Experimental Study on the Application of a Hydroxyapatite Artificial Tendon Sheath to Prevent Adhesions after Tendon Repair

用羟基磷灰石（Hap）或氧化铝陶瓷（Alm）制成的人工腱鞘对鸡屈肌腱2区撕裂伤周围粘连的形成进行了研究。在2区近端和远端滑轮之间切除屈肌鞘，在纤维骨隧道中创建一个窗口。切断深腱后，在缝合部位周围放置Hap或Alm鞘，然后固定3周。将结果与术后未使用陶瓷鞘的对照组以及Hap组与Alm组的结果进行比较。从生物力学和组织学两方面评估粘连形成。Hap组和Alm组肌腱活动度在各时间点均优于对照组。Hap和Alm鞘与肉芽组织或肌腱表面的粘附不牢固。术后3、6、12周组织学观察，陶瓷组肌腱表面包括肌腱缝合处均可见上皮样结构，去除陶瓷鞘后肌腱周围间隙扩大。该间隙的外缘衬有一层纤维细胞样细胞和胶原纤维，类似于新形成的腱鞘。术后12周Hap组肌腱与周围组织间隙较Alm组明显扩大。术后12周的组织学检查显示，Alm组新形成的纤维骨隧道内表面的瘢痕形成倾向于多于Hap组。在对照组中，观察到明显的腱周粘连。

The formation of adhesions around the lacerated flexor tendons in zone 2 was studied in chickens after using an artificial tendon sheath made of hydroxyapatite(Hap) or alumina ceramics(Alm). The flexor sheath was excised between the proximal and distal pulley in zone 2 to create a window in the fibro-osseous tunnel. After suturing the severed profundus tendon, an Hap or Alm sheath was placed around suture site followed by 3 weeks of immobilization. The results were compared with control in which no ceramic sheaths were used after operation and the results obtained from Hap group also compared with them from Alm group. Adhesion formation was assessed both biomechanically and histologically. The mobility of tendon in both Hap and Alm group was better than in control at all the periods studied. Hap and Alm sheath was not firmly adherent to either the granulation tissue or the surface of tendon. Histology at 3, 6, and 12 weeks in ceramics group revealed epithenon-like structure on the tendon surface including the tenorrhaphy site and a wide space around the tendon after ceramics sheath was removed. The outer margins of this space was lined by a layr of fibrocyte-like cells and collagen fibers resembling new formed tendon sheath. However, Hap group showed wider space between tendon and surrounding tissue than Alm group at 12weeks after operation. Histopathological findings at 12 weeks after operation revealed the tendency to more scar formation on the inner face of the new formed fibro-osseous tunnel in Alm group than in Hap group. In the cases of control, marked peritendinous adhesion were observed.