermore, the cell infiltration into the allograft tendon substance should be a target for future studies, to shorten the allograft self-regeneration period.
异体移植物作为屈肌腱重建的一种有吸引力的选择，因为它没有供区并发症，并且更符合滑膜内环境。本研究的目的是使用生物润滑剂分子来修饰移植物表面，以减少粘连并改善手指功能。
14 只狗的第二和第五指的 28 条屈肌腱深肌腱被撕裂并修复，以创建一个具有修复失败和疤痕手指的模型，用于肌腱重建。初次手术后 6 周，使用从犬尸体获得的屈肌腱深肌腱进行屈肌腱重建。每只狗的一根移植物肌腱用生理盐水作为对照，另一根用碳化二亚胺衍生的透明质酸和明胶加润滑素处理。术后 6 周，分析手指功能、移植物力学和生物学。
用碳化二亚胺衍生的透明质酸-润滑素处理的同种异体肌腱在近端肌腱/移植物修复处和屈肌腱鞘内的粘连减少，手指功能改善，移植物滑动能力增强。该治疗还降低了远端肌腱-骨修复处的强度，但两种移植物类型的远端附着断裂率相似。组织学评估显示，有活力的细胞迁移到同种异体肌腱，但仅限于肌腱表面。
碳化二亚胺衍生的透明质酸-润滑素处理同种异体肌腱可改善屈肌腱重建后的手指功能结果。然而，应该注意骨-肌腱愈合延迟的问题。此外，同种异体肌腱实质内的细胞浸润应该是未来研究的目标，以缩短同种异体自身再生的时间。
