| Background and objectiveAchilles tendon injury is one of the most difficult problems for clinicians. The regeneration process of injured tendon is very slow. At present, the traditional methods for treating Achilles tendon injury mainly include extra articular arthrodesis and suturing. However, complications such as high risk of Achilles tendon re-rupture, or ankle joint stiffness caused by aweful prognosis which often lead to unsatisfactory results. As natural biological dressing, Human amniotic membrane(HAM) and small intestine submucosa(SIS) have already been widely used in repairing skin, nerve and corneal tissue defect repair. Researches have proved that HAM and SIS individually applying in the Achilles tendon repair can significantly reduce the formation of scar, but seldom focus on the difference between the two kinds of biological dressings which could further facilitate the instruction of clinical application. Recently, a new non-suture tissue bonding technique, called Photochemical Tissue Bonding(PTB), has been successfully used in repairing of tendon injury and obtained satisfactory outcomes. In this study, we first analyzed the biological properties of HAM and SIS, and then evaluated the effect of the two different materials individually combined with PTB on repairing the injured Achilles tendon. Through the research described above, we aimed to help choose more suitable biological dressings in the repair of Achilles tendon injury, and further to provide guidance in clinical treatment. Methods1 Preparation and properties analysis. HAM and SIS were prepared by traditional methods as the previous reported. An electronic universal testing machine were used to test the elastic modulus of HAM and SIS respectively. H&E staining was performed to observe the cell residue and the arrangement of the extracellular matrix.2 Evaluation of the effects of HAM or SIS combined with PTB technology on repairing the Achilles tendon injury. 72 New Zealand white rabbits were randomly divided into three groups, PTB with SIS, PTB with HAM and the normal control group. Outcome were assessed on day 7, 14, 28 and 56 post operative by scoring adhesion, measurement of Ultimate Stress and Young’s modulus, testing the expression of type I and III collagen and the inflammatory factor expression on surgical wound. Results1 HAM and SIS properties analysis. The elastic modulus of SIS is significantly higher than HAM(P < 0.01). Cells were observed in human amniotic membrane and the extracellular matrix arranged in disorder. No obvious cell residue in the SIS were observed and the collagen aligned orderly.2 Evaluation of the effects of HAM or SIS combined with PTB technology on repairing the Achilles tendon injury. Biomechanical test showed that the Ultimate Stress and Young’s modulus of the P/A group were significantly lower than that of the P/S group at day 7 and 14 post operation(P < 0.05). immunohistochemical detection showed that with the extension of time after surgery, the Achilles tendon stumps gradually regenerated to the center and eventually healed; Western-bolt showed that the content of type I collagen gradually increased while the content of type III collagen was reduced with time extension, andthe content of type I and type III collagen of Achilles tendon was similar to that of normal Achilles tendon on the day 56 post operation. ConclusionBoth of HAM and SIS can be successfully used in repairing of Achilles tendon injury and can significantly reduce postoperative formation of scar. At the early phase of Achilles tendon prosthesis, SIS combined with PTB can obviously improve the tension of the tendon terminal value and young’s modulus, and cause less incidence of early postoperative. |
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