FLEXOR TENDON: RESTORATION OF THE GLIDING SURFACE

最近的研究表明，结缔组织的愈合反应 组织受物理力量的影响很大。一个特别的问题 在指屈肌腱中发现了显著的功能反应。 我们实验室的研究表明，对 指屈肌腱早期松动初步修复，包括 增加力量和漂移，指角旋转，腱周围 血管重塑、修复部位和鞘DNA含量的比较 延迟动员和固定对照。贫困的频繁发生 一期和二期屈肌腱移植后的手指功能 激发了对术后保护性早期活动的新兴趣。我们的 假说是自体屈肌腱移植愈合，不相关 滑膜粘连向内生长，是由早期受控运动刺激的。 此外，愈合反应是供体组织特有的 滑膜内屈肌腱供体表现出更大的细胞存活率和 与滑膜外伸肌腱供体相比，胶原合成增加。我们 建议对自体肌腱移植进行相关机构的重建 肌腱旁路功能在自体移植物转化阶段(无血管 坏死、血运重建、细胞增殖和重塑)。 粘连血管重建术，仅适用于固定化自体 移植物，导致结构上的修复相比于 移植物很早就被动员了。内在的修复过程，依赖于细胞 自体移植后的存活和增殖性鞘反应 固定的。这项提案的目标是确定具体的 自体屈肌腱在无滑膜情况下愈合的方式 在早期被动运动条件下，鞘粘连向内生长。这个 自体屈肌腱移植物的滑面和滑膜将 以形态、生化和生物力学为特征的 技巧。

Recent studies have demonstrated that the healing response of connective tissue is influenced dramatically by physical forces. A particularly striking functional response has been noted in digital flexor tendons. Studies in our laboratories have shown a variety of favorable responses to early mobilization of digital flexor tendons repaired primarily, including increased strength and excursion, digital angular rotation, peritendinous vascular remodeling, and repair site and sheath DNA content compared to delayed mobilized and immobilized controls. The frequent incidence of poor digital function following one- and two-stage flexor tendon grafts has stimulated a new interest in postoperative protected early motion. Our hypothesis is that autogenous flexor tendon graft healing, not associated with synovial adhesion ingrowth, is stimulated by early controlled motion. In addition, the healing response is donor tissue specific with intrasynovial flexor tendon donors exhibiting greater cellular survival and increased collagen synthesis than extrasynovial extensor tendon donors. We propose that tendon autografts treated by reinstitution of the relevant function of tendon bypass the stages of autograft transformation (avascular necrosis, revascularization, cellular proliferation, and remodeling). Revascularization by adhesions, applicable only to immobilized autogenous grafts, leads to repair that is structurally inferior when compared to grafts mobilized early. The intrinsic healing process, relying on cellular survival and proliferative sheath response when the autograft is immobilized. The objective of this proposal is to determine the specific manner by which flexor tendon autografts heal in the absence of synovial sheath adhesion ingrowth under conditions of early passive motion. The flexor tendon autografts' gliding surface and synovial sheath will be characterized using morphological, biochemical, and biomechanical techniques.