几种高分子生物材料屏障作用预防肌腱粘连的系统评价

目的:评价不同高分子生物材料预防肌腱粘连的安全性,分析不同高分子生物材料在预防肌腱粘连中对组织的损伤程度、毒副作用、对肌腱滑移功能的改善,是否影响肌腱愈合等方面的优缺点.方法:以计算机检索方法在检索中国期刊全文数据库中(CNKI:1990/2005)检索关于不同高分子材料预防肌腱粘连的临床研究与实验研究的随机对照实验,检索词为"肌腱粘连、生物材料、屏障".检索后对每项研究的资料结果进行提取、分析.结果:共有11项实验571例肌腱损伤患者、7 项建立肌腱损伤的动物模型的实验研究符合纳入标准,肌腱损伤术后采用高分子材料预防粘连减少外源性粘连生成率,随访结果显示应用高分子生物材料预防肌腱粘连,通过影响肌腱的内源性愈合及外源性愈合,难以在肌腱周围形成粘连带,可形成良好的周围环境,为早期控制被动活动建立基础,后期减少外源性粘连生成,改善肌腱滑移功能有良好结果,并且不影响肌腱愈合.结论:高分子生物材料屏障作用预防肌腱粘连具有很好的临床效果,特别透明质酸钠进行鞘内注射或局部置入,不仅对肌腱有营养作用,也具有润滑作用,其防止肌腱粘连的作用是肯定的.但由于纳入试验少,证据的强度不足,其他有效性指标和安全性,有待更多证据加以评价.

Barrier effects of various high polymer biomaterials on prevention of tendon adhesionA systemic evaluation

OBJECTIVE:To evaluate the safety of various high polymer biomaterials to prevent tendon adhesion,and analyze whether the improvement of injured degree,toxic and side effects,and slipping function of tendon can influence tendon healing.METHODS:A computer-based online search of CNKI was undertaken to identify randomized controlled articles about the effect of various high polymer biomaterials on tendon adhesion with the keywords of "tendon adhesion,biomaterials,and barrier" from 1990 to 2005.Retrieval data were then extracted and analyzed.RESULTS:Among 11 tests,there were 571 patients with tendon injury and 7 animal models with tendon injury,according to inclusion criteria.After surgery,high polymer biomaterials were used to prevent from adhesion and reduce exogenous adhesion incidence.Following-up results demonstrated that high polymer biomaterials which affected endogenous and exogenous healing of tendon might prevent from tendon adhesion,provide foundation for early controlling passive activity,reduce exogenous adhesion occurrence,improve moving function of tendon,and promote tendon healing.CONCLUSION:Barrier effect of high polymer biomaterials can well prevent from tendon adhesion in clinic,especially intrathecal injection or local injection of sodium hyaluronate has both trophic and lubricant actions in preventing from tendon adhesion.However,other effective indicators and safety need to be further studied due to less including tests and weak evidences.