Experimental Study of Artificial Tendon Sheath Using Synovial Cell and Collagen Membrane

肌腱损伤后，修复肌腱周围大量瘢痕形成，导致肌腱活动受限、疼痛、肿胀等临床效果不佳，但有关瘢痕形成机制的文献较少。本研究对缝合的肌腱周围的瘢痕形成以及副腱膜和外膜的作用进行了组织学研究。切断缝合兔肌腱。右侧修复旁、外膜(修复组)，左侧切除(切除组)。术后1周、2周、3周、4周取材，组织学观察肌腱缝合处瘢痕形成情况。术后1周，两组均可见成纤维细胞和疏松结缔组织。切除组明显高于修补组。术后2周，切除组的血管形成和细胞浸润明显多于修复组。术后3周，切除组缝合肌腱周围胶原纤维较修复组明显增多。术后4周与术后3周比较，差异无统计学意义。因此，修复腱旁和腱外膜对于减少瘢痕形成具有重要意义。我们未来的研究项目是人工腱鞘的研制。我们将肌腱旁和外膜的成纤维细胞培养在胶原膜上，并将它们运送到缝合的肌腱周围。如果建立这一程序，将有助于肌腱和韧带手术后的临床效果。

When tendons were injured, massive scar fomation around the repaired tendon caused poor clinical results, such as limitation of range of motion, pain, swelling, etc. But there are few literature about the mechanism of scar formation. Scar formation around the sutured tendon and the role of paratenon and epitenon were investigated histologically in this study.Bilateral Achilles! tendons of rabbits were cut and sutured. On the right side, paratenon and epitenon were repaired (repaired group) , and on the left side, they were resected (resected group). Scar formation around the sutured tendon was investigated histologically at 1, 2, 3, 4 weeks after the operation. At I week, fibroblasts and loose connective tissue were recognized in both groups. They were dominant in resected group than in repaired group. At 2 week, vascuralization and cellular infiltration were dominant in resected group than in repaired group. At 3 weeks, the amount of collagen fiber has increased around the sutured tendon much more in resected group than in repaired group. At 4 weeks, there was no remarkable difference with at 3 weeks. Therefore, repairing of paratenon and epitenon is important to reduce scar formation.Our future study project is the development of artificial tendon sheath. We will culture fibroblasts from paratenon and epitenon on collagen membrane, and transport them around the sutured tendon. If this procedure will be established, it will contribute to the clinical result after tendon and ligament surgery.