| 【objective】Tendon injury, especially the "no man’s land" of hand flexo-r tendon injury adhesion has been the focus of hand surgeons, "false sheath plasty" proposed for prevention of tendon adhesion, which provide-s a new method,but the scholars at home and abroad held different opinions toward the treatment. This research mainly using silicone instead of damaging tendons combined with continuous passive motion to make tendons mod-el, using silica gel article tendon model to do experiments on related animals, adopting chicken flexor tendon sheath damage model, the issue of silicone implant after injury of tendon sheath article tendon model, observation of tendo-n model in different periods after tendon sheath repair gross observation,histo-morphology, formed by false sheath to prevent tendon adhesion to validate its feasibility and effectiveness, and phase ii clinical restore finger function reco-nstruction of flexor tendons provide experimental and theoretical basis for cli-nical application.【Methods】 Preoperative tendon model use medical food grade solid silicone tube(pr-ovided by Shanghai hui jing electrical and mechanical equipment co., LTD.),which is made from 1.0 to 1.5 mm silicone rubber material, then according to the need to choose the right size and length for standby. Healthy female 3 mon-ths chicken only 25, 2.0 + /- 0.2 kg weight, uniform number, each chicken’s r-ight and left foot were randomly divided into: the control group(group A), th-e experimental group(group B), and mark them. And then make unified num-bering again, every large group of animals were randomly divided into 2 w, 4 w 6 w, 8 w and 10 w group. All chicken’s third toe both right and left line fle-xor tendon sheath damaged production of flexor tendon sheath damage model, after the group A mold build directly to 5/0 nylon thread suture, group B afte r building placement silicone article tendon model alternative to 5/0 nylon thre a-d suture after tendon injury, double side outside the hind legs are not fixed. D-aily small amplitude passive flexor movement after postoperative 24 h, 3 to 5 times / time, 2 to 4 times daily, after the completion of the training throw them-back-to-free-cages.After 2 weeks, 4 weeks, 6 weeks, 8 weeks and 10 weeks respectively random kill 5 chickens(remember to do the group A2, B2 res-pectively, A4, B4 and A6, B6, A8, B8 and A10, B10), observe the third toe fl exor tendon in general form(groups of different period of tendon healing, fals-e sheath formation and adhesion), then the shape of the counting and fibroblasts.【Results】 1.Anatomic gross morphologyAll experimental animals of the third toe are healing good, no obvious swelling,and there is no infection and wound dehiscence in their local and deep body.Group A: 2 weeks postoperatively, tendon tissue surrounding has hyperemia and edema, but no obvious adhesion tendon; Postoperative 4 weeks soft tissue reaction, a large number of dense adhesion in tendons surrounding and the surrounding tissue is not easy to separate; Six weeks after operation, adhesion aggravate; And so as 8w,10 w after surgery.Group B: 2 weeks postoperatively, tissue reaction alike group A; Postoperative 4 weeks soft tissue reaction, silicone surface is completely surrounded by tissues surrounding and it formed the false scabbard, whose wall is very thick,there is clearance but no adhesion between sheath and the tendon; 6 weeks the silicone article surface false sheath is thicker than 4 weeks after operation; Postoperative 8 weeks sheath is a bit thin, smooth inner surface with a layer of thin, transparent membrane organization; After 10 weeks off sheath has no obvious change compared to postoperative 8 weeks.2.Adhesion situation Comparing the experimental group’s tendon adhesion and control group’s in different time points after surgery, 2 weeks after operation, experimental group adhesion score compared with the control group, P > 0.05,the difference was not statistically significant; after 4, 6, 8 and 10 weeks, the adhesion group score less than that of the control group, P < 0.05, the differences were statistically significant.3.Form under light microscopeGroup A: after operation, 2w can see a large number of granulation tissue hyperplasia from tendon around. Another two weeks later, inflammatory cells is fewer than before but tendons is repaired by mature collagen fiber, and tendon arrangement tend to be more orderly. Also, a great deal of connective tissue structure is visible in tendon surroundings. Six weeks tendon tissue surface still see inflammatory cells infiltration, collagen fibers increase from the previous, 8, 10 weeks tendon around is connective tissue that consists of collagen fiber and small blood vessels without false sheath structure. Group B: after surgery, 2 weeks later, end inflammatory response obviously, visible tendon outer membrane cell hyperplasia transitions to the silicone surface of a tendon model, and tendon model with a few foreign body giant cells around; Another two weeks later,inflammation has clearly, plenty of new fiber is arranged in the tendon beam direction, and there are still a few foreign body giant cells around the tendon model. False sheath formation, sheath surrounding tendons model wall is composed of cells layer and outer layer, cell layer of 2 ~ 5 layers of endothelial cells.While the other contains blood vessels and parallel to the surface to the outer cell layers of fiber, fiber scattered between cells, and macrophages in the successful fibers; The sixth week collagen fiber mature and arrange orderly around tendon model; 8 weeks sheath grows thin, fiber content between the cells in the stroma decreased significantly, false sheath has1 ~ 3 layers of endothelial cells, and foreign body giant cells around the tendon model is very little. 10 weeks sheath thickness has no significant change compared to eight weeks, and false sheath lining sample still have 1 ~ 3 layers of endothelial cells.4Fibroblast count 2,4, 6, 8, 10 weeks postoperatively, the experiment of fiber cell count is l ess than the control group, P < 0.05, all the differences were statistically signi ficant.【Conclusion】 Using silicone article flexor model combing passive motion forming a "false sheath" is feasible. |
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