Poli-l-laktik asit bileşenli dermal dolgunun tendon iyileşmesi üzerine etkisi

Abstract

Amaç: Tendon iyileşmesi, uzun sürmesi, ağır yük taşıması, yapışıklık oluşumu gibi nedenlerle karmaşık bir süreçtir ve herhangi bir sorun yaşandığında ciddi işlev kayıplarına yol açabilir. İyileşen tendonun önceki gücüne ulaşamadığı gösterilmiştir. Kollajenler, tendonların mekanik dayanımı için oldukça önemlidir. Poli-L-Laktik Asit (PLLA), başarılı mekanik özellikleri ve uygun karakteristik yapısı nedeniyle günümüzde giderek daha popüler hale gelen sentetik bir polimer bileşiğidir. PLLA bazlı dermal dolguların kullanımı 1999 yılında başlamış ve halen devam etmektedir. Literatürde, enjeksiyon yapılan bölgede kollajen sentezini artırdığı gösterilmiştir. Bu çalışmada, PLLA'nın sıçan tendon iyileşme modelindeki etkilerinin araştırılması amaçlandı. Gereç ve Yöntemler: Yirmi dört Wistar Albino dişi sıçan, Rastgele Kontrol Grubu ve PLLA Grubu olmak üzere iki gruba ayrıldı. Kontrol grubunda, sağ Aşil tendonu, kalkaneal yapışma yerinin 4 mm proksimalinden kesildi. PLLA grubunda ise aynı işlem uygulandıktan sonra iki tendon ucu arasına PLLA bazlı dermal dolgu enjekte edildi. Sıçanlar 3 hafta sonra sakrifiye edilerek tendonlar makroskopik, biyomekanik ve histolojik olarak parametrelere göre incelendi. Bulgular: İncelemeler sonucunda, PLLA bazlı dermal dolgu grubunun makroskopik inceleme skorları kontrol grubuna göre daha yüksek bulunmuş ancak bu fark istatistiksel olarak anlamlı bulunmamıştır (p>0,05). Biyomekanik olarak, her iki grupta da değerler düşük bulunmuş ancak PLLA grubunda yük taşıma ve sertlik değerlerindeki azalma, kontrol grubuna göre daha düşük olmuş ve bu fark istatistiksel olarak anlamlı bulunmuştur (p<0,05). Histolojik skorlamalar Bonar kriterlerine göre değerlendirilmiş ve biyomekanik bulgulara paralel olarak PLLA grubu, kontrol grubundan üstün bulunmuştur (p<0,05). Sonuç: PLLA bazlı dermal dolguların (Sculptra) tendon iyileşmesi üzerindeki olumlu etkileri olduğu belirlendi.

Keywords

• Kollajen
• poli-l-laktik asit
• PLLA
• tendon iyileşmesi

The effect of poly-l-lactic acid dermal filler on tendon healing

Abstract

Aim: Tendon healing is a process that can be complicated because of taking long time,heavy burden, adhesion formation, etc., and can cause significant loss of functionif a problem occurs.It’s shown that healing tendon couldn’t reach its previous strength. Collagens are very important for mechanical strength of tendons. Poly-L-Lactic Acid (PLLA) is a synthetic polimeric compound which is becoming more popular nowadays due to its succesful mechanical properties and proper characteristic structure. The use of PLLA-based dermal fillers started in 1999 and is still in use.It has been shown in the literature that they increase collagen synthesis on injection site. In this study, investigation of the effects of PLLA on rat tendon healing model is aimed. Materials and Methods: Twenty four Wistar Albino female rats were divided in two groups randomly as Control group and PLLA group. In control group, right achilles tendon was cut from 4 mm proximal to its calcaneal insertion. In PLLA group, following the same procedure, PLLA-based dermal filler was injected in between 2 tendon sections. Rats were sacrified after 3 weeks and tendons were excised to examine macroscopically, biomechanically and histologically according to parameters. Results: According to examinations, macroscopical examination scores of PLLA-based dermal filler group was higher than control group but was not statistically significant (p>0,05). Biomechanically, values were lower for both groups but decrease in failure to load and stifness values were lower in PLLA group compared to control group. This was statiscally significant (p<0,05). Histological scoring was evaluated according to Bonar Criterias and as biomechanical findings PLLA group was superior to control group (p<0,05). Conclusions: In this study, postive effects of PLLA-based dermal fillers (Sculptra) on tendon healing was shown.

Keywords

• Collagen
• poly-l-lactic acid
• PLLA
• tendon healing

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