FLEXOR TENDON HEALING

在所有工人的急性损伤中，有三分之一是上肢损伤，其中很大一部分是开放性损伤。 需要进行广泛肌腱手术的伤口。实验和临床研究报告说， 一期肌腱和肌腱与骨修复部位延长及粘连形成的临床观察 缝合，修复部位失效最多发生在修复后的前三周。近期 研究表明，修复的肌腱和韧带的生物环境的改变 通过给予生长因子可以导致与对照相比结构性能的改善。我们的 中心假设是选定的生长因子在中期的地点和时间交付 肌腱和肌腱与骨的实质性缝合，将促进细胞增殖和基质 合成，导致更坚硬和更强的修复。科学研究表明，生长因子 团注给药会引起组织和血清浓度的波动，影响不一致 在局部组织上。最近的报告描述了当使用生长因子时改善的结果 在手术修复后维持较长的时间间隔。我们假设小说的利用 提供持续释放增长因子的输送系统，延长其 通过早期修复阶段的有效性，将改善缝合的愈合性能 受控被动运动条件下肌腱和肌腱到骨的附着点 康复。根据初步研究的结果，在具体目标1和2中，我们将评估 血小板衍生生长因子-BB、碱性成纤维细胞生长因子和骨形态发生蛋白-2联合缓释系统的体外给药动力学 (AIM 1)和体内(AIM2)。在目标3和4中，我们将研究应用PDGF-BB和 碱性成纤维细胞生长因子对中间物质肌腱愈合的影响(Aim3)，BMP-2对植入部位愈合的影响(Aim4)，通过评估 修复组织的成熟度、强度和硬度。总而言之，这些研究将建立一个 通过刺激那些内在的细胞过程来改善愈合的生物学基础 细胞复制、新生血管、基质合成和组织重塑。他们将延长我们的 了解关键的早期康复阶段，并将为大多数人提供治疗方案 与肌腱损伤和修复相关的普遍临床问题。

One-third of all acute injuries in workers are to the upper extremity, a large percentage of which are open wounds requiring extensive tendon surgery. Experimental and clinical studies have reported a high ncidence of repair site elongation and adhesion formation following primary tendon and tendon to bone suture, with repair site failure occurring most frequently in the first three weeks following repair. Recent studies have demonstrated that an alteration of the biologicalenvironment of repaired tendons and ligaments by the administration of growth factors can lead to improved structural properties compared to control. Our central hypothesis is that the delivery of selected growth factors at the site and time of mid- substance tendon and tendon to bone suture, will enhance cellular proliferation and matrix synthesis, leading to a stiffer and stronger repair. Scientific studies have shown that growth factor delivery by bolus injection results in fluctuations in tissue and serum concentrations, with inconsistent effects on local tissues. Recent reports have described improved results when growth factor administration was maintained for a prolonged interval after operative repair. We hypothesize that the utilization of novel delivery systems that provide for the sustained release of growth factors, extending their effectiveness through the early stages of repair, will improve the healing properties of sutured tendons and tendon to bone insertion sites under conditions of controlled passive motion rehabilitation. Based on results from preliminary studies, in specific Aims 1 and 2 we will evaluate the kinetics of administration of PDGF-BB, bFGF, and BMP-2 coupled with a sustained delivery system in vitro (Aim 1) and in vivo (Aim2). In Aims 3 and 4, we will study the effects of administration of PDGF-BB and bFGF on mid-substance tendon healing (Aim3), and BMP-2 on insertion site healing (Aim4), by assessing the maturity, and the strength and stiffness of the repair tissue. Taken together, these studies will establish a biological basis for improved healing through the stimulation of those intrinsic cellular processes that lead to cell replication, neovascularization, matrix synthesis, and tissue remodeling. They will extend our understanding of the critical early stages of healing and will provide therapeutic solutions for the most prevalent clinical problems associated with tendon injury and repair.