Noguchi M, Seiler J G, Boardman N D, Tramaglini D M, Gelberman R H, Woo S L
Department of Orthopaedic Surgery, University of Pittsburgh, USA.
J Hand Surg Am. 1997 May;22(3):457-63. doi: 10.1016/S0363-5023(97)80013-5.
This study compared the biomechanical properties of intrasynovial and extrasynovial flexor tendon autografts in an adult canine model. Flexor digitorum profundus (FDP) tissue from the fifth toe of the hindpaw was harvested and transplanted as an intrasynovial graft to the second toe of the left forepaw of each animal. Peroneus longus tendon from the lateral compartment of the hind leg served as the source for the extrasynovial graft that was transplanted to the fifth toe of each dog's left forepaw. The second and fifth FDP tendons of the right forepaw constituted the respective contralateral controls. Postoperatively, each animal underwent a regimen of daily controlled passive mobilization. Three and 6 weeks after grafting, 6 animals were euthanized and their grafts evaluated for gliding function and tensile properties. Results reveal significantly greater angular rotation of the proximal interphalangeal joint in the digits that received intrasynovial grafts relative to those that received transplanted extrasynovial tendon at both 3 and 6 weeks postoperatively. The linear stiffness of the tendons receiving extrasynovial graft significantly exceeded that of the intrasynovial group. These findings correlated with histologic data that postoperative adhesions existed in the specimens with an extrasynovial graft. In addition, the extrasynovial tendon graft complex exhibited significantly higher ultimate loads than intrasynovial tendon graft complex at 6 weeks.
本研究在成年犬模型中比较了滑膜内和滑膜外屈肌腱自体移植的生物力学特性。采集后足第五趾的指深屈肌(FDP)组织,并作为滑膜内移植组织移植到每只动物左前肢的第二趾。来自后腿外侧肌间隔的腓骨长肌腱作为滑膜外移植组织的来源,移植到每只狗左前肢的第五趾。右前肢的第二和第五FDP肌腱构成各自的对侧对照。术后,每只动物接受每日控制性被动活动方案。移植后3周和6周,对6只动物实施安乐死,并评估其移植组织的滑动功能和拉伸特性。结果显示,术后3周和6周时,接受滑膜内移植的手指近端指间关节的角旋转明显大于接受滑膜外移植肌腱的手指。接受滑膜外移植的肌腱的线性刚度明显超过滑膜内组。这些发现与组织学数据相关,即滑膜外移植标本中存在术后粘连。此外,在6周时,滑膜外肌腱移植复合体的极限负荷明显高于滑膜内肌腱移植复合体。