大隐静脉修复鞘管防止屈肌腱粘连的实验研究与临床应用

目的：观察大隐静脉修复鞘管防止屈肌腱粘连的效果和临床应用的可行性。方法：将３０只鸡的双足中趾造成相同的肌腱和腱鞘损伤，一侧用大隐静脉修复鞘管为实验趾；一侧不修复鞘管直接缝合切口为对照趾。随机分组，分别在术后１、２、４、６和１２周进行双侧趾的屈曲功能、大体解剖和光镜观察。结果：实验趾的屈曲功能明显优于对照趾。大体解剖见用大隐静脉修复的鞘管近似正常鞘管结构，可完全阻止肌腱粘连，不影响肌腱愈合。对照趾肌腱与周围组织粘连紧密，影响肌腱滑动。光镜下见移植的静脉外膜与周围组织愈合好，内膜光滑与肌腱无粘连。临床应用２１例３３指，平均随访１８个月，优良率达９０％以上。结论：大隐静脉修复鞘管是防止屈肌腱粘连较有效的方法。     

大隐静脉修复鞘管防治儿童Ⅱ区指屈肌腱粘连

目的探讨自体大隐静脉移植重建腱鞘缺损防止儿童指屈肌腱Ⅱ区损伤中术后粘连的临床效果。方法回顾总结儿童指屈肌腱Ⅱ区损伤应用显微外科手术，采用自体大隐静脉移植重建腱鞘缺损38例，修复56根肌腱及鞘管。结果经6～24个月随访，采用TAM系统法评定疗效：优45指，良6指，可5指，总优良率91．07％．术后无发生肌腱粘连。结论自体大隐静脉移植重建腱鞘缺损防治在儿童指屈肌腱Ⅱ区损伤术后肌腱粘连，手术操作简单，取材方便，效果优良，易于I临床推广应用。     

大隐静脉代腱鞘在手外科的应用

在手掌部屈指肌腱Ⅱ区鞘内屈指肌腱损伤的缝合，或后期游离肌腱的移植术，肌腱的粘连一直是一个尚未能很好解决的问题。作者自１９９２年以来，用自体大隐静脉代腱鞘游离掌长肌腱移植，重建屈指肌腱的功能，手术７例８例，经术后６至２６个月的随访（平均１３个月）手指屈指功能恢复满意。     

自体静脉移植重建腱鞘防止肌腱粘连

１９９０年以来，应用显微外科技术，行自体大隐静脉移植重建腱鞘手术１７例，共修复２３根肌腱、鞘管。术后配合早期功能锻炼，经１０个月～４年随访，按ＴＡＭ法评定疗效，除３根肌腱因伤口感染、移植静脉及肌腱外露，形成瘢痕愈合，疗效差外，其余患者全部达优。详细介绍了自体大隐静脉移植重建腱鞘，防止肌腱粘连的手术方法，强调无损伤操作对预防肌腱粘连的重要性     

脂肪组织腱鞘填充防止肌腱粘连的实验研究

脂肪组织腱鞘填充防止肌腱粘连的实验研究卢全中田万成谢战勇范钦平常风廷宋海涛潘风雨王儒芬本研究目的旨在观察脂肪组织填充腱鞘在兔趾屈肌腱损伤模型中的作用，为临床工作中屈肌腱粘连选择一种预防粘连的材料。材料与方法（一）实验动物和手术方法选用３０只２．５～３...     

大隐静脉修复鞘管在复杂断指再植中的临床应用

复杂手指离断再植术后肌腱粘连是其功能恢复不佳的主要原因之一,往往需要二期肌腱粘连松解术,但效果仍不理想。随着对肌腱愈合机制的不断认识,再植术中修复肌腱的同时修复重建鞘管,特别是对伴有腱周围组织广泛损伤的病例,更应该重视损伤腱鞘的修复重建。因此我们在动物实验基础上[1],将大隐静脉修复鞘管技术应用在复杂断指再植术中,能有效防止屈肌腱粘连,经长期随访,取得了满意效果。1资料与方法1.1一般资料本组35例,男23例,女12例;年龄5～45岁,平均23岁。右手21例,左手14例,共42指。全部病例均为2～5指鞘管区平面损伤,完全离断21例,不完全…     

腱鞘修复对屈指肌腱损伤修复的影响的实验研究

本文报告了对免进行切除腱鞘，从侧面切开腱鞘，从掌面正中切开腱鞘等３种手术后，观察吻合后的不全横断的深肌腱与腱鞘的愈合情况。术后各手术趾的活动范围、腱滑动距离在３种手术间无统计学差异；组织学显示３种方法中，３周时深腱与鞘间粘连最明显，以后减少。说明在一定条件下．不修复腱鞘也可有较好的手术效果。     

手指鞘管内屈肌腱损伤的急诊显微外科修复

目的 回顾性研究手指腱鞘内屈肌腱损伤急诊显微外科修复的效果。方法 应用显微外科技术急诊修复手指腱鞘内屈肌腱操作１５１例３８２条肌腱。结果 优９８例,良３７例,可９例,差７例,优良率８９．４％。结论 手指腱鞘内屈肌腱损伤采用显微肌腱缝合方法并修复腱鞘,一期修复可获得较好疗效。     

肌腱修复时机及腱鞘处理的实验研究

为探讨肌腱修复时机和腱鞘处理的作用，采用６０只来亨鸡双侧第三趾作实验，切断屈趾深肌腱后，根据伤后修复时间（立即、４、８、１４和２０天）分为Ａ、Ｂ、Ｃ和Ｅ五组。左侧足趾作腱鞘直接闭合，右侧作切除。修复后６周末检测腱滑动距离、足趾活动度、腱愈合、腱鞘形态。结果表明早期效果最佳，随伤后时间的延长肌腱功能和愈合变差，延迟较长时间导致明显功能受损。张力下关闭腱鞘在腱愈合时并不能保持其完整性，且不能提高腱功能。研究提示肌腱损伤后最佳修复时机是早期，延迟修复在伤后３周至１个月之内虽均能施行，但应尽可能在伤后较早数日内进行，延迟期内腱修复时不主张同时直接闭合修复腱鞘。     

舒筋汤对肌腱粘连防治的生物力学和生化研究

目的 :研究中药舒筋汤对家兔肌腱损伤术后粘连的防治作用。方法 :将 48只动物分为实验组 (A)、地塞米松组 (B)和生理盐水组 (C) ,均于双下肢第三趾伸趾肌腱中段横行切断后吻合 ,每日 2次分别给予灌胃治疗。术后 30min测定毛细血管通透性 ;术后 2、4、8周行生物力学及羟脯氨酸测定 ,同时观察肌腱的大体解剖形态。结果 :术后 30minA、B组毛细血管通透性显著降低 ,与C组相比呈显著性差异 (P <0 .0 0 1)。术后 2、4、8周A、B组粘连范围较小 ,伸趾功能、肌腱完全拉出力较好 ,与C组相比有显著性差异 (P <0 .0 5 ) ;抗张强度和羟脯氨酸含量测定A组与C组相比无显著性差异(P >0 .0 5 ) ,与B组呈显著性差异 (P <0 .0 5 )。结论 :舒筋汤能有效减轻肌腱损伤术后粘连 ,且不影响愈合。     

A New Technique of Achilles Tendon Rupture Repaired by Double Transverse Mini‐incision to Avoid Sural Nerve Injury: A Consecutive Retrospective Study

ObjectivePercutaneous suture is a classic technique used in Achilles tendon repair. However, the complication rates surrounding the sural nerve remain relatively high. Modified percutaneous repair technology can effectively avoid these complications; however, the surgical procedure is complicated. Hence, the present study was conducted to describe a redesigned repair technique for the Achilles tendon able to avoid sural nerve injury and reduce the complexity of the procedure.MethodsData of patients with acute primary Achilles tendon rupture at our hospital from January 2019 to May 2020 were included. Subjects with expectations for surgical scarring underwent a minimally invasive‐combined percutaneous puncture technique. The surgical time, requirement for conversion to other technologies, and length of postoperative hospitalization were investigated to assess efficacy. The American Orthopedic Foot & Ankle Society (AOFAS) score and the Arner–Lindholm scale (A‐L scale) were used to assess postoperative clinical outcomes (> 24 months). During the 2‐year follow‐up, MRI was performed to observe the healing of the Achilles tendon. In addition, subjective satisfaction with surgical scar healing was recorded.Results Twenty consecutive subjects with an average follow‐up of 28.3 ± 4.5 months (range, 24–41) met the inclusion criteria. None of the 20 enrolled patients required a converted surgical approach. The mean surgical time was 26.9 ± 6.47 min (range, 20–44). None of the patients experienced dysesthesia or anesthesia around the sural nerve. No signs of postoperative infections were observed. MRI data showed that the wounds of the Achilles tendon healed completely in all the subjects. The AOFAS score increased from 55.6 ± 11.07 (range, 28–71) preoperatively to 97.8 ± 3.34 (range, 87–100) at the last follow‐up. The A‐L scale showed that 90% of the subjects (n = 18) presented as excellent and 10% of the subjects (n = 2) presented as good, with an excellent/good rate of 100%. Moreover, subjects'' satisfaction for surgical scars was 9.1 ± 0.78 (upper limit, 10).ConclusionsThe results indicate that this technique can achieve good postoperative function, a small surgical incision, and high scar satisfaction. In addition, this technique should be widely used in suturing Achilles tendon ruptures.     

A Comparison of the Fixation Strengths Provided by Different Intraosseous Tendon Lengths during Anterior Cruciate Ligament Reconstruction: A Biomechanical Study in a Porcine Tibial Model

Background

The purpose of this study was to determine the tibial fixation strength provided by different intraosseous soft tissue graft lengths within the tibial tunnel.

Methods

Porcine tibial bones and digital flexor tendons were used for testing. Bone mineral densities of proximal tibial medial condyles were measured, and two-strand tendon bundles of 8 mm diameter were used. An intraosseous graft length of 2 cm was used in group 1 (n = 10), and a graft length of 4 cm was used in group 2 (n = 10). Tunnels were 4 cm in length and 8 mm in diameter. Tibial fixation was performed using a suture tied around a screw post with a washer and an additionally inserted 7 × 20 mm bioabsorbable screw. After applying preconditioning loading of 10 cycles, 1,000 cycles between 70-220 N were applied at a frequency of 1 Hz. Graft slippage and total graft movement were recorded. Ultimate tensile strength was measured by pull-out testing at an Instron crosshead speed of 1,000 mm/min.

Results

No significant intergroup difference was found for total graft movement after cyclic loading (slippage in group 1, 1.2 mm and group 2, 1.2 mm, respectively, p = 0.917; and total graft movement in group 1, 3.3 mm and group 2, 2.7 mm, respectively, p = 0.199). However, mean ultimate tensile strength in group 2 was significantly higher than that in group 1 (group 1, 649.9 N; group 2, 938 N; p = 0.008).

Conclusions

In a porcine model, ultimate tensile strength was greater for a 4 cm long intraosseous flexor tendon in the tibial tunnel. However, no intergroup difference in graft slippage or total graft movement was observed. The results show that a 2 cm intraosseous graft length in the tibial tunnel is safe and has sufficient strength (> 450 N) for adequate rehabilitation after anterior cruciate ligament reconstruction.     

补肾、健脾及脾肾双补对地塞米松诱发之骨质疏松大鼠PTH、CT、T、E2及BGP值影响的实验研究

目的：探讨补肾，健脾及补肾合健脾三种中药防治由地塞米松诱发之大鼠骨质疏松的效果及作用机制，为临床用药及进一步有效筛选中药提供依据。方法：采用12月龄的老年SD大鼠，随机分为5组，给予地塞米松造模，于中药治疗后6w和13w测定骨密度，血清降钙素，骨钙素，性激 素及甲状旁腺素，结果：三种方药均可有效地改善骨质疏松症状，补肾中药以增高性激素浓度尤其是血清睾酮为主，健脾则通过降低甲状旁腺素（PTH）来抑制骨的吸收，而补肾和健脾则可协同提高血清降钙素（CT）的浓度。结论：补肾，健脾及补肾合健脾在不同环节通过不同的作用机制防治骨质疏松。     

Study on the Distribution of Disease‐Resistant Shrimp Identified by DNA Markers in Respect to WSSV Infection in Different Seasons Along the Entire East Coast of India Aiming to Prevent White Spot Disease in Penaeus monodon

White spot disease caused by white spot syndrome virus (WSSV) is responsible for harming shrimp aquaculture industry and results in a pandemic throughout the world. Undeniably, the knowledge on geographic distribution, transmission, virulence, and seasonal prevalence of this disease alongside information on the distribution of disease‐resistant shrimps may be helpful to understand important aspects of disease biology. This study was intended to estimate WSSV prevalence by qualitative and quantitative PCR method among the Penaeus monodon samples collected from four different places namely Digha, West Bengal; Chilika, Orissa; Visakhapatnam, Andhra Pradesh; and Chennai, Tamil Nadu at three different seasons in the period of 2011–2013 from east coast of India. Along with this, the disease‐resistant prevalence was also investigated using earlier developed 71 bp microsatellite and 457 bp RAPD‐SCAR DNA marker among the collected shrimps. Qualitative PCR depicted that the cumulative WSSV prevalence at four places was the lowest (0%) at pre‐monsoon, whereas, it was the highest (21.2%) during post‐monsoon season. Quantitative real‐time PCR showed the average copy number of WSSV to be the highest (~10³ copy μg⁻¹ shrimp genomic DNA) at post‐monsoon season. Additionally, estimated disease‐resistant prevalence was the highest in Visakhapatnam (79%) and lowest in Digha (21%). It is well known to all that a trait cannot be identified using a single genetic pattern. This study will significantly contribute insight to develop specific pathogen‐resistant (SPR) seeds of P. monodon simultaneously using two DNA markers that would be a cost‐effective and safer approach towards disease prevention instead of conventional trends of seed generation from unselected wild broodstock.