背景:肌腱周围粘连是手部肌腱修复的最常见并发症,通常需要手术干预,导致劳动力损失增加,治疗成本增加。在动物模型中用于减少肌腱粘连的许多药物,然而,这些药物尚未进入临床应用。这项研究是有史以来的第一项临床研究,该研究评估了以胶原片作为抗粘连屏障的环绕肌腱修复部位。
方法:2014年12月至2020年1月,本研究纳入156名患者,在屈肌腱区2处切割干净的孤立指屈肌腱(FDP)肌腱损伤。所有肌腱都用改良的双凯斯勒技术修复。在76名患者中,肌腱修复部位周围有胶原片。从我们的临床记录中随机选择80例患者,并将功能结果与Strickland的总主动运动分级系统进行比较。
结果:对照组的平均总运动范围为79%,胶原片组为81%,两组间差异无统计学意义(Z:-1.393,p=0.164)。在对照组中,根据Strikland分类,非常好和良好的修复为65/80(81%)。在胶原片组中,是62/76(82%),分别。胶原片与对照组的5个FDPTAM测量值之间存在统计学差异(t(35)=0.29,p=0.016,p<0.05)。胶原片组5个FDP肌腱的平均TAM:83.8(SD:8.2),对照组76.1(SD:9.5)。
结论:在文献中第一次,报告了清洁切断肌腱损伤患者使用胶原片修复2区屈肌腱的功能结果。然而,对照组和胶原片组的总主动运动无统计学差异,第5例胶原片环绕的FDS肌腱修复效果较好。建议在具有高粘连风险的患者组中进行前瞻性研究。
BACKGROUND: Peritendinous adhesion is the most common complication of tendon repairs in the hand and often requires surgical intervention, resulting in increased labor loss and increased treatment costs. Many agents used to reduce tendon adhesion in animal models, however these agents have not entered clinical use. This
study is the first-ever clinical
study that evaluates encircling tendon repair site with collagen sheet as an anti-adhesion barrier.
METHODS: Between December 2014 and January 2020, 156 patients included in this
study, with clean cut isolated flexor digitorum profundus (FDP) tendon injury in flexor tendon zone 2. All tendons repaired with modified double Kessler technique. In 76 patients, tendon repair site encircled with collagen sheet. 80 patients were randomly selected from our clinical records and functional results are compared with Strickland\'s total active motion grading system.
RESULTS: The mean total range of motion was 79% in the control group and 81% in the collagen sheet group, and there was no statistically significant difference between the two groups (Z: - 1.393, p = 0.164). In the control group, very good and good repair according to Strikland classification was 65/80 (81%). In the collagen sheet group, it was 62/76 (82%), respectively. There was statistically significant difference between 5 FDP TAM measurements between collagen sheet and control group (t(35) = 0.29, p = 0.016, p < 0.05). The mean TAM of the 5 FDP tendons in the collagen sheet group: 83.8 (SD: 8.2) in the and 76.1 (SD: 9.5) in the control group.
CONCLUSIONS: For the first time in the literature, functional results of Zone 2 flexor tendon repair using collagen sheets in patients with clean cut tendon injuries reported. However, there were no statistical difference about total active motion between control and collagen sheet group, 5th FDS tendon repairs encircled with collagen sheets had better outcomes. Prospective studies in patient groups with high adhesion risk are recommended.