Aşil tendon rüptürü oluşturulan ratlarda enoksaparin sodyum ve hiperbarik oksijen tedavisinin iyileşme üzerine etkilerinin araştırılması
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Tarih
2022
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Düzce Üniversitesi
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info:eu-repo/semantics/openAccess
Özet
Tendonlar tekrarlayan hareketler, dejenerasyon ve travma nedeniyle, akut veya kronik olarak kolayca yaralanabilir. Yaralanmadan sonra tendon iyileşmesi fibrotik skar dokusu oluşumu ile gerçekleşir. Bu dokunun yapısal ve mekanik özellikleri, normal tendona göre zayıftır.Tendonun iyileşme sonrası daha sağlam olması için değişik çalışmalarda bazı biyomateryaller denenmiş, fibroblast içeren hücrelerden iskelet yapıları oluşturulmuş, büyüme faktörleri ve sitokinler de eksojen olarak uygulanmıştır. Bunlardan başka, gen ve hücre tedavisi yoluyla doku mühendisliği de bu amaçla kullanılmıştır. Daha önceki çalışmalarda tendon iyileşmesini etkileyen birçok madde ve faktör incelenmiştir. Düşük molekül ağırlıklı heparinler (DMAH) özellikle alt ekstremite cerrahisi sonrası gelişme ihtimali bulunan derin ven trombozunu önlemek amaçlı yaygın olarak kullanılmaktadır. Hayvan deneyi olarak DMAH grubundan bazı maddeler incelenmiş olmasına rağmen günümüzde en çok kullanılan DMAH olan Enoksaparin sodyumun tendon iyileşmesi üzerine yapılmış çalışma bulunmamaktadır. Bu araştırmada, tendon ve yumuşak dokular dışında kemik doku iyileşmesini de hızlandırdığı bilinen hiperbarik oksijenin tedavisi ile enoksaparin sodyumun aşil tendon rüptürü iyileşmesi üzerine etkilerinin araştırılması amaçlandı. Gereç ve Yöntemler: Çalışmada 36 adet erişkin dişi Wistar Albino cinsi rat kullanıldı. Tüm ratlar 9'arlı 4 gruba ayrıldı. Grup 1'e deneysel olarak oluşturulan aşilotomi ve primer süturasyon sonrası standart bakım koşulları sağlandı.Grup 2'ye aşilotomi ve primer süturasyon sonrası günde 1mg/kg olacak şekilde 21 gün süre ile enoksaparin sodyum subkütan yolla verildi. Grup 3'e aşilotomi ve primer süturasyon sonrası 21 gün süre ile hiperbarik oksijen tedavisi (2.5 ATA basınçta 1 saat) uygulandı. Grup 4'e aşilotomi ve primer süturasyon sonrası 21 gün süre ile hem günde 1mg/kg olacak şekilde enoksaparin sodyum subkütan yolla verildi hem de hiperbarik oksijen tedavisi (2.5 ATA basınçta 1 saat) uygulandı.21 gün sonra süreç tamamlanıp ratlar sakrifiye edildi. Alınan aşil tendon örnekleri histopatolojik olarak değerlendirilirdi. Sonuçlar: Gruplar arasında akut inflamasyon (p=0,785) ve kronik inflamasyon (p=0,827) skorları bakımından anlamlı bir farklılık yokken, neovaskülarizasyon (p=0,009), proliferasyon (p<0,001) ve fibrozis (p=0,006) skorları açısından anlamlı farklılık olduğu görüldü. Neovaskülarizasyon bakımından görülen anlamlı farklılık sadece hiperbarik oksijen ile enoksaparin sodyum+HBO grupları arasında ortaya çıkarken (p=0,006), diğer gruplar ikili ikili karşılaştırıldığında birbirine benzer olarak bulundu. Proliferasyon bakımından görülen anlamlı farklılık enoksaparin sodyum+HBO grubunda ortaya çıkarken, bu grup diğer grupların tümünden anlamlı farklılık gösterdi. Bu farklılık enoksaparin sodyum ile enoksaparin sodyum+HBO (p<0,001), Hiperbarik oksijen ile enoksaparin sodyum+HBO (p=0,017) ve kontrol ile enoksaparin sodyum+HBO (p=0,034) grupları arasında ortaya çıkarken, diğer gruplar ikili ikili karşılaştırıldığında birbirine benzer olarak bulundu. Fibrozis bakımından görülen anlamlı farklılık enoksaparin sodyum ile enoksaparin sodyum +HBO (p=0,012) ve kontrol ile enoksaparin sodyum (p=0,046) grupları arasında ortaya çıkarken, diğer gruplar ikili ikili karşılaştırıldığında birbirine benzer olarak bulundu. Çıkarımlar: Çalışmamızın sonucunda elde ettiğimiz bulgulara bakıldığında enoksaparin sodyum ve hiperbarik oksijen kullanımı, aşil tendon iyileşme sürecine olumlu yönde etki etmiştir. Bu sonuçlara dayanarak enoksaparin sodyum ve hiperbarik oksijen tedavisinin, aşil tendon rüptürü sonrasında kullanımının iyileşme süreci ve komplikasyonları önleme aşamasında faydalı olacağı kanaatindeyiz. Anahtar Kelimeler: Aşil tendon rüptürü, hiperbarik oksijen, enoksaparin sodyum, rat
Objective: Tendons can be easily injured acutely or chronically due to repetitive movements, degeneration and trauma. Tendon healing after injury occurs with the formation of fibrotic scar tissue. The structural and mechanical properties of this tissue are weaker than the normal tendon. Some biomaterials have been tried in different studies to make the tendon more robust after healing, skeletal structures have been formed from cells containing fibroblasts, growth factors and cytokines have also been applied exogenously. Tissue engineering through gene and cell therapy has also been used for this purpose. Many substances and factors affecting tendon healing have been examined in previous studies. Low molecular weight heparins (LMWH) are widely used to prevent deep vein thrombosis, which may develop after lower extremity surgery. Although some substances from the LMWH group have been examined as an animal experiment, there is no study on tendon healing of Enoxaparin sodium, which is the most widely used LMWH today. In this study, we aimed to investigate the effects of hyperbaric oxygen therapy and enoxparin sodium on the healing of Achilles tendon rupture, which is known to accelerate bone tissue healing in addition to tendon and soft tissues. Material and Methods: 36 adult female Wistar Albino rats were used in the study. All rats were divided into 4 groups of 9 each. Group 1 was provided with standard care conditions after the experimentally created achilotomy and primary suturing. Group 2 was given enoxaparin sodium subcutaneously at 1mg/kg/day per day for 21 days after achilotomy and primary suturing. Hyperbaric oxygen therapy (1 hour at 2.5 ATA pressure) was applied to Group 3 for 21 days after achilotomy and primary suturing. Group 4 was given both 1mg/kg/day enoxaparin sodium subcutaneously for 21 days after achilotomy and primary suturing, and hyperbaric oxygen therapy (1 hour at 2.5 ATA pressure). After 21 days, the process was completed and the rats were sacrificed. Achilles tendon samples taken were evaluated histopathologically. Results: While there was no significant difference between the groups in terms of acute inflammation (p=0.785) and chronic inflammation (p=0.827) scores, there was a significant difference in neovascularization (p=0.009), proliferation (p<0.001) and fibrosis (p=0.006) scores. Significant difference in neovascularization is observed only between hyperbaric oxygen and enoxaparin sodium+HBO groups (p=0.006), other groups are similar to each other when paired pairs are compared. Significant difference in proliferation occurs in the enoxaparin sodium+HBO group, this group differs significantly from all other groups. It occurs between enoxaparin sodium and enoxaparin sodium+HBO (p<0.001), Hyperbaric oxygen and Enoxaparin sodium+HBO (p=0.017) and control and enoxaparin sodium+HBO(p=0.034) groups, other groups duo are similar to each other when compared. Significant difference in fibrosis is observed between enoxaparin sodium and enoxaparin sodium+HBO (p=0.012) and control and enoxaparin sodium (p=0.046) groups. Other groups are similar when paired with each other. Conclusions: Considering the findings we obtained as a result of our study, the use of enoxaparin sodium and hyperbaric oxygen had a positive effect on the Achilles tendon healing process. Based on these results, we believe that the use of enoxaparin sodium and hyperbaric oxygen therapy after Achilles tendon rupture will be beneficial in the healing process and prevention of complications. Keywords: Achilles tendon rupture, hyperbaric oxygen, enoxaparin sodium, rat
Objective: Tendons can be easily injured acutely or chronically due to repetitive movements, degeneration and trauma. Tendon healing after injury occurs with the formation of fibrotic scar tissue. The structural and mechanical properties of this tissue are weaker than the normal tendon. Some biomaterials have been tried in different studies to make the tendon more robust after healing, skeletal structures have been formed from cells containing fibroblasts, growth factors and cytokines have also been applied exogenously. Tissue engineering through gene and cell therapy has also been used for this purpose. Many substances and factors affecting tendon healing have been examined in previous studies. Low molecular weight heparins (LMWH) are widely used to prevent deep vein thrombosis, which may develop after lower extremity surgery. Although some substances from the LMWH group have been examined as an animal experiment, there is no study on tendon healing of Enoxaparin sodium, which is the most widely used LMWH today. In this study, we aimed to investigate the effects of hyperbaric oxygen therapy and enoxparin sodium on the healing of Achilles tendon rupture, which is known to accelerate bone tissue healing in addition to tendon and soft tissues. Material and Methods: 36 adult female Wistar Albino rats were used in the study. All rats were divided into 4 groups of 9 each. Group 1 was provided with standard care conditions after the experimentally created achilotomy and primary suturing. Group 2 was given enoxaparin sodium subcutaneously at 1mg/kg/day per day for 21 days after achilotomy and primary suturing. Hyperbaric oxygen therapy (1 hour at 2.5 ATA pressure) was applied to Group 3 for 21 days after achilotomy and primary suturing. Group 4 was given both 1mg/kg/day enoxaparin sodium subcutaneously for 21 days after achilotomy and primary suturing, and hyperbaric oxygen therapy (1 hour at 2.5 ATA pressure). After 21 days, the process was completed and the rats were sacrificed. Achilles tendon samples taken were evaluated histopathologically. Results: While there was no significant difference between the groups in terms of acute inflammation (p=0.785) and chronic inflammation (p=0.827) scores, there was a significant difference in neovascularization (p=0.009), proliferation (p<0.001) and fibrosis (p=0.006) scores. Significant difference in neovascularization is observed only between hyperbaric oxygen and enoxaparin sodium+HBO groups (p=0.006), other groups are similar to each other when paired pairs are compared. Significant difference in proliferation occurs in the enoxaparin sodium+HBO group, this group differs significantly from all other groups. It occurs between enoxaparin sodium and enoxaparin sodium+HBO (p<0.001), Hyperbaric oxygen and Enoxaparin sodium+HBO (p=0.017) and control and enoxaparin sodium+HBO(p=0.034) groups, other groups duo are similar to each other when compared. Significant difference in fibrosis is observed between enoxaparin sodium and enoxaparin sodium+HBO (p=0.012) and control and enoxaparin sodium (p=0.046) groups. Other groups are similar when paired with each other. Conclusions: Considering the findings we obtained as a result of our study, the use of enoxaparin sodium and hyperbaric oxygen had a positive effect on the Achilles tendon healing process. Based on these results, we believe that the use of enoxaparin sodium and hyperbaric oxygen therapy after Achilles tendon rupture will be beneficial in the healing process and prevention of complications. Keywords: Achilles tendon rupture, hyperbaric oxygen, enoxaparin sodium, rat
Açıklama
Anahtar Kelimeler
Aşil tendon rüptürü, hiperbarik oksijen, enoksaparin sodyum, rat, Achilles tendon rupture, hyperbaric oxygen, enoxaparin sodium, rat, Ortopedi ve Travmatoloji, Orthopedics and Traumatology
