【摘要】：目的 肌腱粘連是肌腱手術(shù)后最常見(jiàn)的致殘?jiān)蛑�。預(yù)防肌腱粘連是肌腱修復(fù)手術(shù)后面臨的一個(gè)重大挑戰(zhàn)。本實(shí)驗(yàn)旨在利用大鼠跟腱損傷模型，研究在手術(shù)修復(fù)損傷肌腱中應(yīng)用膠原膜包裹受損肌腱對(duì)肌腱愈合強(qiáng)度、愈合質(zhì)量以及預(yù)防肌腱粘連發(fā)生的作用，探討其臨床運(yùn)用的可行性。 方法 切斷60只雄性Sprague-Dawley大鼠（250±18克）雙側(cè)后肢跟腱共120條，改良Kessler’s法進(jìn)行手術(shù)縫合。按隨機(jī)對(duì)照原則分為空白對(duì)照組（G1，切開(kāi)皮膚分離軟組織但未切斷肌腱，n=40）、手術(shù)組（G2，肌腱切斷后單純縫合，n=40）、膠原膜治療組（G3，肌腱切斷，手術(shù)縫合并包裹膠原膜，n=40）。每組隨機(jī)分為2組，分別于術(shù)后四周及八周處死大鼠，取得肌腱，進(jìn)行大體觀察評(píng)價(jià)、生物力學(xué)評(píng)價(jià)、組織學(xué)切片HE染色及免疫組織化學(xué)方法染色分析。 結(jié)果 大體觀察評(píng)價(jià)分析顯示膠原膜治療組比手術(shù)組肌腱粘連程度顯著降低。 生物力學(xué)測(cè)試結(jié)果顯示：術(shù)后4周，手術(shù)組與膠原膜治療組肌腱平均最大張力比對(duì)照組降低（p0.05），但膠原膜治療組相比手術(shù)組增高（p 0.05）。術(shù)后8周，膠原膜治療組的最大張力相比手術(shù)組增高（p 0.05），膠原膜治療組的最大張力與對(duì)照組無(wú)顯著性差別（p0.05）。 HE染色組織學(xué)觀察結(jié)果：術(shù)后4周，手術(shù)組見(jiàn)瘢痕組織。膠原膜治療組肌腱膠原纖維束排列不規(guī)則，但更密集，且線性排列方式優(yōu)于手術(shù)組。術(shù)后8周與術(shù)后4周相比，手術(shù)組和膠原膜治療組的修復(fù)更成熟，膠原蛋白基質(zhì)更密集，膠原纖維束規(guī)則排列，總膠原基質(zhì)的面積更寬。術(shù)后8周，，膠原膜治療組的膠原基質(zhì)總面積超過(guò)手術(shù)組。術(shù)后8周在手術(shù)組部分區(qū)域發(fā)現(xiàn)有骨化形成。 Ⅰ型膠原、Ⅱ型膠原的免疫組織化學(xué)染色結(jié)果顯示：術(shù)后8周膠原膜治療組和手術(shù)組Ⅰ型膠原的表達(dá)均略強(qiáng)于相應(yīng)組術(shù)后四周；術(shù)后4周和8周，膠原膜治療組分別都比相應(yīng)手術(shù)組有顯著強(qiáng)表達(dá)的Ⅰ型膠原蛋白（p 0.05）。 手術(shù)組在術(shù)后4周或8周都可觀察到Ⅱ型膠原的棕色染色，但在術(shù)后8周時(shí)較多。術(shù)后4周和8周的Ⅱ型膠原表達(dá)，膠原膜治療組均比手術(shù)組弱（p0.05）。 結(jié)論 用膠原膜包裹損傷肌腱相比于無(wú)包裹的損傷肌腱愈合更好，粘連程度降低。
[Abstract]:Objective tendon adhesion is one of the most common causes of injury after tendon surgery. Preventing tendon adhesion is a major challenge after tendon repair. The purpose of this study was to study the effect of collagen membrane on tendon healing strength, healing quality and prevention of tendon adhesion, and to explore the feasibility of clinical application of collagen-coated tendon in the repair of tendon injury in rats using the model of Achilles tendon injury in order to study the effect of collagen-coated tendon on tendon healing strength, healing quality and prevention of tendon adhesion. Methods 120 Achilles tendons of 60 male Sprague-Dawley rats (250 鹵18 g) were amputated and sutured by modified Kessler's method. According to the principle of random control, they were divided into blank control group (G1), operation group (G2), collagen membrane treatment group (G3, tendon amputation, surgical suture and encapsulation of collagen membrane). Each group was randomly divided into two groups. The rats were killed at four and eight weeks after operation. The tendons were obtained, the gross observation and evaluation, biomechanical evaluation, HE staining of histological sections and immunohistochemical staining were carried out. Results the gross observation and evaluation showed that the degree of tendon adhesion in collagen membrane group was significantly lower than that in operation group. The results of biomechanical test showed that the mean maximum tension of tendon in the operation group and collagen membrane treatment group was lower than that in the control group (p0.05), but the collagen membrane treatment group was higher than that in the operation group (p0.05). At 8 weeks after operation, the maximal tension of collagen membrane treatment group was higher than that of the operation group (p 0. 05). There was no significant difference between the collagen membrane treatment group and the control group (p0. 05). HE staining histological observation: at 4 weeks after operation, scar tissue was found in the operation group. The collagenous fibers in the collagen membrane group were irregular, but more dense, and the linear arrangement was better than that in the operation group. After 8 weeks compared with 4 weeks after operation, the repair of the operation group and collagen membrane treatment group was more mature, collagen matrix was more dense, collagen fiber bundle arranged regularly, the area of total collagen matrix was wider. At 8 weeks after operation, the total area of collagen matrix in the collagen membrane treatment group was larger than that in the operation group. 8 weeks after operation, ossification was found in some areas of the operation group. The immunohistochemical staining results of type 鈪

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