Peterson W W, Manske P R, Kain C C, Lesker P A
J Orthop Res. 1986;4(4):458-65. doi: 10.1002/jor.1100040409.
The effect on tendon gliding of flexor sheath excision versus incision/closure following primary flexor tendon repair was examined biomechanically and histologically in forty-one chickens. There was no significant difference in either the tendon excursion required to fully flex the digit or in the work of flexion (the integration of the forces that resist tendon gliding during excursion) between the sheath excised and sheath closed groups. The results were unaffected by postoperative immobilization or intermittent passive motion. Histologically, it was noted that at 3 weeks the healing tendon was surrounded by a layer of granulation tissue that was nearly identical in both the sheath excised and the sheath closed digits. Of note was the finding that a synovial lining could not be identified in those digits that had previously undergone sheath closure. However, at 6 weeks postoperatively, a new gliding surface could be identified surrounding the tendon in both the sheath excised and the sheath closed digits. This study indicates that closure of the flexor sheath after primary tendon repair does not improve tendon gliding as measured biomechanically. Despite its repair, the flexor sheath does not maintain its synovial characteristics as demonstrated histologically, and a new sheath must subsequently be formed.
在41只鸡身上，通过生物力学和组织学方法研究了一期屈指肌腱修复后，屈肌腱鞘切除与切开/缝合对肌腱滑动的影响。在完全屈曲手指所需的肌腱移动距离或屈曲功（在移动过程中抵抗肌腱滑动的力的积分）方面，腱鞘切除组和腱鞘缝合组之间没有显著差异。结果不受术后固定或间歇性被动活动的影响。组织学上，在3周时观察到，愈合中的肌腱被一层肉芽组织包围，在腱鞘切除的手指和腱鞘缝合的手指中，这层肉芽组织几乎相同。值得注意的是，在先前进行腱鞘缝合的手指中未发现滑膜衬里。然而，术后6周时，在腱鞘切除的手指和腱鞘缝合的手指中，均可在肌腱周围发现新的滑动表面。本研究表明，一期肌腱修复后缝合屈肌腱鞘，在生物力学测量中并不能改善肌腱滑动。尽管进行了修复，但屈肌腱鞘并未保持其组织学上显示的滑膜特征，随后必须形成新的腱鞘。
