| Objective: By observing flexor tendon adhensive,tensile test and related pathological examination by used of tube intermittent application of sodium hyaluronate in paratenon on experimental rabbit model of the second and third toe in the right hind leg,and evaluate the efficiency and safety of preventing the adhesion of flexor tendon without peritendineum by intermittent application of sodium hyaluronate through the installing tube in paratenon.Method: Fifty-four healthy white New-Zealand rabbits(4-6months old,3-3.5kg,27 male and 27 female)were randomly divided into three group: control group(group A),single-dose group(group B)and intermittert application group(group C).For each group on the second and third toes of the right hind leg of experimental rabbits were used and each group has 36 toes.In each group,the flexor tendon of the second toe at the proximal phalanx level was transected and the peritendineum was removed.The transected tendon was repaired with the modified Kessler's method.In group A,the wounds were closed directly.In group B,single dose sodium hyaluronate was locally applied around the tenorrhaphy site before wound closure.In group C,24# closed venous indwelling needles were used for installing the tube into the paratenon close to the repaired tendons,0,2ml sodium hyaluronate gel(15mg/ml)was transfused into it through the indwelling needles,And sodium hyaluronate was spread around the flexor tendon through the tube.In each group,the right legs used for the experiment were splinted for 3 weeks after surgery.In group C,the tube was retained in 72 hours,and sodium hyaluronate was transfused into around the repaired tendon once a day.6 rabbits in each group were sacrificed at 2nd,4th,8th week after surgery.Biomechanics tests(Tension test and Slide distance test),gross observation and histological observations were used as measures in evaluation.Result:(1)Gross observation: in group B & C,peritendineum defect area came into “false peritendineum” as time goes on,and the tendons have good shape and smooth surface.There is only a little adhesion with the toe superficial flexor tendons,easily to be separated.However,group A at the site of repaired tendons,there were some adhesion with medium density surrounding tissue,with wide range and it is difficult to be separated between them.The adhesion level has statistically difference(P?0.05)at 2nd and 8th week,but there is not statistically difference at 4th week(P?0.05).(2)Histological observation: as time went on,Group B and C,the gap between tendon and the surrounding was gradually clear,there was not significant inflammatory cell infiltration with the mature fiber cells and collagen fibers configuration lined up orderly.However,group A,the gap between tendon and the surrounding was unclear,with more mature fiber cells and configuration lined up irregularly.(3)Biomechanical tests showed: 1)Sliding distance ratio: there is statistically difference(P?0.05)in respectively at 2nd week,4th week,and 8th week.However,the comparison between groups the result showed that at both 2nd week and 4th week,the sliding distance ratio in group C is better than in group B,but there is not statistically difference(P?0.05.However,at 8th week there is statistically difference(P?0.05)between group A and group B,and between group A and group.There is statistically difference(P?0.05)among all groups.2)Tensile strength ratio: after the operation at 2nd week,4th week and 8th week,the tensile strength of these three groups increased gradually as time went on,but there is not statistically difference between groups(P?0.05).Conclusion: Intermittent application of sodium hyaluronate through the percutaneous tube in 72 hours after tendon repair,compared to single dose sodium hyaluronate,has better effect with less tendon adhesion and without affecting the tensile strength. |
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