屈指肌腱损伤修复术后早期活动作用的实验研究

选用白来亨鸡56只,建立肌腱损伤的模型并设计不同的术后活动方法及制动方法。为比较这些方法对损伤肌腱愈合及功能的影响,进行了实体显微镜、普通光学显微镜、扫描电镜等项观察,并测量了肌腱的滑动功能。结果表明:适量的术后早期活动可促进损伤肌腱的愈合,改善其滑动功能,而制动则不利于肌腱损伤的修复及功能的恢复。     

肌腱内缝合结合医用胶修复肌腱损伤

探讨部结肌腱内缝合结合医用胶修复技术修复肌腱损伤的治疗效果。此技术保持了缝合强度，减少了肌腱损伤，增加断端的接触面，利于肌腱的联接。     

船员屈指肌腱损伤的治疗

目的探讨船员屈指肌腱损伤的特点和治疗方法。方法对本院收治的５２例船员屈指肌腱损伤临床资料进行总结并着重对治疗效果进行分析。结果本组Ⅰ期修复４３例１６８条,Ⅱ期修复９例２４条。术中用套圈缝合法或改良Ｋｅｓｓｌｅｒ法缝接肌腱,Ⅱ期行粘连肌腱松解术８例２５条,术后２４小时开始功能锻炼。治疗效果经对４３例１４６条随访３个月～３年（平均１年６个月）,根据ＴＡＭ疗效标准评定为：锐割伤５７条中,优４７条,良８条,中２条,优良率为９６．５％;缆绳绞轧伤３６条中,良２１条,中９条,差６条,优良率为５８．３％;压榨断开伤５３条中,优２９条,良１６条,中６条,差２条,优良率为８４．９％。结论屈指肌腱损伤疗效与损伤类型关系密切。锐器切割伤疗效最佳,缆绳绞轧伤最差。对缆绳绞轧伤应积极创造条件,采取相应措施,以提高其疗效     

手指屈肌腱损伤243指一期修复缝合方法

手指屈肌腱损伤修复方法较多 ,各有所长。1992年以来 ,我们在继承传统方法基础上 ,自行设计并应用  形缝合法 ,修复手指屈肌腱损伤 12 1例2 4 3指 ,效果较好。1　临床资料1 1　一般情况　本组 12 1例 2 4 3指 ,男 96例 ,女2 5例 ;年龄 10～ 53岁。切割伤 69例 ,电锯伤 39例 ,挤压伤 13例 ;拇指 4 3指 ,示指 77指 ,中指 68指 ,环指 35指 ,小指 2 0指 ;指深浅肌腱同时断裂197指 ,深腱断裂 4 6指 ;Ⅰ区 4 6指 ,Ⅱ区 88指 ,Ⅲ区 63指 ,Ⅳ区 33指 ,Ⅴ区 13指 ;合并骨关节损伤56指 ,滑车损伤 96指。1 2　手术方法　显露肌腱两断端 ,并修齐。显微…     

屈指肌腱损伤的康复治疗

康复医学的目的在于尽量消除或减轻由伤痛所造成的功能障碍，最大限度地恢复其生活及劳动能力。康复医学的范围很广，本文只涉及屈指肌腱损伤的康复治疗。     

套索锁扣结缝合法在伸指肌腱I区损伤中的应用

对27例伸指肌腱I区损伤患者用套索锁扣结缝合法修复,患者均获得平均14个月(9~16个月)的随访,切口(创伤)均I期愈合,除1例肌腱再断裂后期行关节融合治愈外,其余患者手指功能恢复良好.术后无肌腱粘连、关节僵硬及异位骨化发生,无甲床损伤.根据TAM(total active movement)系统评定:优19例,良7例,可、差1例,优良率96.3%.该方法操作简单,抗张强度及防滑脱撕裂作用强,可早期功能锻炼,临床效果好,值得推广应用.     

V区屈指肌腱修复后的功能评价及影响因素分析

目的 评价V区屈指肌腱修复后的功能并分析影响功能的有关因素. 方法 对2003年9月-2009年7月收治的52例(163指)腕前区涉及V区屈指肌腱损伤患者的临床资料进行回顾性分析,术后随访平均32个月,采用三种不同束数的腱缝合法缝合肌腱.测量患指关节主动活动度、握力、捏力,检查患指指浅屈肌腱( flexor digitorum superficialis,FDS)独立运动功能,并采用上肢功能评定量表(disability of arm,shoulder and hand,DASH)评分.对V区屈肌腱损伤平面、 缝合方法 、手术者的经验和肌腱损伤复合程度等影响因素进行统计学分析. 结果 随访163指中,146指(89.6％)获得优或良的关节活动度,147指涉及FDS损伤中,103指(70.1％)获得独立的FDS运动功能；握力、捏力平均恢复到健侧的2/3,DASH平均11.9分.采用2束Kessler法缝合组、手术者经验级别低组以及复合损伤严重组的术后功能要明显差于各自对应的其他组(P＜0.05),损伤不同平面对功能结果 影响不大(P＞0.05). 结论 V区屈肌腱损伤修复后功能恢复良好,缝合方法 、手术者的经验和复合损伤的严重程度对功能有明显影响；提高手术者的经验可有效改善术后功能.     

肌腱缝合术中应用生物膜防止肌腱术后黏连的临床研究

目的 研究生物膜在肌腱缝合术中防止肌腱术后黏连的作用.方法 针对神经修复术后恢复无效的桡神经损伤患者,以是否使用生物膜行肌腱缝合术分为试验组(使用生物膜)和对照组(不使用生物膜).术后8～24周随访,每1～2个月随访1次.有效随访资料者73例,其中试验组35例,对照组38例.根据中华医学会手外科学会上肢部分功能评定试用...     

带前臂筋膜掌长肌腱游离移植修复屈指肌腱术

我们首先用掌长肌带前臂筋膜进行屈指肌腱移植及腱鞘重建，术后早期被动活动取得良好效果。现介绍如下。临床资料１９８４～１９９０年共用带筋膜的掌长肌移植修复屈指肌腱２３例，其中男１４例，女９例；年龄１５～４３岁，平均２５例。１指肌腱损伤１２例，２指６例，３...     

Endobutton fixation of hamstring tendon grafts

The EndoButton (Acufex, Mansfield, MA) is one of many devices available for hamstring or patellar tendon graftfemoral fixation in anterior cruciate ligament reconstructive surgery. The strengths and weaknesses of the device are discussed. Recent modifications to the device and the operative technique may improve its effectiveness.     

Biomechanical properties of quadruple tendon and patellar tendon femoral fixation techniques

Two femoral fixation techniques for quadruple hamstring tendon grafts were compared under cyclic loading with the patellar tendon: the rectangular inserted pin (TransFix) and biodegradable interference screw fixation of the quadruple tendon and titanium interference screw fixation of the middle third of the patellar tendon. Porcine specimens were mounted onto a tension load machine, and the tendon-fixation-femur-complex was tested for stiffness, displacement during 800 cycles of loading between 50 and 250 N and ultimate tension load. TransFix fixation showed the greatest stiffness at 183.6 N/mm ( P<0.05). The least displacement under cyclic loading was observed for the titanium interference screw followed by the TransFix and biodegradable interference screw ( P<0.01). The ultimate tension load was greatest for the TransFix fixation at 1303+/-282 N, followed by patellar tendon fixation with 763+/-103 N and the biodegradable interference screw fixation with 480+/-133 N ( P<0.001). To reduce initial elongation of the graft and displacement at the fixation site, preconditioning of both the tendon and tendon-fixation complex is especially important when using quadruple tendons. TransFix fixation provides better stability and greater stiffness and pull-out strength than the other techniques. This finding is of clinical relevance to surgeons of the anterior cruciate ligament.     

Pathophysiology of overuse tendon injury

Overuse tendon injury is one of the most common injuries in sports.The etiology as well as the pathophysiological mechanisms leading to tendinopathy are of crucial medical importance.At the moment intrinsic and extrinsic factors are assumed as mechanisms of overuse tendon injury. Except for the acute, extrinsic trauma, the chronic overuse tendon injury is a multifactorial process. There are many other factors, such as local hypoxia, less of nutrition, impaired metabolism and local inflammatory that may also contribute to the development of tissue damage.The exact interaction of these factors cannot be explained entirely at the moment.Further studies will be necessary in order to get more information.     

The influence of screw geometry on hamstring tendon interference fit fixation

We used a standardized model of calf tibial bone to investigate the influence of screw diameter and length on interference fit fixation of a three-stranded semitendinosus tendon graft for anterior cruciate ligament reconstruction. Biodegradable poly-(L-lactide) interference screws with a diameter of 7, 8, and 9 mm and a length of 23 and 28 mm were used. We examined results in three groups of 10 specimens each: group 1, screw diameter equaled graft diameter and screw length was 23 mm; group 2, screw diameter equaled graft diameter plus 1 mm and screw length was 23 mm; group 3, screw diameter equaled graft diameter and screw length was 28 mm. The mean pull-out forces in groups 1, 2, and 3 were 367.2+/-78 N, 479.1+/-111.1 N, and 537.4+/-139.1 N, respectively. The force data from groups 2 and 3 were significantly higher than those from group 1. These results indicate that screw geometry has a significant influence on hamstring tendon interference fit fixation. Increasing screw length improves fixation strength more than oversizing the screw diameter. This is important, especially for increasing tibial fixation strength because the tibial graft fixation site has been considered to be the weak link of such a reconstruction.     

Functional postoperative treatment of Achilles tendon repair.

Twenty-one patients with surgically repaired Achilles tendon tears that were treated postoperatively with a functional orthosis rather than routine cast immobilization were evaluated. The orthosis allowed unrestricted plantar flexion and limited dorsiflexion to neutral. Toe-touch weightbearing crutch ambulation was allowed immediately and was gradually increased over the 6 to 8 weeks of treatment. Of the 21 patients, 14 were men and 7 were women; the average age at injury was 35.6 years (range, 19 to 65). The minimum followup was 2 years, with an average of 31 months. The repairs were acute in 18 of the patients and chronic in 3. Subjectively, 16 patients felt they returned to their preinjury level of activity and only 1 was not satisfied with his result. Objectively, there were no significant alterations in ankle range of motion when compared to the contralateral limb, with plantar flexion unchanged and dorsiflexion increased an average of only 2 degrees. The average plantar flexion and dorsiflexion strength, power, and endurance of the ankles as measured by isokinetic testing revealed no significant differences when comparing the operated leg to the nonoperated side: strength, 99% and 93%, respectively; power, 98% and 96%, respectively; and endurance, 93% and 91%, respectively. The angles at which the peak torques occurred were similarly not statistically different. Two patients had superficial wound infections, and 1 had scar adherence of the skin to the tendon. No one had rerupture of the tendon. In conclusion, while the many benefits of postoperative early motion are well proven, there has been hesitation to implement this after Achilles tendon surgery due to the concern of compromising the repair. As shown by this study, early controlled motion can safely and effectively be used following Achilles tendon repair in the motivated, reliable patient.     

儿童手腕部肌腱并神经损伤的治疗

目的 探讨儿童手腕部肌腱及神经损伤的治疗方法及效果。方法 本组手腕肌腱损伤56例，其中合并神经损伤24例。经过严格清创后，尽快对断裂肌腱行改良Kessler缝合，损伤神经行外膜吻合。术后行树脂石膏外固定及功能锻炼。结果 术后随访44例，按手功能标准进行疗效评价，其中优28例，良14例，差2例，优良率95．5％；随访病例中合并运动神经损伤者18例，优12例，良4例，差2例，优良率88．9％。结论 对儿童手腕部肌腱断裂合并神经损伤，应尽早诊断，确定肌腱、神经损伤部位及程度，及时采用微创显微外科技术予以修复。术后合理运用药物及功能锻炼，是提高其疗效的重要措施。     

Growth changes in the elastic properties of human tendon structures

The purpose of this study was to investigate the growth changes in the elastic properties of human tendon structures. 9 younger boys (age 10.8 +/- 0.9 years, YBG), 9 elder boys (14.8 +/- 0.3 years, EBG), and 14 young adult men (24.7 +/- 1.6 years, ADG) volunteered to take part in the present study. Using a B-mode ultrasonic apparatus, the elongation of tendon and aponeurosis of vastus lateralis muscle (VL) was noninvasively measured in vivo, while subjects performed the extension of knee joint isometrically with force production levels from zero (relax) to maximal voluntary contraction (MVC) within 5 seconds. A curvilinear relationship was found between elongation of tendon structures (dL) and muscle force (Fm). This relationship consisted of two components, a steep initial change in length followed by a linear-region. The relationship between dL and Fm was fitted to a linear regression, and then the dL and dFm within 50 to 100% MVC was defined as compliance of tendon structures. The MVC force was the greatest in ADG and the lowest in YBG among the three groups. Significant age-related differences were found in compliance; 4.1 +/- 0.9 x 10(-2) mm/N for YBG, 2.9 +/- 1.1 x 10(-2) mm/N for EBG and 1.8 +/- 0.3 x 10(-2) mm/N for ADG. The dL/thigh length (TL) was significantly greater in YBG than in the other two groups above 0.35 MPa of Fm per muscle cross-sectional area (muscle stress). However, there was no significant difference between EBG and ADG in the relationship between dL/TL and muscle stress. The ratio of fascicle length to TL in YBG was significantly lower than those in the other two groups. These results suggest that the tendon structures in younger boys are more compliant than those in older boys and young men. The observed properties of tendon structures in the younger boys may play a role in protecting younger boys from athletic injuries associated with immature muscle-tendon complex.     

髌腱损伤的低场磁共振诊断

髌腱损伤主要见于运动员,但非运动员外伤性、病理性及医源性的髌腱损伤也日渐增多,合并其他病变时常因漏诊延误治疗,影响膝关节功能,故临床工作中应予以重视.影像检查时常规X线平片和CT检查难以显示,MRI成像具有极高的软组织分辨力,可以清楚显示髌腱,准确诊断髌腱损伤并发现其并发症,在临床中应用日益广泛.     

术前3D数字化技术模拟对胫骨平台骨折手术操作、术后关节功能恢复的影响

目的 探讨术前3D数字化技术模拟手术复位及操作对复杂胫骨平台骨折患者的手术效果及关节功能恢复的影响.方法 前瞻性分析2016年2月—2018年8月新疆医科大学第六附属医院骨病矫形外科收治的92例复杂型胫骨平台骨折患者资料,随机数字表法分为3D模拟组(术前CT扫描数据导入Minics软件内进行三维重建模拟骨折复位、手术入...     

Bone tunnel and suture anchor fixation of distal biceps tendon ruptures

Several different techniques to secure the distal end of the biceps tendon back to the radial tuberosity have been described in the literature. This paper will focus on 2 of the more common ones: (1) a 2-incision technique using a bone tunnel and (2) a 1-incision technique with suture anchors. Both of these techniques have been shown to produce similarly good clinical results.