Komurcu M, Akkus O, Basbozkurt M, Gur E, Akkas N
Gulhane Military Medical Academy and Medical Faculty, Department of Orthopaedics and Traumatology, Ankara, Turkey.
J Hand Surg Am. 1997 Sep;22(5):826-32. doi: 10.1016/S0363-5023(97)80076-7.
The effects of microsurgical and medical treatments on reduction of adhesions in surgically traumatized flexor tendons of rabbits are quantified in this study. The effects of the mentioned techniques were investigated for the following 4 groups: (1) neither primary sheath repair nor aprotinin application was done, (2) primary sheath repair was done but no aprotinin was used, (3) primary sheath repair was not done but local aprotinin (15,000 IU/kg) was applied, and (4) primary sheath repair was done and local aprotinin was applied. At the sixth and twelfth postoperative weeks, the flexor digitorum profundus tendons of the second and the third digits were subjected to biomechanical tests. Only the third digit was used in macroscopic and histopathologic evaluations. There were 6 digits included in each subgroup of biomechanical tests and 4 digits per subgroups in macroscopic and histopathologic evaluations. Work of flexion (WOF) values were obtained by calculating the area under the load-displacement curve. Percent resistive work of flexion (PRWOF) was obtained by calculating the difference between the WOF value for the repaired right digit and the WOF value for the contralateral corresponding nonrepaired digit. Combined primary sheath repair and medical treatment yielded the best results in reducing the restrictive adhesions in injured tendons. The differences between the PRWOF values of group 4 were 33.7% +/- 8.2% and 15.8% +/- 7.7% for the sixth and twelfth postoperative weeks, respectively. The corresponding values for group 1 were 95.7% +/- 13.8% and 51.75% +/- 10.25%.
本研究对显微外科手术和药物治疗对兔手术创伤屈肌腱粘连减少的影响进行了量化。对以下4组研究了上述技术的效果：（1）既未进行一期腱鞘修复也未应用抑肽酶，（2）进行了一期腱鞘修复但未使用抑肽酶，（3）未进行一期腱鞘修复但局部应用抑肽酶（15,000 IU/kg），以及（4）进行了一期腱鞘修复并局部应用抑肽酶。在术后第6周和第12周，对第二和第三指的指深屈肌腱进行生物力学测试。仅对第三指进行大体和组织病理学评估。生物力学测试的每个亚组中有6个手指，大体和组织病理学评估的每个亚组中有4个手指。通过计算负荷-位移曲线下的面积获得屈曲功（WOF）值。通过计算修复的右手手指的WOF值与对侧相应未修复手指的WOF值之间的差异获得屈曲阻力功百分比（PRWOF）。一期腱鞘修复与药物治疗相结合在减少损伤肌腱的限制性粘连方面产生了最佳效果。第4组在术后第6周和第12周的PRWOF值差异分别为33.7%±8.2%和15.8%±7.7%。第1组的相应值分别为95.7%±13.8%和51.75%±10.25%。
