Department of Biomedical Engineering, the Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital Ludwigshafen, Ludwigshafen, Germany.
Acta Biomater. 2021 Apr 1;124:15-32. doi: 10.1016/j.actbio.2021.01.027. Epub 2021 Jan 27.
Tendon adhesion formation describes the development of fibrotic tissue between the tendon and its surrounding tissues, which commonly occurs as a reaction to injury or surgery. Its impact on function and quality of life varies from negligible to severely disabling, depending on the affected area and extent of adhesion formed. Thus far, treatment options remain limited with prophylactic anti-inflammatory medications and revision surgeries constituting the only tools within the doctors' armamentarium - neither of which provides reliable outcomes. In this review, the authors aim to collate the current understanding of the pathophysiological mechanisms underlying tendon adhesion formation, highlighting the significant role ascribed to the inflammatory cascade in accelerating adhesion formation. The bulk of this article will then be dedicated to critically appraising different therapeutic structures like nanoparticles, hydrogels and fibrous membranes fabricated by various cutting-edge technologies for adhesion formation prophylaxis. Emphasis will be placed on the role of the fibrous membranes, their ability to act as drug delivery vehicles as well as the combination with other therapeutic structures (e.g., hydrogel or nanoparticles) or fabrication technologies (e.g., weaving or braiding). Finally, the authors will provide an opinion as to the future direction of the prevention of tendon adhesion formation in view of scaffold structure and function designs.
肌腱粘连形成描述了肌腱与其周围组织之间纤维组织的发展，通常是对损伤或手术的反应。其对功能和生活质量的影响因受影响的区域和形成的粘连程度而异，从微不足道到严重致残不等。到目前为止，治疗选择仍然有限，预防性抗炎药物和修正手术是医生治疗手段中仅有的两种方法，但都无法提供可靠的结果。在这篇综述中，作者旨在整理目前对肌腱粘连形成的病理生理机制的理解，强调炎症级联反应在加速粘连形成中的重要作用。然后，本文的大部分内容将专门用于批判性评估不同的治疗结构，如纳米粒子、水凝胶和由各种先进技术制造的纤维膜，以预防粘连形成。重点将放在纤维膜上，它们作为药物输送载体的能力，以及与其他治疗结构（如水凝胶或纳米粒子）或制造技术（如编织或编织）的结合。最后，作者将就支架结构和功能设计方面，对预防肌腱粘连形成的未来方向提出意见。
