Pastukh V. Prevention of posttraumatic adhesions around the tendons

Object: posttraumatic regeneration of tendons. Objective: To improve the effectiveness of the prevention of post-traumatic adhesions around the tendon by injection of the medications which prevent the formation of adhesions of tendon with surrounding tissues around the tendon suture. Methods: clinical; X-ray; histological, biomechanical, mathematical modeling, statistical. It has been found that the destructive changes with a peak in the control series of tendons and treated with hyaluronidase (II stage of histological disorders; (18.6 ± 2.5) and (18.7 ± 1.5) points) developed 60 days after partial the modeling damage of the Achilles tendon in conditions of prevention of post-traumatic adhesions. Less expressed abnormalities have been found in a series of experiments with hyaluronic acid and three dimensional water-containing polyacrylamide polymer with silver ions (I stage of histological disorders, (14.8 ± 2.7) and (15.4 ± 3.2) points). The scientific data were complemented: the introduction around the tendon suture hyaluronic acid, hyaluronidase, three-dimensional polyacrylamide water-containing polymer with silver ions under the conditions of modeling of partial damage of the Achilles tendon does not disturb the process of tendon regeneration. For the first time was established that the introduction of hyaluronic acid and three-dimensional polyacrylamide water-containing polymer with silver ions around the tendon suture prevents the formation of adhesions of injured tendon with the surrounding tissues. Increasing of the density of III type collagen in the regenerate of rabbits' Achilles tendon in 14, 30 and 60 days after injury with a maximum accumulation in control animals and group with the introduction of hyaluronidase has been shown. Collagen type III has also been found in parts of the tendon, which are located above and below the site of traumatic injury. This reduces the strength properties of the tendon. For the first time it was revealed (with the use of methods of mathematical modeling and biomechanical studies) that after the repair of the injured tendon in the control group and after the introduction around the tendon suture of drugs indicators that characterize the mechanical properties of tissues - modulus of elasticity, the tolerated stress and ultimate stress were increased. This was associated with the formation of tendon-like tissue in the area of injury. The highest rates of the strength were recorded for the control group animals. Formed adhesions increased cross-sectional area of regenerate and accordingly the strength characteristics of the tendons. The indicators characterizing the plastic properties of tissues (the elongation) declined. High rates that characterize the plastic properties of tissue are fixed in the specimens of Achilles tendons of rabbits, which used three-dimensional hyaluronic acid and water-containing polyacrylamide polymer with silver ions, and the lowest - in the control group. For the first time it was found that the use of hyaluronic acid and three-dimensional water-containing polyacrylamide polymer with silver ions for the prevention of posttraumatic adhesions positive effect on the recovery of the plastic properties of the tendon. The method of preventing tendogenic contracture after tenolysis of flexor of fingers, that involves the introduction of intraoperative around the tendon hyaluronic acid (patent 62870 UA), was developed and introduced in practice. The method of treatment of injuries of the flexor tendons of the fingers, that involves the introduction of intraoperative around the tendon hyaluronic acid (patent 60652 UA), was developed and introduced in practice. Recommendations for the integrated prevention of posttraumatic adhesions around the tendon with the intraoperative administration of tendon suture around 1-2 ml of hyaluronic acid or polyacrylamide polymer were developed. The results of researches are introduced into clinical practice in KZOZ "Kharkiv Regional Clinical Traumatological Hospital" and educational process on department of trauma, spine and anesthesiology, Kharkiv Medical Academy of Postgraduate Education of Ukraine. Traumatology and Orthopedics