锁骨钩钢板固定与单纯同种异体肌腱重建喙锁韧带治疗肩锁关节脱位效果对比

目的比较锁骨钩钢板固定与单纯同种异体肌腱重建喙锁韧带治疗肩锁关节脱位的效果。方法选取2013年8月-2017年12月收治的29例肩锁关节脱位患者,分别采用锁骨钩钢板固定与单纯同种异体肌腱重建喙锁韧带治疗,对两组的手术时间、手术出血量、住院时间、手术侧的肩关节功能评分、术后疼痛视觉模拟评分(visual analogue scale, VAS)进行分析比较。结果锁骨钩钢板组需二次手术取出内固定物,较同种异体肌腱重建喙锁韧带组增加了手术创伤,在手术时间、手术出血量、住院时间、手术侧的肩关节功能评分、VAS评分对比中差异均无统计学意义。结论锁骨钩钢板与单纯同种异体肌腱重建喙锁韧带治疗肩锁关节脱位总体疗效相当,均值得推广应用。     

锁骨钩钢板结合掌长肌腱重建喙锁韧带治疗肩锁关节脱位

目的探讨锁骨钩钢板结合掌长肌腱重建喙锁韧带治疗肩锁关节脱位的临床疗效。方法对21例TossyⅢ型肩锁关节脱位采取锁骨钩钢板内固定联合游离掌长肌腱重建喙锁韧带的方法治疗。结果患者随访6~27个月,平均15个月。切口均一期愈合,无内固定物松动、断裂、骨折及再脱位等并发症发生。根据Lazzcano评分标准:优17例,良4例,优良率100%。结论锁骨钩钢板固定联合掌长肌腱重建喙锁韧带治疗肩锁关节脱位操作简单,并发症少,增强肩锁关节稳定性,防止肩锁关节再脱位或半脱位发生,是一种有效的术式。     

锁骨钩钢板固定加同种异体韧带移植治疗肩锁关节脱位患者的护理

目的探讨锁骨钩钢板固定加同种异体韧带移植重建喙锁韧带治疗肩锁关节脱位患者的护理方法。方法对21例肩锁关节脱位患者采用锁骨钩钢板固定加同种异体韧带移植重建喙锁韧带治疗,加强术前、术后护理评估和功能锻炼指导。结果20例(95.2%)韧带移植患者肩关节功能恢复达优良。结论对肩锁关节脱位行锁骨钩钢板固定加异体韧带移植重建喙锁韧带患者予以正确的护理和适当的功能锻炼,有助于获得满意治疗效果。     

上肢

是否保留肩袖对肩巨大钙化性肌腱炎手术疗效的影响；张力带钢丝内固定加掌长肌腱移植重建喙锁韧带治疗肩锁关节脱位；带胸大肌蒂锁骨膜瓣转移治疗锁骨骨折不愈合；锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位；锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折29例分析；     

胸小肌肌腱重建喙锁韧带结合锁骨钩钢板治疗肩锁关节脱位

目的探讨采用胸小肌肌腱重建喙锁韧带结合锁骨钩钢板治疗肩锁关节脱位的临床疗效。方法对48例（50肩）肩锁关节脱位采用胸小肌肌腱重建喙锁韧带结合锁骨钩钢板治疗。结果本组获得10～18个月的随访,术后疗效评定：优42例,可8例。结论采用胸小肌重建喙锁韧带结合锁骨钩钢板治疗肩锁关节脱位临床疗效好,具有损伤小、操作简单的优点。     

掌长肌腱重建韧带与钩钢板治疗肩锁关节脱位的比较

目的比较自体掌长肌腱重建喙锁韧带并同时修复肩锁韧带与钩钢板固定治疗肩锁关节脱位的疗效差异。方法将2016年1月至2019年6月收治并符合选择标准的40例肩锁关节脱位患者随机分为两组,分别采用自体掌长肌腱重建喙锁韧带同时修复肩锁韧带(A组,20例)以及钩钢板固定(B组,20例)进行治疗。术后随访时间至少5个月(B组随访至拆除钢板后5个月)。记录并进行比较两组手术时间、手术出血量、住院费用及住院时间(B组统计两次住院数据相加);采用医学影像信息系统(picture achining communication sytems,PACS)测量术后及末次随访时患侧喙锁间隙及肩峰与锁骨远端下缘的水平与健侧的差值;测量肩关节活动度并采用Karlsson标准评定关节功能恢复情况,采用疼痛数字评分法(numeric rating scales,NRS)评估患肩疼痛情况。结果两组术中出血量相差不大,均获得满意疗效,差异无统计学意义(P>0.05)。A组较B组手术时间更长,术后疼痛较轻,关节活动功能较好,并发症、住院费用及住院时间更少,差异有统计学意义(P<0.05)。结论两种术式均能取得良好疗效,钩钢板内固定手术简单便捷,并发症较多;重建韧带手术时间较长,关节活动功能更好,并发症、住院费用及住院时间更少。     

陈旧性肩锁关节脱位的治疗

目的：探讨陈旧性肩锁关节脱位临床治疗的效果。方法：运用锁骨钩钢板及喙锁韧带重建术治疗陈旧性肩锁关节脱位患者14例。结果：14例获8～18个月随访,按Lazzcano疗效标准评价,取除内固定前优6例,良4例,取除内固定后优10例,良4例。未出现钢板断裂、松动、脱钩及肩锁关节再脱位。结论：锁骨钩钢板内固定及掌长肌腱重建喙锁韧带术治疗陈旧性肩锁关节脱位是一种操作简便、疗效确切的较好手术方法,若钢板寄留体内影响肩关节功能,应取出。     

AO锁骨钩钢板固定与改良Weaver法治疗急性肩锁关节脱位（Ⅲ～Ⅵ型）

目的探讨AO锁骨钩钢板固定与改良Weaver法治疗急性Ⅲ～Ⅵ型肩锁关节脱位的疗效。方法55例Ⅲ～Ⅵ型肩锁关节脱位患者采用AO锁骨钩钢板固定或改良Weaver法进行治疗,其中23例（Ⅲ型7例,Ⅳ型11例,Ⅴ型4例,Ⅵ型1例）应用一期修复喙锁韧带锁骨钩钢板治疗,32例（Ⅲ型2例,Ⅳ型9例,Ⅴ型17例,Ⅵ型4例）应用改良Weaver法一期重建喙锁韧带,回顾性分析其效果及预后。结果根据Karlsson标准,总体优良率96．3％,修复喙锁韧带锁骨钩钢板固定组总体优良率95．6％;改良Weaver法喙锁韧带重建组总体优良率96．8％。结论一期修复喙锁韧带锁骨钩钢板固定及改良Weaver法一期重建喙锁韧带对于治疗急性Ⅲ～Ⅵ型肩锁关节脱位均能取得满意的疗效。     

自体及同种异体肌腱重建喙锁韧带结合钩钢板固定治疗肩锁关节脱位的疗效比较

目的比较自体跖肌腱及同种异体肌腱重建喙锁韧带联合钩钢板固定治疗肩锁关节脱位的疗效差异。方法将2013年1月-2014年6月收治并符合选择标准的33例肩锁关节脱位患者随机分为两组,分别为自体跖肌腱重建喙锁韧带结合钩钢板固定组(A组,17例)以及同种异体肌腱重建喙锁韧带结合钩钢板固定(B组,16例)。术后31例患者随访达12个月,其中A组15例、B组16例。两组患者性别、年龄、侧别、致伤原因、伤后至手术时间、肩锁关节脱位分型等一般资料比较,差异均无统计学意义(P0.05),具有可比性。记录并比较两组手术时间、住院时间及住院费用;采用X线片测量术前、术后1周及末次随访时患肩喙锁间隙;末次随访时测量肩关节活动度并采用Constant-Murley评分评价关节功能恢复情况,采用疼痛视觉模拟评分(VAS)评估患肩疼痛情况。结果与B组比较,A组手术时间明显延长,住院费用明显降低,比较差异有统计学意义(P0.05);两组住院时间比较差异无统计学意义(t=1.046,P=0.316)。两组患者切口均Ⅰ期愈合,钩钢板均于术后3个月取出。两组患者均获随访,其中A组随访时间19~34个月,平均21.3个月;B组18~37个月,平均23.7个月。X线片复查示无肩峰下骨溶解等情况发生,两组术前、术后1周及末次随访时的患肩喙锁间隙比较,差异均无统计学意义(P0.05)。随访期间,无肩锁关节再脱位、排斥反应发生。末次随访时,两组肩关节活动度、Constant-Murley评分及VAS评分比较,差异均无统计学意义(P0.05)。结论应用自体跖肌腱或同种异体肌腱重建喙锁韧带联合钩钢板治疗肩锁关节脱位,临床疗效满意;但自体跖肌腱重建手术费用低于同种异体肌腱,因此可根据患者经济情况选择合适治疗方式。     

股薄肌腱假体重建喙锁韧带治疗急性Ⅲ型肩锁关节脱位临床分析

目的探讨同种异体股薄肌腱重建喙锁韧带治疗急性Ⅲ型肩锁关节脱位的临床疗效。方法选择2008年1月至2012年8月,收治的急性肩锁关节脱位患者23例,所有患者均经诊断确定为TossyⅢ度肩锁关节脱位。均采用同种异体股薄肌腱重建喙锁韧带进行治疗,比较患者术前、术后1个月以及末次随访时肩锁关节疼痛、功能以及稳定的JOA评分以及患肢的康复情况。结果与患者术前JOA评分相比,术后1个月和末次随访时肩锁关节疼痛、功能以及稳定性的JOA评分均明显提高,差异均有统计学意义（P〈0.05）。所有患者临床疗效评价优为19例,占82.61%,良为4例,占17.39%。所有患者均无锁骨钻孔经过喙肩韧带处骨折、内固定物松散断裂或钩部折断等并发症的发生。结论同种异体股薄肌腱重建喙锁韧带治疗急性Ⅲ型肩锁关节脱位,能够有效地提高患者的治疗效果,并能降低患者再脱位的可能性,是一种切实可行的临床治疗方法,值得进一步推广应用。     

Healing,Inflammation, and Fibrosis: Tendon: Principles of Healing and Repair

Tendon stores, releases, and dissipates energy to efficiently transmit contractile forces from muscle to bone. Tendon injury is exceedingly common, with the spectrum ranging from chronic tendinopathy to acute tendon rupture. Tendon generally develops according to three main steps: collagen fibrillogenesis, linear growth, and lateral growth. In the setting of injury, it also repairs and regenerates in three overlapping steps (inflammation, proliferation, and remodeling) with tendon-specific durations. Acute injury to the flexor and extensor tendons of the hand are of particular clinical importance to plastic surgeons, with tendon-specific treatment guided by the general principle of minimum protective immobilization followed by hand therapy to overcome potential adhesions. Thorough knowledge of the underlying biomechanical principles of tendon healing is required to provide optimal care to patients presenting with tendon injury.     

CLOSURE OF LARGE PHARYNGO-OESOPHAGEAL FISTULAS WITH FREE FLAP TRANSFER AFTER RESECTIONS FOR CANCER

Postoperative salivary fistulas still remain a serious and potentially lethal problem in head and neck reconstruction particularly if the fistula is large and involving one half or more of the circumference of the pharyngo-oesophagus. Pedicled flaps have traditionally been the flaps of choice for closure of these fistulas, but the results are often disappointing. During the period 1982 to 1995, we have used either a radial forearm free flap or a jejunal free flap to close large and complex pharyngo-oesophageal fistulas after resection for cancer in 15 patients. Although two patients developed major fistulas that required additional operations for closure, successful closure was achieved in all but one case: the success rate was therefore 14/15 (93%). We consider that jejunal flaps are suitable for circumferential pharyngo-oesophageal reconstruction and forearm flaps for non-circumferential defects.     

Auto‐crosslinked hyaluronic acid gel accelerates healing of rabbit flexor tendons in vivo

This study's purpose was to assess the in vivo effect of auto‐crosslinked hyaluronic acid (HA) gel, a natural HA derivative with increased viscosity and tissue residence time, on adhesions and healing of injured and surgically repaired rabbit digital flexor tendons. The second and third right deep digital flexor tendons from 48 rabbits (n = 96 tendons) were cut and repaired with a modified Kessler and running peripheral suture. Animals were randomized to two groups, receiving either HA gel or saline injected around both freshly repaired tendons. After 2, 3, 6, and 12 weeks, six rabbits in each group were euthanized. Tendon pull‐out force and breaking strength were measured as a value for adhesion formation and tendon healing, respectively. A histological assessment of adhesions and healing was related to the mechanical results. A significantly faster increase in breaking strength was found in HA gel‐treated compared to saline‐treated tendons; this coincided with a significantly accelerated tissue repair response after injury. No significant difference in adhesion formation was found between the two groups at any time. Our results indicate a significant acceleration of in vivo healing of tendons treated with HA gel. Adhesion formation was unaffected. These results could have important clinical value in promoting rehabilitation after tendon injury. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:408–415, 2009     

Is cultured tendon fibroblast a good model to study tendon healing?

Cultured tendon fibroblasts (CTFs) from intact explants are widely used to study tendon healing in vitro. The significance of these findings may rely on similarities between CTFs and healing tendon fibroblasts in situ. Our purpose was to compare CTFs with fibroblasts cultured from healing tendons. We cultured CTFs from intact and healing tendons at day 7 and day 14 postinjury in a rat model of patellar donor site injury. The mRNA expression of COL1A1, COL3A1, decorin, and biglycan, with or without supplementation of 1 ng/mL TGF‐β1, was compared by quantitative real‐time RT‐PCR. The expression of proliferation cell nuclear antigen (PCNA) and α‐smooth muscle actin (α‐SMA) was determined by immunostain. COL3A1 and decorin mRNA in CTFs was lower as compared to day 7 healing fibroblasts, but its biglycan mRNA level was higher than day 14 healing fibroblasts. TGF‐β1 increased COL1A1 and decorin mRNA in CTFs, but decreased the mRNA of all four genes in day 7 healing tendon fibroblasts. CTFs exhibited lower PCNA immunopositivity as compared to day 7 and day 14 healing fibroblasts, but a higher α‐SMA immunopositivity than cultured day 14 healing fibroblasts. These findings showed that CTFs did not resemble healing tendon cells with respect to major cellular activities related to tendon healing. Thus, fibroblasts from healing tendon may be a more appropriate model for studying cellular activities in tendon healing. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:374–383, 2008     

Flexor tendon grafting using a plantaris tendon with a fragment of attached bone for fixation to the distal phalanx: a preliminary cohort study

PURPOSE: Secure methods of graft attachment ensure safe early motion after flexor tendon grafting. This has been achieved at the proximal graft juncture using Pulvertaft's technique. For secure distal attachment, we investigate the results of flexor tendon grafting using the plantaris tendon with a fragment of attached bone fixed with a screw to the distal phalanx. METHODS: Thirteen digits from 10 patients with longstanding flexor tendon injuries in zone II had surgical reconstruction. A plantaris tendon-bone graft was attached to the distal phalanx using a mini-screw. This was followed by immediate active motion. At 3 and 8 months after surgery, total active motion was calculated as the sum of the degrees of active flexion in the proximal and distal interphalangeal joints minus the sum of the degrees of extension deficits for each of these joints. The results of total active motion were compared to the normal contralateral digit. RESULTS: Three months after surgery, the mean rate of recovery, relative to the normal contralateral finger, was 74%, whereas 8 months after surgery, this value was 70%. This difference was statistically significant. There were no failures or poor results (ie, less than 50% recovery). CONCLUSIONS: The tendon-bone plantaris graft employed here ensured immediate active motion and early use of the involved hand in daily activities. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.