FLEXOR TENDON--RESTORATION OF THE GLIDING SURFACE

最近的研究表明，结缔组织的愈合反应 组织受到物理力的显著影响。 一个特别 在指屈肌腱中已经注意到显著的功能反应。 我们实验室的研究表明， 指屈肌腱的早期活动主要修复，包括 强度和偏移增加，手指成角旋转，腱周 血管重塑和修复部位和鞘DNA含量相比， 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 刺激了对术后保护早期运动的新兴趣。 我们 假设是自体屈肌腱移植物愈合，不相关 与滑膜粘连向内生长，是由早期控制运动刺激。 此外，愈合反应是供体组织特异性的， 滑膜内屈肌腱供体表现出更高的细胞存活率， 增加胶原合成比滑膜外伸肌肌腱供体。 我们 建议肌腱自体移植物通过相关的 肌腱旁路功能自体移植物转化阶段（无血管 坏死、血管再生、细胞增殖和重塑）。 粘连血运重建，仅适用于固定的自体 移植物，导致修复在结构上不如 移植物早期活动。 内在的愈合过程，依赖于细胞 存活和增殖鞘反应时，自体移植物是 无法动弹 本提案的目的是确定具体的 在没有滑膜的情况下，屈肌腱自体移植物愈合的方式 早期被动运动条件下鞘粘连向内生长。 的 屈肌腱自体移植物的滑动表面和滑膜鞘将 通过形态学、生物化学和生物力学 技术.

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.