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

采用羟基磷灰石（Hap）或氧化铝陶瓷（Alm）人造肌腱鞘，研究了鸡屈指肌腱撕裂后2区粘连的形成。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。将切断的深肌腱缝合后，在缝合处周围放置Hap或Alm鞘，然后固定3周。结果与术后不使用陶瓷护套的对照组比较，Hap组与Alm组比较。从生物力学和组织学上评估粘连形成。在各个时间段，Hap组和Alm组的肌腱活动度均优于对照组。无论是肉芽组织还是肌腱表面，Hap和Alm鞘都不牢固粘附。陶瓷组3、6和12周组织学显示，去除陶瓷护套后，肌腱表面出现了类似上皮的结构，包括腱接部位和肌腱周围宽阔的空间。这个间隙的外边缘排列着一层纤维细胞样细胞和胶原纤维，类似于新形成的肌腱鞘。术后12周，Hap组肌腱与周围组织间隙明显大于Alm组。术后12周组织病理学检查结果显示，与Hap组相比，Alm组新形成的纤维骨隧道内表面瘢痕形成较多。在对照组中，观察到明显的腱鞘粘连。

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.