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

肌腱损伤后，修复后的肌腱周围形成大量瘢痕，导致肌腱活动受限、疼痛、肿胀等不良临床效果，但关于瘢痕形成机制的文献报道较少。本研究从组织学角度探讨了肌腱缝合后瘢痕的形成以及腱旁和腱外膜的作用。切断兔肌腱并缝合。右侧修复腱旁和腱外膜（修复组），左侧切除腱旁和腱外膜（切除组）。术后1、2、3、4周分别观察肌腱周围瘢痕形成情况。第1周时，两组均可见成纤维细胞和疏松结缔组织。手术切除组较手术修复组优势明显。2周时，切除组血管化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数量明显增多，修复组明显少于切除组。4周时与3周时无显著差异。因此，修复腱旁和腱外膜对减少瘢痕形成具有重要意义，人工腱鞘的研制是今后的研究方向。将腱旁和腱外膜的成纤维细胞培养在胶原膜上，并将其运输到缝合肌腱周围。如果这种方法能够建立，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.