腱縫合及び移植の修復に関する研究

The procedures of tendon repair after suturing and grafting are discussed in this paper. Animal experiments were performed on the Achilles and long digital flexor tendons in rabbits, and after the operation histological examinations were conducted weekly until the sixth week. As for the grafting, free autogenous and homogenous tendon grafts were used. In addition, tendon fixation through a drill hole in the tibia was experimented. Results are as follows: 1. The peritenoneum and connective tissues surrounding the tendon play an essential role in repairing tendons that are sutured and grafted. 2. Histological investigations reveal that the fibrous union becomes fairly firm in the third postoperative week and almost complete in the sixth week. 3. The newly-formed tissue between the tendon stumps is not a truly regenerated tendinous tissue but a scar tissue. 4. Blood vessels that take part in the tendon repair originate from the surrounding connective tissues and in the sixth week they are almost completely in a definite arrangement. 5. Tendon grafts, both autogenous and homogenous, degenerate once and then are replaced with the surrounding connective tissues with round cell infiltration, connective tissue cell proliferation and blood vessel invasion. 6. At these replacements, elemental substance of the collagenous fibers remains and is involved in reconstruction of the fiber bundles. 7. Adhesions always occur about the sutured area and around the graft, but the gliding mechanism appears again after the fifth or sixth postoperative week. 8. Adhesions are marked especially near the silk sutures. 9. Thension to which the healing tendon is subjected tends to produce the separation at the suture line. But the nuclei and fibers of the newly-formed connective tissue and the blood vessels are arranged in a parallel form more rapidly with such functional stimuli than without. 10. The separation at the suture line occurs in the first to second week but does not continue to widen after the third week. 11. Two weeks of immobilization following operation, therefore, seems to be sufficient, and restricted use may be commenced thereafter. 12. When the tendon is grafted through a drill hole in a bone, the firm anchorage is obtained by its gradual ossification and incorporation in the bone. 13. Ossification of the tendon under these circumstances occurs by replacement of the tendon with the invading osteoblasts which form bone. 14. Contiguity of the collagenous fibers between the tendon and the bone is observed in the sixth week after grafting. 15. Ossification of the transplant is observed most markedly in the cortical area and least in the medullary portion.