Expermental Study On Streptomycin Combined Slow-releasing Degradable Menbrane To Prevent Tendon Adhesion

Objective:Tendon injury is the common of clinical multiple injury. The healing process of tendon include of the intrinsic healing and the extrinsic healing after the tendon repair. Because the response of tendon intimal cell obviously slow that of tendon extimal cell, blood capillary of fibroblast hyperplasia from paratenon grow together the broken ends of tendon and tendon sheath, at same time, come into being cicatrical adhesion to affecting function of tendon. Therefore, it is a better way the prevent or decrease adhesion that some suitable measures are applied to make the tendon regeneration inside faster than the proliferation of peritendinous connective tissues. Many scholars focus on drug menbrane in studying of preventing tendon adhesion. Drug menbrane is provided with biocompatibility, uncytotoxicity, absorbability and penetrate into the position of injury. It is a better way to prevent peritendinous adhesion. Reseach object in this experiment is SD rat of injurying achilles`s tendon. The streptomycin combined slow-releasing degradable menbrane place the position of tendon injury, observe affecting streptomycin combined slow-releasing degradable menbrane to tendon healing. Investigate that streptomycin combined slow-releasing degradable menbrane affec intrinsic healing and the extrinsic healing of tendon in order to provide a safe and efficiency treatment of avoiding tendon adhesion for clinic.Method:1. Seventy-two SD rats were divided into groups A,B,C randomly(24 rats each group). In group A, sutured achiles tendon were encapsulated with streptomycin combined slow-releasing degradable menbrane; in group B, sutured achilles tendon were encapsulated with Vitamin C combined slow-releasing degradable menbrane; in group C, sutured achilles tendon were encapsulated with slow-releasing degradable menbrane without any drug.2. H.E. staining, Mallory staining, AgNO3 staining;3. Electrom microcope sample making;4. Ninety days later, macroscopic evaluate the tendon healing and extent of peritenon adhesion5. Ninety days later, histological evaluate tendon healing and extent of peritenon adhesion6. Determination of hydroxzylproline content 7. ultimate tensile strength assayResult:1. Macroscopic evaluation:In the experimental group(A group), tendon show features such as no combined slow-releasing degradable menbrane residual, smooth surface , no adhesion with tissues around, fine gliding. B group, tendon show features such as no combined slow-releasing degradable menbrane residual, rougy surface, immobilize gliding and firmed adhesion with tissues around. At 90 days postoperatively, peritendinous adhesion in the experimental group is significantly slighter than that in the B,C group(P<0.01).2. Histological evaluation: the fibroblast, collagen fibrils, the AgNO3 staining grains of vitamin C inside the tendon in the experimental group(A group) are much more than those B,C group. The peripheral tissue in group A almost remains the formal loose connective tissue, but it became dense connective tissue in groups B, C and grew into the tendon. The fibroblast, collagen fibrils, the AgNO3 staining grains of vitamin C around the tendon in group B are much more than those A group. Electron microscope show the fibroblast have active function collagen fibrils are thin and disordered in the A group. These structural changes in the A group are obviously much better than those in the B,C groups. 3. The content of hydroxyproline in the experimental group(A group) is much higher than that in the control group(B,C groups)(P<0. 01).4. At 90 days postoperatively, the ultimate tensile strength in group A was higher than those B and C, C group was higher than those B group(P<0.05).Discussion:Tendon adhesion after surgical repair refer to around tissue hyperplasia and invasion. Majority scholars think that the extrinsic healing are necssity process, adhesion is inevitable. Experiments comfirm that the intrinsic healing and the extrinsic healing are important and also essential during the process of tendon repair. It is the key to solving the problem that some suitable measures are applied to make the tendon regeneration inside faster than the proliferation of peritendinous connective tissues. In recent years internal and external scholars stress on the study of drug menbrane, such as lactic acid, 5-Fu, Sodium Hyaluronate for preventing tendon adhesion, in spite of achieving some success, those of drug menbrane have their limitations. At home the study of applying antibiotic combinated menbrane for avoiding tendon adhesion is less. So, this study assess an effect of streptomycin combined slow-releasing degradable menbrane applied topically on the tendon adhesion and the healing process, it is one of a better way to prevent tendon adhesion, it is worth of clinic spreading.The tendon healing depend on its nutriture and external enviromental condition. Vitamin C engage in collagen fibrils cell compounding collagen fibrils, lack of vitmin C, hydroxylase of forecollagen protein molecule can not complish, the forming collagen fibrils restrain, the vigor of fibroblast obviously decrease. Reducing concentration of vitamin C around tendon can lessen connective tissue hyperplasia and less grow into inside tendon. So it will promote intrinsic healing. This study reveal that as broad-spectrum antibiotic streptomycin can decrease concentration of vitamin C around tendon. We think that streptomycin possibly alter active eatate of hydronium in cell membranes, so, affect transportation of nutrient substance of cell and metaboliztion. Concentration of vitamin C around tendon reduce, lessen connective tissue hyperplasia, indirectly increase intrinsic healing. On the other hand, slow-releasing degradable menbrane as barrier prevent connective tissue to grow into inside tendon, promote intrinsic healing and avoid tendon adhesion and strengthen gliding. This will advance comeback of the tendon function.Conclusion:As biomembrane barrier, streptomycin combined slow-releasing degradable menbrane prevent connective tissue to grow into inside tendon and indirectly promote intrinsic healing ,therefore, avoid tendon adhesion. Secondly, streptomycin can decrease concentration of vitamin C around tendon, make the tendon regrneration inside faster than the proliferation of peritendinous connective tissues, in order to lessen or avoid tendon adhesion. Thirdly, the operation is simple, safety. It is an ideal treatment srategy to prevent peritendinous adhesion.