| Objective: Tendon injury is a common injury in the department of hand surgery. The postoperative recovery of hand function is always affected by tendon adhesion after tendon repair. To prevent tendon adhesion, especially the adhesion after flexor tendon repair is always the key in the rehabilitation of hand surgery. Our topic group introduced flexor tendon injury Leghorn chicken model and applied postoperative tropical decimeter wave therapy after tendon repair to analyze and investigate the mechanism of decimeter wave in the prevention of postoperative tendon adhesion and promotion of tendon healing through biomechanical techniques, which was to provide a theoretical basis for clinical application.Methods: Totally 68 healthy male white 6-month Leghorn chickens with bodymass of (2.24±0.072) kg were randomly divided into A group (decimeter wave therapy after operation group),B group (sodium hyaluronate product,SHP, therapy in operation group) and C group (control group) with 22 chickens , D group (normal group) with 2 chickens ,each by lot drawing method.The III and IV toes of both feet in the selected Leghorn chickens were employed for the establishment of tendoninjury model. Bruner skin incision centered the proximal interphalangeal joints of the toe was selected, and modified Kessler infra-tendon suture was made at 3 mm of the distal Camper cross of flexor digitorum superficialis under unbend position of interphalangeal joints by 5 - 0 nylon non-traumatic seam. And 7– 0 non-traumatic seams were used for the serial suture of the peritendinous and epitenon suture. SHP was partly applied in chickens of B group in operation.Gypsum support was applied and fixed by adhesive plaster after operation when the talocrural joint was in 900 of plantar flexion, mewarsophalangeal joint was in 900 of flexion, and interphalangeal joints were in unbend position. The operative sites of the III and IV toes were exposed. The external fixation was removed after 3 weeks and the chickens then had free activity. Decimeter wave therapy was applied in chickens of A group since day 1 to week 3 after operation with frequency of 915 MHz, power of 8 W, and radiation distance of 10 cm once a day and 10 minutes each time. Physiotherapy was applied in chicken of the B and C group beside micro-thermotherapy machine at the same time when chickens of A group received decimeter wave therapy. Two chickens of A,B or C group were randomly selected for execution at 7,14,21,28 days postoperation, The III toes repaired tendons and tendon adhesions were examined Macroscopically,and after Macroscopically examnation the tissue blocks from tendons repair site at 14,28 days postoperation were examined by transmission electron microscopy. Two chickens of A,B or C group were randomly selected for execution at 7,14,21,28 days postoperation, the IV toes of both feet repaired tendons and tendon adhesions were examined histologically. Two chickens of A,B or C group were randomly selected for execution at 1,7,10,14,18,21,28 days respectively for the biomechanical analysis. Two chickens of D group were executed at frist analysis for normal tendon gliding distance M. Observation biomechanical parameters of every experimental group at difference time , Biomechanical parameters including: Tensile strength of rupture(Pmax),Tensile power of rupture(Wmax),Elongation ratio of rupture(δmax) and Tensile power of adhering zone rupture(W0).Results: Peritendinous adhesions in A,B group were looser, and tendons healing status was better as compared with the C group by macroscopic and histological observations at 7,14,21,28 days postoperation. Electron microscopy revealed more fibroblasts with active metabolism and more collagen formation in A,B group than in C group. Biomechanical analysis:Tensile strength of rupture(Pmax): In the 7th, 10th,14th,18th,21st and 28th day after operation, the difference of Pmax between A, B group and C group has statistical significance by LSD-t test (P<0.05). The results of A, B group are higher than that of C group. In 14th and 18th day, there is also significant difference between A and B group (P<0.05), A group is higher than B group.Tensile power of rupture(Wmax): In the 7th, 10th,14th,18th,21st and 28th day after operation, the difference of Wmax between A, B group and C group has statistical significance by LSD-t test (P<0.05). The results of A, B group are higher than that of C group. In 18th and 21st day, there is also significant difference between A and B group (P<0.05), A group is higher than B group.Elongation ratio of rupture(δmax) : In the 7th, 10th,14th,18th,21st and 28th day after operation, the difference ofδmax between A, B group and C group has statistical significance by LSD-t test (P<0.05). The results of A, B group are higher than that of C group. In 18th and 21st day, there is also significant difference between A and B group (P<0.05), A group is higher than B group.Tensile power of adhering zone rupture(W0): In the 7th, 10th,14th,18th,21st and 28th day after operation, the difference of W0 between A, B group and C group has statistical significance by LSD-t test (P<0.05). The results of A, B group are lower than that of C group. In 18th ,21st and 28th day, there is also significant difference between A and B group (P<0.05), A group is lower than B group.Conclusions:Topical decimeter wave therapy after flexor tendon repair can increase local blood circulation, reduce local edema, and shorten in-flammatory process. And then the healing speed and time become fast, decimeter wave promote intrinsic healing; it can prevent the adhesion of tendon,reduce extrinsic healing. Meawhile decimeter wave therapy can make functional training as early as possible.Decimeter wave therapy can improve the qualities of tendon's wound healing,decrease the time of emolliate and the possibility of rupture again, inerease the time and dependablity of utility than Topical admoved SHP .Decimeter wave therapy is one of the best method of the tendon healing was accelerated and the accretion was inhibited.Decimeter wave therapy can be used widely with the clinical study. |
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