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背景:自体肌腱移植治疗外伤后肌腱缺损存在机体再次损伤和取材局限的不足。碳纤维人工肌腱、人发肌腱等人工肌腱被证实也可进行移植,但其植入体内后存在着免疫排斥反应和生物力学强度的不适应。因此,开发新的人工肌腱替代物是目前需要解决的主要问题。目的:观察轴卷的猪小肠黏膜下层作为人工肌腱移植修补鸡左、右足第3趾2cm肌腱缺损,以及修补后的免疫排斥反应和生物力学适应性。设计:随机对照动物实验。单位:上海交通大学附属第六人民医院骨科。材料:12周Leghorn鸡45只,雌雄不限,体质量4.0～4.5kg。方法:实验于2002-09/2003-06在上海交通大学附属第六人民医院骨科完成。①将45只12周的Leghorn鸡随机分为3组。取自体移植组20只和猪小肠黏膜下层移植组20只鸡的左、右足第3趾,于中节趾骨处切断趾深屈肌腱并造成2cm的肌腱缺损模型。自体移植组缺损的肌腱进行原位缝合;猪小肠黏膜下层移植组缺损的肌腱用猪小肠黏膜下层进行修补;空白组5只,不作任何处理。②在肌腱移植术后3,6,9周进行组织形态学、移植免疫学、生物力学及功能恢复的测定。主要观察指标:①各组鸡手术趾大体观察及植入物光镜观察。②术前3d、移植后3d、1周、2周白细胞分类计数。③各组鸡生物力学测试及功能恢复试验结果。结果:45只鸡均进入结果分析。①术后9周时,肉眼下,猪小肠黏膜下层形态同正常肌腱已基本相同,光镜下,猪小肠黏膜下层上成纤维细胞沿长轴方向有序排列且出现胶原细胞外间质。②术后2周内,猪小肠黏膜下层移植组与自体移植组白细胞测量结果差异无显著性意义(P>0.05),表明猪小肠黏膜下层作为异种材料没有明显免疫排斥。③在生物力学测试中,猪小肠黏膜下层移植组在术后12周时生物力学强度要优于自体移植组[(22.22±0.90),(20.78±0.94),P<0.05]。④在功能恢复试验中,3组掌趾关节的活动度无明显差异(P>0.05),空白组的近节趾间关节活动度要优于猪小肠黏膜下层移植组及自体移植组[(21.0±1.6)°,(15.1±1.7)°,(16.0±2.1)°,P<0.05)。结论:猪小肠黏膜下层植入鸡体内后,没有发现有免疫排斥反应的迹象,可作为修复肌腱缺损的异种材料。
BACKGROUND: Autologous tendon transplantation for the treatment of post-traumatic tendon defects presents the problem of re-injury of the body and limitation of drawing. Artificial tendons such as carbon fiber artificial tendon, human hair tendon and other artificial tendons were also proved to be transplanted, but there is immune adaptability and biomechanical incompatibility after implantation. Therefore, the development of new artificial tendon substitutes is currently the main problem to be solved. OBJECTIVE: To observe the small intestine submucosa of axis roll as artificial tendon graft for repair of 2cm tendon defects in the third toe of chicken and right foot, as well as immune rejection and biomechanical adaptability after repair. Design: Randomized controlled animal experiments. SETTING: Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital. MATERIALS: 45 Leghorn chickens for 12 weeks, male or female, body weight 4.0-4.5kg. Methods: The experiment was performed at Department of Orthopedics, the 6th People ’s Hospital, Shanghai Jiao Tong University from September 2002 to June 2003. ① 45 12-week-old Leghorn chickens were randomly divided into 3 groups. The left and right third toe of 20 chickens in the autotransplantation group and 20 chickens in the small intestinal submucosal transplantation group were cut at the mid-toe phalanx toe flexor tendon and a 2cm tendon defect model. The tendons in the autograft group were sutured in situ. The defective tendon in the piglet intestinal submucosa transplantation group was repaired with the small intestine submucosa of the piglets. Five rats in the blank group received no treatment. ② The histomorphology, transplantation immunology, biomechanics and functional recovery were measured 3, 6 and 9 weeks after tendon transplantation. MAIN OUTCOME MEASURES: ① Gross observation of operation toe and observation of implant by light microscope in each group. ② preoperative 3d, 3d, 1 week, 2 weeks after transplantation leukocyte count. ③ chicken in each group of biomechanical testing and functional recovery test results. Results: All 45 chickens entered the result analysis. ① At 9 weeks after operation, the morphology of porcine small intestinal submucosa was almost the same as that of normal tendon. Under light microscope, the fibroblasts in the small intestine submucosa arranged orderly along the long axis and showed extracellular matrix extracellular matrix. ② Within 2 weeks after operation, there was no significant difference in leukocyte measurement between porcine intestinal submucous transplantation group and autologous transplantation group (P> 0.05), indicating that porcine intestinal submucosa had no obvious immunological rejection as a foreign material. (3) In the biomechanical test, biomechanical strength of porcine intestinal submucosa transplantation group was superior to autologous transplantation group at 12 weeks after operation ([22.22 ± 0.90], (20.78 ± 0.94), P <0.05]. ④ In the functional recovery test, there was no significant difference in mobility of the three groups (P> 0.05). The mobility of proximal interphalangeal joint in the blank group was better than that in the porcine intestinal submucous transplantation group and the autologous transplantation group [(21.0 ± 1.6) °, (15.1 ± 1.7) °, (16.0 ± 2.1) °, P <0.05). Conclusion: There is no evidence of immunological rejection after implanted into the small intestine submucosa of chicken, which can be used as a heterogeneous material to repair tendon defects.