Surface treatment of flexor tendon autografts with carbodiimide-derivatized hyaluronic Acid. An in vivo canine model.
Surface treatment of flexor tendon autografts with carbodiimide-derivatized hyaluronic Acid. An in vivo canine model.
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DOI：
10.2106/jbjs.e.00871
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发表时间：
2006-10
期刊：
影响因子：
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通讯作者：
Chunfeng Zhao;Yu-Long Sun;P. Amadio;Toshikazu Tanaka;A. M. Ettema;K. An
中科院分区：
文献类型：
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作者：
Chunfeng Zhao;Yu-Long Sun;P. Amadio;Toshikazu Tanaka;A. M. Ettema;K. An
临床和实验研究表明，在滑膜内环境下，滑膜外肌腱移植后，限制性粘连和手指运动不良是常见的并发症。本研究的目的是验证一种假设，即使用碳二酰亚胺衍生透明质酸明胶聚合物（cd-HA）对滑膜外肌腱进行表面修饰，可以改善犬模型肌腱移植后的滑动能力和数字功能。方法取24只犬双后爪腓骨长肌腱，移植1只前爪2、5指指深屈肌腱。植骨前，将腓骨长肌腱的一条涂覆cd-HA， cd-HA由1%透明质酸、10%明胶、0.25% 1-乙基-3-（3-二甲氨基丙基）盐酸碳二亚胺（EDC）和0.25% n -羟基琥珀酰亚胺（NHS）组成，另一条仅浸泡在生理盐水中。8只狗在1周、3周和6周时被杀死。屈曲、肌腱滑动阻力的数字归一化工作和透明质酸定量（透明质酸结合蛋白染色技术）是结果测量。结果cd-HA治疗组各时间点肌腱屈曲归一化功明显低于盐水治疗组（p < 0.05）。cd-HA组在第3周和第6周的滑行阻力显著低于盐溶液组（p < 0.05）。cd- ha处理后的肌腱染色强度与盐水处理后的肌腱染色强度之比在第0周显著高于第3周和第6周（p < 0.05），但在第0周和第1周之间无显著差异。结论：用碳二酰亚胺衍生透明质酸-明胶聚合物处理滑膜外自体肌腱移植体表面可减少屈曲功和肌腱滑动阻力。cd-HA明胶可为外科医生提高肌腱移植手术质量提供一种新的有效方法。
BACKGROUND Clinical and experimental studies have demonstrated that restrictive adhesions and poor digital motion are common complications after extrasynovial tendon grafting in an intrasynovial environment. The purpose of this study was to test the hypothesis that surface modification of an extrasynovial tendon with use of a carbodiimide-derivatized hyaluronic acid-gelatin polymer (cd-HA) improves gliding ability and digital function after tendon grafting in a canine model in vivo. METHODS The peroneus longus tendons from both hindpaws of twenty-four dogs were harvested and transplanted to replace the flexor digitorum profundus tendons in the second and fifth digits of one forepaw. Prior to grafting, one of the peroneus longus tendons was coated with cd-HA, which consists of 1% hyaluronic acid, 10% gelatin, 0.25% 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC), and 0.25% N-hydroxysuccinimide (NHS), while the other was immersed in saline solution only. Eight dogs were killed at one, three, and six weeks. Digital normalized work of flexion, tendon gliding resistance, and hyaluronic acid quantification (with the hyaluronic acid-binding-protein staining technique) were the outcome measures. RESULTS The normalized work of flexion of the tendons treated with cd-HA was significantly lower than that of the saline-solution-treated controls at each time-point (p < 0.05). The gliding resistance of the cd-HA group was significantly lower than that of the saline-solution group at three and six weeks (p < 0.05). The ratio between the intensity of staining of the cd-HA-treated tendons with that of the saline-solution-treated controls was significantly greater at time-0 than at three or six weeks (p < 0.05), but there was no significant difference between time-0 and one-week values. CONCLUSIONS Treating the surface of an extrasynovial tendon autograft with a carbodiimide-derivatized hyaluronic acid-gelatin polymer decreases digital work of flexion and tendon gliding resistance in this flexor tendon graft model in vivo. CLINICAL RELEVANCE cd-HA gelatin may provide surgeons with a new and useful method to improve the quality of tendon graft surgery.