| Objective:Zone? flexor tendon injuries are very common in hand surgery.Because of the fine and complex of the flexor tendon and its adjacent structures zone?,it is difficult to repair.After the surgery,the complications such as tendon adhesion,tendon rupture,joint stiffness and so on are very common.Among them,the tendon adhesion seriously limits the recovery of hand function.Patients often need ? period surgery for the treatment of tendon release,which increase the patient's pain and burden,and became a difficult problem to be solved.Tendon healing way includes endogenous and exogenous healing ways,Endogenous healing refers to the tendon cells has the potential ability to repair itself,the cells from tendon directly involved in the repair process,which can avoid the happening of tendon adhesion.Exogenous healing refers to the tendon repair rely on granulation tissue from tendons surrounding tissue.At the same time,scar tissue adhesion formation between tendon and tendons surrounding tissue.Scar adhesion seriously limits the tendons of sliding,the recovery of hand function.So how to avoid the tendon exogenous healing,promote tendon endogenous healing,become the key to prevention of tendon adhesion.A lot of basic and clinical investigation has been carried out by experts,although many methods of prevention of adhesion get a positive progress in the study,but the postoperative tendon adhesion problem still tricky in the zone? flexor tendon repair.Over a long period of time,the scholars domestic and international research find that Amniotic membrane has the following advantages:smooth,soft,good permeability,good plasticity and no antigenicity,don't contain blood vessels and lymphatic vessels,don't produce rejection,etc.Amniotic membrane is an ideal biological anti-adhesion materials.Amniotic membrane is widely used in acute,ophthalmology,gynecology,obstetrics,and other fields,which achieved good clinical effect.This study aims to confirm the biological amniotic membrane to prevent zone? flexor tendon repair clinical application effect of postoperative tendon adhesion,for clinic provide a simple,safe and effective method to prevent zone? flexor tendon adhesion.Methods:According to principles of randomized controlled,the 14 cases of acute flexor tendon of hand injuried patients,who were treated in The third hospital affiliated to hebei medical university,From October 2014 to June 2016,were divided into two groups:the Test Group and the Control Group,14 patients in each group.In the same operation conditions,the Test Group used the Amniotic membrane to wrap the anastomotic after flexor tendon suture;the Blank Control Group used nothing.There were 8 cases with neurovascular injury among the 14 cases of 36 tendons in Test Group,and 7 cases among the 14 cases of 37 tendons in Control Group.The injuried tendons were sutured by Johnsons brand 3-0?5-0tendon suture with the double modified Kessler'S technique along with continuous paratenon suturing,postsurgical conventional anti—inflammatory and detumescence treatment.A1 l patients are fixed limb position on the tendon relaxation by plaster,wrist palmar flexion 200-300,the metacarpophalangeal joint flexion 300-400,Interphalangeal joints straight,fixed for 4 weeks,after 4 weeks to remove the plaster and Gradually strengthen resistance exercise,but need to avoid hard,gradual recovery grip strength.All patients were in the same early rehabilitation exercise plan.Results:Two groups of patients with postoperative wound were primary healing,did not appear red and swollen,leakage and other severe inflammatory reaction.Postoperative follow-up time:16 weeks after surgery.100% of the patients were followed up.The status of the functional recovery of tendon were evaluated by the total active motion(TAM)system.The Test Group 14 patients with 36 flexor tendon in an integrated rate of 94.4% fine.The Control Group 14 patients with 37 flexor tendon in an integrated rate of 75.6%fine.By chi-square test,?2 for the 5.022,P value is Less than 0.05,between the two groups have statistical significance.Conclusion: Biological amniotic membrane is made of fresh amniotic membrane and keep the original organization structure of fresh amniotic membrane and the existing basic chemical composition.Biological amniotic membrane mainly include the epithelial cell layer and base layer.Basement membrane containing laminin,Fibronectin Fn,? type and V type collagen protein and some cell growth factors such as the epidermal growth factor,basic fibroblast growth factor and other ingredients.Biological amniotic membrane as a good mechanical barrier can avoid the tendon and tendon surrounding tissues direct contact,which can effectively prevent tendon surrounding tissues invasion.At the same time,biological amniotic membrane has good permeability,don't affect the exchange of nutrients in tendon healing.Biological amniotic membrane containing cell growth factors such as the epidermal growth factor,basic fibroblast growth factor,hepatocyte growth factor and other ingredients,which can promote tendon cells and fibroblasts growth and proliferation.Biological amniotic membrane can prevent leukocyte infiltration,inhibit a variety of proteases activity,which include Fiber protease,trypsin,collagen enzyme and so on.By suppressing the corresponding protease,thus reduce inflammation reaction degree,shorten the duration of inflammation and prevent new blood vessels and scar formation,adjust the repair of damaged tissue.Biological amniotic membrane for its smooth,soft features can be wrapped tightly tendon end,which reduced the tendon of the early rehabilitation exercise sliding resistance,further reduce the risk of tendon rupture.Biological amniotic membrane is a kind of ideal anti-adhesion material,can effectively prevent the formation of zone? flexor tendon injuries repair postoperative adhesion and has a good prospect of clinical application. |
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