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섬유소 접착제가 토끼의 손상된 아킬레스건 치유에 미치는 영향

Other Titles
 Effect of fibrin sealant on the healing process of ruptured achilles tendon in rabbit 
Authors
 이윤태 
Issue Date
1993
Description
의학과/박사
Abstract
[한글]아킬레스건 파열은 대부분 건 부착부의 2∼6cm 상방에서 불규칙한 형태로 발생되며 치료에 대해서 수술적 봉합과 비수술적 치료 사이에 논란이 많다. 정상 근육기능을 원하는 젊은 사람에 있어서는 수술적 봉합이 좋은 치료방법으로 권장되지만 불규칙한 형태로 파열된 건의 수술적 봉합은 수기상의 어려움과 함께 누공, 재파열, 주위 조직과의 유착을 일으키기도 한다. 이러한 점을 감안하여 비봉합방법으로 조직에 완전히 흡수되고 손상조직의 치유를 촉진시키며 조직관용이 좋은 생체물질의 필요성을 느끼게 되었다.

최근 신경접합, 피부이식, 골연골접합등에 생체조직 접착제를 이용한 연구가 진행되고 있지만 건손상의 경우에는 아직 거의 이용되고 있지 않으며 섬유소 접착제가 건손상 치유에 미치는 생역학 및 조직학적 영향은 아직 잘 알려져 있지 않다. 따라서 본 연구에서는

토끼의 아킬레스건을 절단후 섬유소 접착제가 아킬레스건 손상 치유과정에 미치는 생역학적 변화 및 조직학적 변화를 살펴보고자 하였다.

실험동물은 체중 2.0∼2.5Kg의 흰색 토끼 128마리를 사용하였으며, 아킬레스건을 절단후 치료방법에 따라 근접군, 섬유소접합군, 봉합군, 섬유소접합 및 봉합군으로 구분하였다. 수술후 1주, 2주, 4주, 6주째에 각 군별로 8마리중 5마리는 생역학적 검사, 3마리는 조직학적 검사를 통하여 건손상 치유를 관찰하여 다음의 결과를 얻었다.

1. 생역학적 검사상 최대부하는 수술 1주후 섬유소접합군, 봉합군, 섬유소접합 및 봉합군이 근접군보다 높았고, 섬유소접합 및 봉합군은 섬유소접합군보다 높았으며, 섬유소접합군과 봉합군간에 차이는 없었다. 수술 2주후 최대부하는 섬유소접합 및 봉합군이 근접

만 시킨 군보다 높았으며 섬유소접합군과 봉합군간에 차이는 없었다. 흡수에너지는 수술 1주후 섬유소접합 및 봉합군이 다른 군들보다 높았으며, 섬유소접합군과 봉합군간에 차이는 없었고, 섬유소접합군과 봉합군이 근접만 시킨 군보다는 높았다. 강성은 수술 2주후 근접만 시킨 군이 다른군들보다 낮았다.

2. 손상 복구건의 시간경과에 따른 유착정도는 수술 1주후 붕합군과 섬유소접합 및 봉합군이 근접군보다 심하였으며, 수술 2주후에는 봉합군이 섬유소접합군보다 심하였다.

3. 육안 소견상 근접군과 섬유소접합군에서는 접합부위에 곤봉모양의 비후가 관찰되지 않았다.

4. 조직학적 검사상 수술 1주, 2주후에는 섬유소 접착제를 사용한 군에서 망상 및 교원섬유가 더 많이 형성되는 것을 관찰할 수 있었다.

이상의 결과로 미루어 보아 섬유소 접착제로 아킬레스건 파열을 접합하는 경우, 수술 2주내의 초기에는 봉합하는 처치와 비슷한 물리적 특성을 가지는 것으로 판단되며 또한 충분한 양의 망상 및 교원섬유가 형성되는 것을 도울 뿐 아니라 주위 조직과의 유착을 감소

시키는 것으로 생각된다. 따라서 섬유소 접착제로 아킬레스건 파열을 접합하는 것은 치료방법의 하나로 이용될 수 있을 것으로 판단된다.



[영문]The site of Achilles tendon rapture occurs 2 to 6cm above the tendon insertion into the calcaneus and it comes in very irregular shapes. The treatment of Achilles tendon rupture is controversial between surgical repair and conservative treatment.

Although surgical repair is recommended as a choice of treatment among young men who need a powerful muscle function, but it is difficult to repair when it comes in the irregular forms. It also has several complications such as fistula, rerupture and adhesion to the adjacent tissues. In order to minimize such complications, the biomaterial which can be absorbed completely, enhances healing of injured tissue and has a good tolerance to host tissue is introduced.

Recently, many researches have been studied about nerve repair, skin graft and treatment of osteochondral fracture using fibrin sealant, but it has rarely been used in tendon repair. The biomechanical and the histological effects of fibrin sealant onto the tendon healing are not well estabilished. The purpose of this

study is to investigate the biomechanical and the histological effects of fibrin sealant on the healing process of the ruptured Achilles tendon in rabbits For this study one hundred and twenty eight white rabbits were used. After Cutting of Achilles tendon, they were divided into the 4 groups according to the

method of treatment; approximation group, fibrin sealant group, suture group and fibrin sealant with suture group. The animals were sacrificed at varying intervals of one, two, four and six weeks after the treatment and the specimens were prepared

for the biomechanical and the histological examinations. The following results were obtained.

1. On the biomechanical test, at one week after the operation the maximum loads of the fibrin sealant group, the suture group and the fibrin sealant with suture group were greater than that of the approximation group, and the maximum load of the fibrin sealant with suture group was greater than that of the fibrin sealant group. At two weeks after the operation the maximum load of the fibrin sealant with suture group was greater than that of the approximation group. There was no difference of maximum load at one and two weeks after the operation between the suture group and the fibrin sealant group. Atone week after the operation the

absorption energy was greater in the fibrin sealant with suture group than the other groups, and the absorption energy of the fibrin sealant group and the suture group was greater than that of the approximation group. The stiffness of the approximation group was smaller than the other groups at two weeks after the

operation.

2. Regarding to the degree of adhesion of repaired Achilles tendon as the time lapse, at one week after the operation more adhesions occurred in the suture group and the fibrin sealant with suture group than the approximation group. At two weeks

after the operation there was more adhesion in the suture group than the fibrin sealant group.

3. On the gross examination there were no club-shaped hypertrophy of repaired portion in the approximation group and the fibrin sealant group.

4. On the microscopic examination the fibrin sealant group and the fibrin sealant with suture group showed more formation of reticulin and collagen fibers than the approximation group and the suture group at one and two weeks after the operation.

Therefore, it is thought that fibrin sealant treatment of ruptured Achilles tendon yields an equivalent biomechanical characteristics to suture treatment in the first two weeks after the operation, and fibrin sealant not only helps the formation of reticulin and collagen fibers but also reduces adhesion to the

adjacent tissues. So, it is suggested that fibrin sealant can be used in Achilles tendon rupture as a useful method of treatment among many conventional modalities.
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https://ymlib.yonsei.ac.kr/catalog/search/book-detail/?cid=CAT000000005731
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1. College of Medicine (의과대학) > Others (기타) > 3. Dissertation
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/116596
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