同种异体肌腱移植在治疗肩锁关节脱位中的应用

肩锁关节脱位是肩部常见的损伤之一，多由直接暴力所致，治疗方法目前较多，但各有利弊。自2000年2月至2005年10月，笔者对36例肩锁关节脱位采用同种异体肌腱移植治疗，术后获得了满意的效果。现报告如下。     

自体半腱肌及股薄肌肌腱桥接修补陈旧性MyersonⅢ型跟腱断裂疗效分析

目的:探讨半腱肌及股薄肌肌腱桥接修补陈旧性MyersonⅢ型跟腱断裂的临床疗效。方法:2006年4月至2008年10月,根据术前MRI检查测量跟腱缺损长度,共收治陈旧性MyersonⅢ型跟腱断裂患者共24例,运用自体半腱肌及股薄肌肌腱进行桥接修补,术后给予石膏外固定,进行常规康复治疗。采用Amer-Lindholm法评定疗效。结果:所有患者均获得随访,随访时间12～30个月,平均18个月。依据Amer-Lindholm疗效评定标准,优21例,良2例,差1例,优良率95.8%。随访期内无跟腱再断裂、周围神经损伤及切口深部感染等并发症。结论:自体半腱肌及股薄肌肌腱桥接修补陈旧性MyersonⅢ型跟腱断裂是一种安全、疗效满意的方法。     

同种异体关节移植的现状

同种异体关节移植较广泛应用于修复各种原因造成的大段骨关节端缺损，同种异体骨关节移植中存在的免疫排斥反应及骨延迟愈合、不愈合、疲劳骨折、创伤性关节炎、感染等并发症是影响治疗效果的重要因素。本文综述了近几年国内外临床及实验研究文献中对以上问题的分析及新近提出的有效应对措施，如在移植骨上复合生长因子促进移植骨与宿主骨愈合，利用骨膜和软骨膜移植、修复软骨缺损，利用碱性成纤维细胞生长因子（bFGF)、肝细胞生长因子（HGF）、血小板诱导生长因子（PDGF）、转移因子β（TGF－β）等生长因子促进软骨修复等措施。此外，还简要引述了制备、贮存供体材料的新观点。     

跟腱延长术治疗陈旧性跟腱断裂15例

跟腱断裂在小腿和足部肌腱损伤中较为常见。新鲜损伤病例的治疗,效果大多满意。跟腱突然断裂往往未引起伤者的重视,加上临床误诊等原因,治疗时常常已成陈旧性损伤,其发生率高达20%～30%[1]。陈旧性跟腱断裂治疗上有一定难度,治疗效果常不如早期就诊的病例。2009年1月—2012年5月,我们应用跟腱延长术治疗陈旧性跟腱断裂15例,效果良好。现报道如下。     

同种异体神经移植的影响因素

异体神经修复神经缺损易被排异。人们采用了一些预处理方法,如冷冻,放疗等来降低异体神经移植体的抗原性,虽然取得了一些进展,但结果仍不满意。应用免疫抑制剂,效果较理想,但停药后排异反应仍难避免。神经移植体的血供及手术吻合方式对神经再生也有影响,总之,周围神经同种异体移植的关键是免疫排斥,这一方面的研究仍处于实验阶段。     

异体肌腱移植的实验研究

 采用兔跟腱-80 ℃低温冷冻保存2周后异体移值,术后2、4、6、8周观察其组织形态学变化,测定肌腱的生物力学强度,并与正常肌健、新鲜自体移植肌腱对照.结果表明冷冻异体肌腱和新鲜自体肌腱的生物力学强度基本相同,但弱于正常肌腱,没有明显的排斥反应,异体肌腱经低温冷冻处理后可以代替自体肌腱移植.     

同种异体肌腱移植在治疗肩锁关节脱位中的临床应用

肩锁关节脱位是肩部常见的损伤之一,多由直接暴力所致,治疗方法目前较多,但各有利弊。2000-02~2005-10我们对36例肩锁关节脱位采用同种异体肌腱移植治疗,获得了满意的效果,现介绍如下。1临床资料1.1一般资料:本组36例,男28例,女8例。年龄42~52岁,平均26.5岁。左肩锁关节脱位21例,右肩15例。致伤原因:车祸伤15例,骑摩托车、自行车致伤8例,高处坠落伤5例,骑马摔伤2例,其他原因引起的损伤6例。受伤到就诊时间为2 h~34 d,手术前时间3~7 d,损伤程度按A llm an分:II度17例,III度19例。1.2同种异体肌腱取材准备:本组肌腱来源健康的尸体,均经过术…     

异种异体和同种异体半月板移植修复兔膝关节半月板缺失的预后研究

目的:研究同种异体半月板和异种异体半月板移植后,移植物在关节内的转归和移植物对关节软骨的保护作用.方法:切除30只成年新西兰白兔的内侧半月板造成内侧半月板缺失的模型,并将新西兰兔分为A组和B组.A组进行同种异体内侧半月板移植.B组从猪半月板取小块半月板组织,修剪成同兔内侧半月板形态和尺寸相同的异种异体半月板植入物,进行兔内侧半月板的异种异体移植.在术后第6周、第12周、第24周时宰杀动物,观察移植半月板、内侧胫骨平台软骨、股骨内髁负重区软骨和股骨滑车软骨的大体形态学改变和组织病理学改变.结果:同种异体半月板移植后,半月板在关节内的形态良好,与关节囊周围愈合良好,移植24周后,可见关节软骨损伤不明显.异种异体半月板移植后短期半月板和关节软骨情况良好,24周后移植物部分被吸收,关节软骨也出现退变和损伤.结论:用猪的半月板组织塑形后移植替代兔内侧半月板组织,术后24周移植物被溶解吸收,并开始出现关节软骨退变.同种异体内侧半月板移植后,半月板的结构和功能重建良好,而且对关节软骨起到了良好的保护作用.     

低温冷冻和酒精处理的同种异体周围神经移植的效果比较

目的 比较低温冷冻和酒精处理的同种异体周围神经移植的疗效。方法 取45只成年雄性SD大白鼠，随机分为A、B、C、D4组。A、B、C组为实验组，每组10只；D组为供体组，15只，切取双侧坐骨神经15mm作为供神经。A组的供体神经在－196℃下保存3周，37℃生理盐水复温后桥接于受体一侧坐骨神经10mm缺损段；B组用70％酒精浸泡8小时后，桥接于受体一侧坐骨神经10mm缺损段；C组的供体神经不经任何预处理，桥接于受体一侧坐骨神经10mm缺损段。术后17周进行电生理测定，光镜观察及移植异体神经中段的轴突计数。结果 A、B实验组的电生理测定及移植神经中段的轴突计数结果无显著性差异，光镜下的形态学变化相似。A、B组与C组、电生理测定与移植体中段轴突计数均有显著性差异。结论 两种预处理方法降低异体神经的抗原性具有相似的近期效果。     

Reconstruction of quadriceps tendon with Achilles tendon allograft in older children with congenital dislocation of the knee

This is a case report of two children with congenital dislocation of the knee. They have been treated surgically with Z-lengthening of the quadriceps tendon and additional reconstruction of the quadriceps tendon with Achilles tendon allograft to fill in the remaining average 6 cm gap of the tendon. The patients were two girls, 6 and 9 years old. One of them had an operative treatment previously with a tendon lengthening procedure and it was failed and the other patient was untreated before. Preoperatively, untreated case was unable to walk. The other patient was limping. None of them was able to flex their knees beyond the neutral extension position. Postoperatively, both patients were able to walk and the knees were reduced to a range of motion of 0°–95° of flexion. The mean follow-up time was 20 months.     

Arthroscopic and open surgical techniques for meniscus replacement – meniscal allograft transplantation and tendon autograft transplantation

Open, arthroscopically assisted and arthroscopic methods for lateral and medial meniscus allograft transplantation with bone plug fixation are described. An open technique for medial and lateral meniscus transplantation without bone plug fixation, as well as an open technique for autograft quadriceps tendon replacement of the medial meniscus are described.     

Tendon elongation and muscle function after repair of Achilles tendon rupture

Thirty-four recreational atlethes with a mean age of 40 years were operated for a fresh subcutaneous rupture of the Achilles tendon with an approximating suture of the tendon in combination with 8 weeks in an equinus below-knee plaster. The elongation of the tendon during the rehabilitation was measured radiographically with implanted steel-wire indicators. The residual muscle function and the range of motion were recorded 1 year after the operation in 30 of the patients. There was no change in the passive range of motion and no elongation of the tendon during the primary healing period. The muscle function, measured with a special dynamic step test, was significantly impaired compared with the healthy side. Although the function was reduced in 17% of the patients, there was no subjective discomfort.     

Bilateral Achilles tendon rupture: a report on two cases

Two cases of traumatic bilateral Achilles tendon rupture are reported. One of the patients was a healthy middle-aged man, who had been an active nationallevel gymnast 20 years earlier. He had not suffered any complaints of Achilles tendons before. The ruptures occurred when, after a sauna, he showed his guests a vault forwards, which he had been able to perform easily. This time the landing took place on the toes, causing a high peak stretch to the calf muscles and Achilles tendons. The total rupture of both Achilles tendons was treated surgically, with an excellent result 2 days after the trauma. End-to-end suturation and a fascial flap plasty were made on both sides. No macroscopic degeneration could be detected on the rupture sites. He was allowed to walk freely 6 weeks after the surgery. The second case was a 54-year-old woman, who had suffered from Achilles tendinitis and peritendinitis for 2 years. Both tendons had been surgically treated, and severe adhesions and local degenerative changes had been found. The tendon rupture occurred when she injured her left ankle while getting out of the car. Two days later she fell at home, because of the weakness of the left side, and consequently the right Achilles tendon was injured. She was treated conservatively for 10 days, before the surgery was performed. Both tendons were ruptured and an extensive degeneration of the area was observed. The right side suffered from a rerupture, which was again treated surgically. After surgery the recovery was slow, but the final result 3 years later was moderate. Neither of the patients had any systemic diseases.     

急性闭合跟腱断裂端端缝合术后远期疗效观察

目的 评价急性闭合跟腱断裂端端缝合术后的远期疗效.方法 2000年11月-2006年6月收治28例急性闭合跟腱断裂患者,其中男20例,女8例,年龄19～48岁,平均36.5岁,术前MRI提示跟腱完全断裂,所有病例均在伤后4d内行手术治疗.跟腱断端稍做修整后,采用Kessler法或Bunnell法行端端缝合,术后随访12～36个月,平均20个月,参照Arner-Lindholm评分标准进行疗效评定,并对术后并发症进行记录.结果 28例患者中优19例,良9例,优良率100%,术后3个月均恢复正常行走并开始康复训练.随访期内无周围神经损伤,无跟腱再断裂.术后并发症包括浅表伤口感染1例、伤口皮缘坏死l例,并发症发生率7.1%.结论 端端缝合术修复急性闭合跟腱断裂术后并发症少,长期随访疗效优良.     

Achilles tendon rupture in an elite athlete following multiple injection therapies

Achilles tendinopathy is common, and its management continues to be challenging, especially in elite athletes. Despite a wide range of novel management options, none guarantees a rapid return to high level sporting activity. Eccentric exercise has been shown to reduce symptoms and normalise imaging abnormalities, but time constraints on professional athletes often make this an unrewarding isolated management strategy. Eccentric exercises concurrent with ongoing training may not be as successful as eccentric training alone, reducing one's confidence in this modality for the “in-season” tendinopathy in the elite athlete. When a professional athlete is faced with a tendinopathy recalcitrant to eccentric exercise, manual therapy and orthotics, a more invasive approach is often attempted to expedite a return to unencumbered training. Numerous injection therapies are described, ranging from homeopathic products to glucocorticosteroids. The robustness of the literature surrounding these techniques is variable, but when an athlete is desperate to return to full training, clinicians working with elite athletes are often tempted to utilise more empirical management options. We present a patient who illustrates the potential dangers of injection therapy in the elite athlete, in particular sequential injection therapy involving vascular sclerosants, which to our knowledge has not previously been described. Written consent for the presentation of this case was obtained from the athlete concerned.     

Increased unilateral tendon stiffness and its effect on gait 2–6 years after Achilles tendon rupture

Achilles tendon rupture (ATR) alters tissue composition, which may affect long‐term tendon mechanics and ankle function during movement. However, a relationship between Achilles tendon (AT) properties and ankle joint function during gait remains unclear. The primary hypotheses were that (a) post‐ATR tendon stiffness and length differ from the noninjured contralateral side and that (b) intra‐patient asymmetries in AT properties correlate to ankle function asymmetries during gait, determined by ankle angles and moments. Ultrasonography and dynamometry were used to assess AT tendon stiffness, strain, elongation, and rest length in both limbs of 20 ATR patients 2–6 years after repair. Three‐dimensional ankle angles and moments were determined using gait analysis. Injured tendons exhibited increased stiffness, rest length, and altered kinematics, with higher dorsiflexion and eversion, and lower plantarflexion and inversion. Intra‐patient tendon stiffness and tendon length ratios were negatively correlated to intra‐patient ratios of the maximum plantarflexion moment and maximum dorsiflexion angle, respectively. These results suggest that after surgical ATR repair, higher AT stiffness, but not a longer AT, may contribute to deficits in plantarflexion moment generation. These data further support the claim that post‐ATR tendon regeneration results in the production of a tissue that is functionally different than noninjured tendon.     

A new finding in the radiographic diagnosis of Achilles tendon rupture

The authors describe a new radiographic sign of rupture of the Achilles tendon system. It is a fracture, with separation through an osteophyte at the insertion of this tendon. Previously reported signs are also discussed as well as the present case report.     

Calf muscle atrophy and Achilles tendon healing following experimental tendon division and surgery in rats

We used a rat model to study the effects of immobilization of the calf muscle-tendon complex after an experimental Achilles tendon repair. Immobilizations of the complex in either a relaxed or tensioned position were compared by histochemical and morphometric analyses at the site of the tendon injury as well as in the gastrocnemius and soleus muscle bellies. The type of immobilization did not affect the healing of the tendon injury because no reruptures occurred in either of the treatment groups and the average tendon end-to-end distance did not differ between the groups. However, immobilization in a relaxed position led to a significantly more extensive fiber atrophy in the calf muscles. In clinical practice, these results suggest that rehabilitation after Achilles tendon surgery can be early and gradually tension- and load-increasing without a significant increase in the risk of rerupture of the tendon.     

Exact moment of tendon of pectoralis major muscle rupture captured on video

A powerlifting athlete ruptured his left tendon of the pectoralis major muscle while attempting to lift 160 kg in a Brazilian bench press championship. The injury seemed to occur in the concentric phase of exercise; however, the more common mechanism of rupture is during the eccentric phase. The tendon was reinserted to the humerus 3 weeks later with screws and washers. The athlete returned to competitive activities after 5 months. One year later he lifted 170 kg and won the national championship.