肩关节镜下两种方法治疗肱二头肌长头肌腱炎的对比研究

目的:比较肩关节镜下肱二头肌长头肌腱单纯切断术与切断固定术治疗肱二头肌长头肌腱炎的临床疗效。方法:自2015年1月至2017年1月将40例肱二头肌长头肌腱炎患者根据不同手术方式分为单纯切断组和切断固定组。单纯切断组18例,其中男6例,女12例;年龄(62.2±6.1)岁;病程(8.5±2.2)个月。切断固定组22例,其中男8例,女14例;年龄(60.5±6.3)岁;病程(8.1±2.3)个月。比较两组患者的手术时间,并分别于术前及术后3、6、12个月采用VAS评分评价疼痛缓解程度,观察Popeye畸形发生例数,采用UCLA肩关节功能评分评价临床疗效。结果:40例患者获得随访,时间12～17(14.3±2.1)个月。单纯切断组8例术后出现Popeye畸形,切断固定组未出现Popeye畸形。单纯切断组手术时间(40.55±7.51) min,切断固定组(75.33±9.45) min,差异有统计学意义(P0.05)。两组患者术后3、6、12个月VAS评分较术前下降,术后3个月单纯切断组VAS评分低于切断固定组(P0.05),但术后6、12个月两组比较差异无统计学意义(P0.05)。单纯切断组术组及切断固定组术后3、6、 12个月UCLA评分较术前明显提高(P0.05);术后3个月单纯切断组UCLA评分较切断固定组高(P0.05),但术后6、12个月两组评分比较差异无统计学意义(P0.05)。根据UCLA评分,单纯切断组优5例,良10例,差3例;切断固定组优8例,良12例,差2例;两组比较差异无统计学意义(χ~2=0.057,P=0.81)。结论:关节镜下肱二头肌长头肌腱单纯切断术与切断固定术对于肱二头肌长头肌腱炎的治疗均能获得良好的临床疗效,术后早期单纯切断术疗效优于切断固定术,晚期无显著性差异。     

Differential expression of neural cell adhesion molecule (NCAM) after tenotomy in rabbit skeletal muscle.

Tenotomy is a commonly encountered event in orthopaedic surgery. In 23 rabbit extensor digitorum longus (EDL) muscles, within 24 h after tenotomy, a marked drop in maximum force production occurred. This was not explainable based on architectural changes and histological examination using standard markers for muscle injury, i.e., haematoxylin and eosin morphology, developmental myosin heavy chain (MHC) immunolabeling, and quantitation of muscle fiber type percentage, area and distribution. The expression of neural cell adhesion molecule (NCAM), a glycoprotein expressed during muscle development was measured as a function of time in these muscles. NCAM expression was increased as early as one day after tenotomy with 2.2+/-1.2% of the fibers showing positive expression. This expression level increased significantly to 15.4+/-15.2% after 7 days and then subsided to 13.2+/-10.6% 21 days after tenotomy. Two-way analysis of variance demonstrated a significant effect of time and a significant time x tenotomy method interaction. These results suggest that tenotomy leads to possible changes in muscle-nerve connections and/or excitation-contraction (EC) coupling.     

Subscapularis tenotomy vs. lesser tuberosity osteotomy during total shoulder arthroplasty: When less is more

Mobilization of the subscapularis is necessary during total shoulder arthroplasty, but high rates of subscapularis dysfunction have been reported postoperatively. Two methods are commonly used: subscapularis tenotomy with tendon-to-tendon repair and lesser tuberosity osteotomy with bone-to-bone repair. There is conflicting data as to which of these methods provides superior results. This article reviews the literature to date and provides the preliminary results from a prospective randomized controlled trial comparing subscapularis tenotomy to lesser tuberosity osteotomy. Our results show that lesser tuberosity osteotomy and subscapularis tenotomy both provide a reliable, consistent healing method for subscapularis management with comparably excellent outcomes.     

Anatomy of soleus α-motoneurone dendrites in normal cats and in cats subjected to chronic postnatal tenotomy or overload of the soleus muscle

Summary The anatomy of intracellularly HRP-labeled soleus -motoneurone dendrites was studied both in normal adult cats (normal soleus, NS) and in adult cats which at a postnatal age of 5–7 days had been subjected to chronic tenotomy of either the soleus muscle (tenotomized soleus, TS), or all the soleus synergists contributing to the achilles tendon (overloaded soleus, OS). A set of structural rules seemed to govern the architecture of normal soleus -motoneurone dendrites. Thus, the dendrites branched dichotomously and the number of daughter branches originating from a preterminal branch was proportional to the diameter of that parent branch. Branch diameter decreased across branching points according to the 3/2 power rule of Rall (1959). Branching occurred down to a preterminal branch diameter of about 0.8 m. Through all branch orders there existed a quite precise relation between the diameter of a preterminal branch and the membrane area of its distal dendritic arborization. The average dendritic path distance from soma to termination was not closely related to the diameter of the stem dendrite, since thick stem dendrites rather generated more profusely branched arborizations than thin stem dendrites. As a corollary of these characteristics close relations existed between the dendritic stem diameter on one hand, and the total number of branches, combined dendritic length, total dendritic membrane area and total volume, on the other. In the OS material, the dendrites were not different from those of normal soleus motoneurone dendrites. In the TS material, the dendrites were less branched and had greater dendritic path lengths, although the relations between various size-parameters within the dendrites were not significantly altered compared with normal dendrites. It was concluded that the change in branching pattern was due to a net elimination of dendritic branches following the muscle tenotomy.     

Passive Skeletal Muscle Excursion after Tendon Rupture Correlates with Increased Collagen Content in Muscle

Purpose

This study was designed to measure time-dependent changes in muscle excursion and collagen content after tenotomy, and to analyze the correlation between muscle excursion and collagen content in a rabbit model.

Materials and Methods

Twenty-four rabbits underwent tenotomy of the second extensor digitorum longus (EDL) muscles on the right legs and were randomly assigned to three groups based on the period of time after tenotomy (2, 4, and 6 weeks). The second EDL muscles on left legs were used as controls. At each time after tenotomy, passive muscle excursion and collagen content, determined by hydroxyproline content, were measured bilaterally, and the ratio of each value to the normal one was used.

Results

The mean ratio of muscle excursion after tenotomy to the value of the control decreased in a time-dependent fashion: 92.5% at 2 weeks, 78.6% at 4 weeks, and 55.1% at 6 weeks. The mean ratio of hydroxyproline content in muscle to the value of the control increased in a time-dependent fashion: 119.5% at 2 weeks, 157.3% at 4 weeks, and 166.6% at 6 weeks. There was a significant negative correlation between the ratio of hydroxyproline content in muscle after tenotomy to the control values and the ratio of muscle excursion after tenotomy to the control values (r=-0.602, p=0.002).

Conclusion

The decrease in muscle excursion seems to correlate with the increase in collagen content in the muscle in a time-dependent fashion following tenotomy.     

Percutaneous flexor tenotomy for preventing and treating toe ulcers in people with diabetes mellitus

IntroductionThe purpose was to examine the effectiveness of flexor tenotomy in a modified technique to prevent and heal neuropathic and neuroischaemic pressure ulcers on the tip of the toe in claw- or hammer-toe deformities in people with diabetes.Patients and methodsA consequetive 4 years series of 38 patients was retrospectively studied. Percutaneous tenotomy on the superficial and deep flexor tendons was performed in 65 toes through a small transverse plantar stab incision just proximal to the web level. There were 16 (42%) patients with 27 ulcerated toes and 22 (58%) patients with 38 toes with impending ulceration. Ten patients had neuropathic ulcers and six patients had neuro-ischaemic ulcers. Sixteen patients (42%) had macrovascular disease. Ten (26%) had proliferative rethinopathy, 7 (18%) macroalbuminuria and 18 (47%) microalbuminuria.ResultsAll surgical incisions healed uneventfully. Twenty-five (93%) of the toe ulcers healed in median 21 days (range 7–224 days). Three patients had recurrence of the ulcer. There were no infections in the incisions or toe amputations. No patients treated with preventive tenotomy experienced toe ulceration. No complications were recorded in neuro-ischaemic ulcers. During the follow up period of median 31 months (range 2–48 months) 33 other ulcers were recorded in 18 patients (47%). One of these developed a transfer ulceration under the adjacent metatarso-phalangeal joint and another had a late pressure ulcer on a neighbouring toe. The other 31 ulcers were not related to ulcers treated with tenotomy.ConclusionTenotomy is a simple, safe and effective procedure for preventing and treating distal plantar neuropathic toe ulcers in claw toe or hammer toe deformities in people with diabetes with or without serious co-morbidity. The results suggest that tenotomy should be considered also in neuroischaemic ulcers.     

The target phenomenon in rat muscle following tenotomy and neurotomy

Summary Target fibers were checked at regular intervals in two groups of rat gastrocnemius muscle namely after tenotomy and neurotomy. The highest amount of target fibres was observed during the first week. following tenotomy and around the seventh week, when the muscle became again functional by spontaneous union of the tendon. The target phenomenon was restricted to the type II fibres. It appeared also in the early stage of re-innervation, 5 weeks following neurotomy and remained present subsequently in a transitional zone between denervated and re-innervated muscle fibres and was restricted to the type I muscle fibres. The target phenomenon was not the only histochemical alteration observed following tenotomy and neurotomy. This experimental study allowed to determinate more precisely the causal factors of the target phenomenon.     

Electrophysiological study of conditioning lesion effects on rat sciatic nerve regeneration following either prior section or freeze. II. Blocking by prior tenotomy

The conditioning lesion effects refer to the earlier formation and the accelerated regeneration of axonal sprouts following two successive axotomies. In a previous study, we observed that a prior freeze or a prior cut of rat sciatic nerve resulted in differences in the enhancement of the regeneration rate and the reduction of the initial delay. These differences were interpreted as a possible non-neuronal cells influence on the intrinsic regulation of the conditioning lesion phenomenon. In the present study, we attempted to modify the status of the muscles using tenotomy before the prior nerve injury to determine the respective influence of the muscular cells on conditioning lesion effects. Thus, the conditioning lesion, which was either a cut or a freeze of the tibial nerve at the ankle, was performed 14 days after foot sole muscles were tenotomized, close to their insertion into the calcaneus bone. The test lesion was always a freeze of the sciatic nerve at midthigh performed 7 days following the prior lesion. The elongation of the regenerating sprouts was electrophysiologically evaluated and the regeneration rate as well as the initial delay were calculated by means of regression analysis. Tenotomy did not influence the regeneration as was demonstrated in a group with a single sciatic nerve lesion. In contrast, when prior lesion was performed, the tenotomy prevented both the enhancement of the rate of regeneration and the reduction of the initial delay, whatever was the type of the conditioning lesion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Tenotomy procedure alleviates the "slow to see" phenomenon in infantile nystagmus syndrome: model prediction and patient data

Our purpose was to perform a systematic study of the post-four-muscle-tenotomy procedure changes in target acquisition time by comparing predictions from the behavioral ocular motor system (OMS) model and data from infantile nystagmus syndrome (INS) patients. We studied five INS patients who underwent only tenotomy at the enthesis and reattachment at the original insertion of each (previously unoperated) horizontal rectus muscle for their INS treatment. We measured their pre- and post-tenotomy target acquisition changes using data from infrared reflection and high-speed digital video. Three key aspects were calculated and analyzed: the saccadic latency (Ls), the time to target acquisition after the target jump (Lt) and the normalized stimulus time within the cycle. Analyses were performed in MATLAB environment (The MathWorks, Natick, MA) using OMLAB software (OMtools, available from http://www.omlab.org). Model simulations were performed in MATLAB Simulink environment. The model simulation suggested an Lt reduction due to an overall foveation-quality improvement. Consistent with that prediction, improvement in Lt, ranging from approximately 200 ms to approximately 500 ms (average approximately 280 ms), was documented in all five patients post-tenotomy. The Lt improvement was not a result of a reduced Ls. INS patients acquired step-target stimuli faster post-tenotomy. This target acquisition improvement may be due to the elevated foveation quality resulting in less inherent variation in the input to the OMS. A refined behavioral OMS model, with "fast" and "slow" motor neuron pathways and a more physiological plant, successfully predicted this improved visual behavior and again demonstrated its utility in guiding ocular motor research.