课题背景：肌腱愈合以肌腱组织再生为主要过程，包括内源性愈合和外源性愈合。外源性愈合虽是肌腱发生粘连的主要原因，但在一定程度上也协助了肌腱的内源性愈合。理想的药物和方法应该在阻止外源性愈合的同时，还需要保证给内源性愈合以足够的营养。当归注射液具有活血化瘀、改善局部组织供血、增强组织修复和自愈能力的功效，安全可靠，疗效肯定。

应用要点：①实验于动物损伤的肌腱局部注射当归注射液，可以活血化瘀，增强损伤的肌腱组织修复和自愈能力；同时当归注射液可以直接供给损伤肌腱一定的营养，从而加快了肌腱的愈合，提高了愈合质量。②文章采用局部注射，与静脉给药相比，可使受损伤的肌腱局部药物浓度较高，作用更加直接有效，而且操作更为方便快捷，有利于临床应用。

偏倚或不足：实验仍存在许多亟待解决的问题，比如不同的药物浓度对成纤维细胞的抑制效果是否一样，药物浓度与其对肌腱愈合的促进作用以及对粘连的预防和改善作用存在怎样的关系等。


摘要
目的:肌腱断裂缝合术后粘连是常见的难题之一。观察当归注射液对吻合后的家兔肌腱愈合及其周围组织粘连的影响，探索一种防止肌腱粘连同时促进肌腱愈合的方法。
方法：实验于2005-10/2006-05在湖北中医学院中心实验室完成。①实验分组及方法：选用大耳白兔30只，制备肌腱吻合模型，造模后按随机数字表法分为3组（n =10）：当归注射液组每隔5 d于腱周注射当归注射液2.0~2.5 mL/只，连续4次；生理盐水组于腱周给予等量生理盐水；空白对照组不作特殊处理。②实验评估：术后2，4，6周，分别观察肌腱色泽、吻合处的愈合形态、腱内外膜增殖情况及胶原纤维生成和排列情况，并测定羟脯氨酸含量、吻合口抗张力强度、粘连范围及肌腱滑动度。
结果：30只白兔均进入结果分析。①肌腱愈合情况：当归注射液组术后肌腱色泽正常，术后2周腱外膜增厚并桥接吻合口两端，腱内膜亦开始增殖；4周后腱内膜明显增厚，胶原纤维增多并与腱长轴基本一致排列；6周后吻合口腱纤维排列整齐，与腱轴方向一致。术后2周各组羟脯氨酸含量、吻合口抗张力强度差异均无显著性意义（P > 0.05）；当归注射液组的吻合口抗张力强度、羟脯氨酸含量高于空白对照组、生理盐水组（P < 0.05~0.01），后两组差异无显著性意义（P > 0.05）。②肌腱粘连情况：当归注射液组术后2周肌腱开始膨大并渐增大，出现薄膜样粘连；4周膨大最为明显，吻合口间隙消失，6周吻合口膨大消失，粘连膜样消失，肌腱滑动度较大，腱外形恢复正常。术后2周各组肌腱滑动度、粘连范围差异均无显著性意义（P > 0.05）；术后4，6周当归注射液组的肌腱滑动度大于空白对照组、生理盐水组（P < 0.05~0.01），粘连瘢痕范围小于空白对照组、生理盐水组（P < 0.05~0.01），后两组差异无显著性意义（P > 0.05）。
结论：当归注射液局部应用可促进肌腱的内源性愈合，加快肌腱的愈合速度，提高愈合质量；同时可通过抑制外源性愈合，减少或防止肌腱的粘连。
关键词：当归；注射剂；腱损伤；伤口愈合；粘连；组织构建

王锋.局部注射当归注射液对肌腱断裂愈合及粘连的影响[J].中国组织工程研究与临床康复，2008，12(11):2083-2086 [www.zglckf.com/zglckf/ejournal/upfiles/08-11/11k-2083(ps).pdf]

Effect of angelica solution injection on tendon healing and adhesion

Abstract


AIM：Adherence of tendon is one of the difficulties after suture. This study observed the effect of angelica solution on the healing tendon after anastomosis in rabbits to find out a method to prevent the adherence of tendon and facilitate the healing of tendon.
METHODS: The experiment was performed at the Experimental Center of Hubei Traditional Medicine College from October 2005 to May 2006. ①Thirty big-eared white rabbits were made into models of tendon anastomosis, and then randomly divided into three groups (n =10): angelica solution group, which was injected with 2.0-2.5 mL solution for each animal every five days for four times; saline control group, which was injected with 9 g/L saline; blank control group, which was not given any treatment. ②Two, four and six weeks after operation, the color and luster of tendon, the healing condition in the stoma, the proliferation of tendon endometrium and adventitia, and the generation and arrangement of collagen fibers were observed. The content of hydroxyproline, tensile strength of tendon in the stoma, dimension of adhesion, and tendon gliding mobility were determined.
RESULTS: Thirty rabbits were all involved in the result analysis. ①The color of solution group was normal; two weeks after operation, the epitendineum thickened and bridged the two tips of stoma, and the endometrium also proliferated; 4 weeks later, the endometrium thickened apparently, and the collagen increased and arrayed approximately along the normal tendon cells; 6 weeks later, the tendon fiber lined up in order, and coincided with the axis of tendon. Two weeks after operation, there was no significant difference in the content of hydroxyproline and the tensile strength among the groups (P > 0.05); in 4 and 6 weeks, the content of hydroxyproline and the tensile strength in solution group were significantly higher than in control group and saline group (P < 0.05-0.01), but there was no difference between the control group and saline group (P > 0.05). ②The tendon of solution group began to expand and enlarge gradually 2 weeks after operation, presenting film-like adhesion; in 4 weeks, the expansion became the largest, and the interspace between the stoma disappeared; in 6 weeks, the expansion of the stoma and the adhesion disappeared, the tendon had more gliding mobility, and the contour of tendon recovered normal. In 2 weeks, the gliding mobility of tendon and the adhesion dimension had no marked difference among the groups; in 4 and 6 weeks, the gliding mobility of tendon was significantly larger (P < 0.05-0.01) but the adhesion dimension smaller (P < 0.05-0.01) in solution group than the control group and saline group. No significant difference was found between the control group and saline group (P < 0.05).
CONCLUSION: The local application of angelica solution can facilitate the endogenous healing of tendons, accelerate the healing and improve healing quality. Moreover, it can resist the exogenous healing, and decrease or prevent the adherence of tendons.

Wang F.Effect of angelica solution injection on tendon healing and adhesion.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(11):2083-2086(China) [www.zglckf.com/zglckf/ejournal/upfiles/08-11/11k-2083(ps).pdf]