Ding Baozhi, Wang Xin, Yao Min
1 Shanghai Key Laboratory of Orthopaedic of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medcine, China.
2 Department of Burns and Plastic Surgery, Shanghai Ninth People's Hospital, Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, China.
Surg Innov. 2019 Apr;26(2):153-161. doi: 10.1177/1553350618824448. Epub 2019 Jan 30.
We utilized a novel approach of combined photochemical tissue bonding (PTB) and human amniotic membrane (HAM) to improve hand tendon repair and also evaluated its efficacy.
Subei chickens underwent surgical transection of the flexor digitorum profundus tendons and repair by (1) SR (standard Kessler suture; n = 24; 6-0 prolene) and (2) HAM/PTB (n = 24), where a section of HAM was stained with 0.1% Rose Bengal, wrapped around the ruptured tendon and bonded with 532 nm light (0.5 W/cm, 200 J/cm). Total active motion, gross appearance, extent of adhesion formation, biochemical properties, and inflammatory cells of the repaired tendon were evaluated on days 3, 7, 14, and 28 postoperatively.
PTB strongly bonded HAM with flexor digitorum profundus tendon surface. No significant difference was observed between the tensile properties of either group on all postoperative time points. The joint activities and the adhesion formation levels were significantly better in the HAM/PTB group compared with those in the SR group on day 14. Histological examination revealed drastically reduced number of inflammatory cells in the HAM/PTB group than in the SR group on days 7 and 14 after surgery.
These findings revealed that PTB sealing of HAM around the tendon repair site provided considerable benefits for hand tendon repair by eliminating technical difficulties and obvious contraindications. Thus, this novel procedure has considerable benefits in repairing hand tendon damage.
我们采用了一种光化学组织黏合（PTB）与人类羊膜（HAM）相结合的新方法来改善手部肌腱修复，并评估其疗效。
将苏北鸡的指深屈肌腱进行手术切断，并通过以下方法进行修复：（1）标准凯斯勒缝合（SR，标准凯斯勒缝合；n = 24；6-0普理灵缝线）和（2）HAM/PTB（n = 24），其中将一段HAM用0.1%孟加拉玫瑰红染色，包裹在断裂的肌腱周围，并用532 nm光（0.5 W/cm，200 J/cm）进行黏合。在术后第3、7、14和28天评估修复肌腱的总主动活动度、大体外观、粘连形成程度、生化特性和炎性细胞。
PTB将HAM牢固地黏合在指深屈肌腱表面。两组在所有术后时间点的拉伸性能均未观察到显著差异。在术后第14天，HAM/PTB组的关节活动度和粘连形成水平明显优于SR组。组织学检查显示，术后第7天和第14天，HAM/PTB组的炎性细胞数量比SR组大幅减少。
这些发现表明，在肌腱修复部位周围用PTB封闭HAM可为手部肌腱修复带来诸多益处，消除了技术难题和明显的禁忌证。因此，这种新方法在修复手部肌腱损伤方面具有显著优势。
