透明质酸钠在防治肌腱损伤术后粘连中的临床观察

目的观察透明质酸钠（施沛克）防止肌腱粘连的作用。方法一期修复新鲜肌腱损伤30例47条肌腱,术中用腱心缝合法缝合肌腱后,在肌腱周围均匀涂抹2%的施沛克0.5～1ml,术后72h开始功能锻炼,2周拆线后开始蜡疗。另选30例41条肌腱用同样方法修复,但不用施沛克作对照。结果两组经术后2、4、8周的随访,按TAM法评定疗效,施沛克组47条肌腱,疗效优良42条,优良率为89.4%,显著高于对照组的65.9%（P〈0.05）。结论施沛克具有促进肌腱愈合,防止或减轻术后肌腱粘连的作用。     

透明质酸钠预防手屈指肌腱粘连回顾性对照研究

目的：评价透明质酸钠防治手屈指肌腱粘连的有效性和安全性。方法：回顾性分析56例手屈指肌腱手术者，在肌腱损伤修复部鞘内或局部，分别注入透明质酸钠凝胶制剂。A组30例，注入20mg/2mL；B组28例不同透明质酸钠。其它治疗两上同；术后4，7，12周测定相关部位的功能、疼痛、肿胀情况，按关节功能、握拳功能评价透明质酸钠预防粘连的效果。结果：56例经4－12周随访，A组优良率70．00％，无明显不良反应。B组39．29％，两组比较P＜0．05。结论：透明质酸钠凝胶预防术后屈指肌腱粘连有明显的作用，作用安全、方便。     

玻璃酸钠在预防屈指肌腱断裂修复后粘连的临床效果观察

目的 探讨玻璃酸钠预防屈指肌腱断裂修复后粘连的临床效果及可行性.方法 选取2013年1-10月来我院就诊的急性手部屈肌腱锐性损伤完全断裂患者68例的100条断裂肌腱作为研究对象,随机分成对照组和治疗组,每组50条断裂肌腱.对照组用普通医用丝线作Kessler法缝合肌腱,治疗组选用普理灵3-0缝线行Kessler法缝合肌腱加用玻璃酸钠外涂外露肌腱,按照手指总主动活动度（TAM）标准评定两组临床疗效.结果 经过对68例患者断裂肌腱的随访观察3个月,治疗组的优良率为86%,对照组的优良率为62%,两组比较差异有统计学意义（P＜0.05）.经随访观察治疗组未发现伤口红肿等炎症反应,也无其他不良反应出现.结论 在屈指肌腱断裂修复术中应用玻璃酸钠预防修复后肌腱粘连临床效果显著,且无明显不良反应,临床可推广应用.     

游离脂肪片加透明质酸钠预防腰突症术后瘢痕粘连形成

目的通过对腰椎间盘术后瘢痕粘连患者在再次手术中使用游离脂肪片加透明质酸钠来观察该法对硬膜外瘢痕粘连形成的预防效果。方法在腰椎间盘术后瘢痕粘连65例病人的再次手术中使用游离脂肪片加透明质酸钠预防瘢痕组织再次形成。结果全部病例术后随访时间平均3年零2个月,根据Macnad疗效评分标准,优13例,良43例,进步8例,差1例,优良率86.2%。结论游离脂肪片加透明质酸钠两者联合应用,可扬长避短,提高手术效果,有效预防椎板切除术后瘢痕粘连形成。     

透明质酸钠预防手屈指肌腱黏连临床应用

目的:评价透明质酸钠防治手屈指肌腱术后黏连的有效性和给药方法。方法:50例71指手屈指肌腱损伤者随机分成2组,A组在肌腱损伤修复部鞘内或局部分别置管并注入透明质酸钠凝胶制剂。B组不用透明质酸钠。其他治疗两组相同。术后4,8,12周测定相关部位的功能、疼痛、肿胀情况,按关节功能、握拳功能评价透明质酸钠预防黏连的效果。结果:50例经平均12个月随访,A组最佳疗效率87.2%,无明显不良反应,B组最佳疗效率为59.4%。两组比较差异有显著性(P<0.05)。结论:透明质酸钠凝胶有预防术后屈指肌腱黏连作用,使用安全。     

肌腱断端锁定缝合法的临床应用

目的:探讨一种在kessler缝合法基础上改良的肌腱缝合方法(肌腱断端锁定缝合法)的可行性及优点。方法:2004年3月至2007年3月临床病例125例,男84例,女41例,平均年龄27.6岁(14～62岁);随机分两组,A组(改良组):65例,断裂屈肌腱120条,应用肌腱断端锁定缝合法缝合肌腱断端,B组(对照组):60例,断裂屈肌腱112条,应用kessler缝合法缝合肌腱断端。观察各组术中肌腱断端吻合口平整光滑情况;两组术后均应用Kleinert方案指导早期功能锻炼,随防3～9个月,评定术后功能恢复情况。结果:肌腱断端吻合口A组明显比B组平整光滑,抗拉力强。按美国手外科学会提出的测量主动活动TAM法进行功能评价,A组:优85条,良22条,可13条,优良率为89.16%;B组:优50条,良29条,可25条,差8条,优良率为70.53%;两组优良率差异有统计学意义(P<0.01)。结论:肌腱断端锁定缝合法具有比kessler缝合法吻合口光滑、平整、抗拉力强的优点,适合术后早期功能锻炼,是一种较好的防止术后肌腱粘连肌腱缝合方法,值得临床推广应用。     

肌腱断端锁定缝合法修复Ⅱ区指屈肌腱的临床应用

目的探讨肌腱断端锁定缝合法修复Ⅱ区指屈肌腱的可行性及优点。方法 2008年3月至2011年3月临床病例155例,男114例,女41例,平均年龄23.6岁;随机分组,A组(实验组):79例,断裂Ⅱ区屈肌腱95条,应用肌腱断端锁定缝合法吻合。B组(对照组):76例,断裂Ⅱ区屈肌腱93条,应用改良kessler缝合法吻合。观察各组肌腱断端吻合口光滑及滑动情况,随防6~18月,评定术后恢复功能。结果肌腱断端吻合口A组明显比B组平整光滑,滑动性更佳,抗拉力更强。主动活动TAM法进行功能评价,A组:优61条,良22条,可11条,差1条,优良率87.36%;肌腱断裂再次修复2条,断裂发生率2.10%。B组:优36条,良35条,可16条,差6条,优良率76.34%;肌腱断裂再次修复6条,断裂发生率5.37%。两组优良率及断裂发生率有显著差异(P<0.01)。结论肌腱断端锁定缝合法修复Ⅱ区指屈肌腱具有吻合口更光滑、抗拉力及抗疲劳更强等优点,适合术后早期功能锻炼,利于减少粘连,恢复功能。     

透明质酸钠预防手外伤后肌腱粘连60例疗效观察

手外伤后肌腱粘连是一种常见后遗症,透明质酸钠作为防粘连剂在国外已有30多年的历史,在国内报道较少,我们自2000～2002年开始用透明质酸钠预防手外伤后屈肌腱粘连,发现透明质酸钠对防止肌腱粘连有较好的疗效,具体报告如下。     

球囊联合透明质酸钠在重度宫腔粘连分离术后预防再粘连的临床观察

目的探讨球囊联合透明质酸钠凝胶在重度宫腔粘连分离术后预防再粘连的临床疗效。方法将2011年6月至2012年6月我院经宫腔镜确诊的重度宫腔粘连患者32例随机分为对照组及观察组,对照组在重度宫腔粘连分离术后使用宫内节育器(IUD),观察组采用球囊导尿管联合透明质酸钠凝胶,比较两组术后的疗效及术后3月宫腔再次粘连情况。结果观察组患者的宫腔形态恢复正常率及月经量恢复正常率较对照组差异均有统计学意义(P<0.05);宫腔再次粘连率明显低于对照组。结论重度宫腔粘连分离术后放置球囊导尿管并加用透明质酸钠可有效预防宫腔再次粘连,提高月经改善率。     

可吸收医用膜预防肌腱粘连的临床疗效观察

目的：观察可吸收防粘连膜预防肌腱修复术后粘连的临床疗效。方法42例急性手部屈伸肌键损伤患者分为试验组和对照组,试验组(20例)用聚-DL-乳酸可吸收医用膜(上海典范医疗科技有限公司生产)包绕肌腱缝合端,对照组(22例)不使用可吸收性医用膜,对损伤肌腱均采用5-0肌腱缝线行改良Kessler法修复,所有病例术后均行石膏托外固定,1周后行被动手指功能训练,3周后拆除石膏托,行主动性手指屈伸锻炼。观察两组的治疗效果。结果随访6~11个月,平均8.2个月,屈肌腱修复后的功能用TAM系统评定法评定。试验组综合优良率为81.13%(20/53),对照组综合优良率为52.94%(22/51),两组比较差异有统计学意义(P<0.05)。结论可吸收医用膜临床使用时操作简单、方便,可以在后续的临床诊断以及治疗中进一步的推广,从而提升整体手术治疗以及患者肌腱修复的有效性。     

舒筋汤溻渍联合三步理筋法治疗手部Ⅱ区屈肌腱术后粘连的效果观察

目的：探讨舒筋汤结合三步理筋手法用于手部Ⅱ区屈肌腱修复术后粘连的临床疗效。方法将90例（136指）手部Ⅱ区屈肌腱粘连患者随机分为治疗组（45例70指）和对照组（45例66指）。治疗组予以中药洗剂舒筋汤结合三部理筋手法治疗,对照组予以红外理疗灯照射结合手部术后常规功能锻炼法。通过测量手指总主动活动度（TAM）评定疗效。结果治疗组总有效率97.1%,对照组总有效率87.9%,两组比较差异有统计学意义（P＜0.05）。结论舒筋汤结合理筋手法对于治疗Ⅱ区屈肌腱术后粘连疗效明显,可极大限度改善手部功能。     

屈指肌腱鞘管阻滞麻醉效果分析

目的:总结屈指肌腱鞘管阻滞麻醉的临床效果。方法:对160指手术行屈指肌腱鞘管内阻滞麻醉,观察其麻醉效果、起效时间、持续时间及副损伤。结果:本组160指手术均采用屈指肌腱鞘管麻醉,除3例(3指)外,余患者都在安全无痛苦下顺利完成手术,无感染及指神经损伤并发症。结论:屈指肌腱鞘管阻滞麻醉是应用于手指手术的一种操作简单、安全有效的麻醉方法。     

Liquid silicones in reconstructive surgery of the tendons. Experimental studies]

The results of reconstruction of flexor tendons of the hand are not satisfactory despite many operative methods. Since 70 years different surgical methods were described from which only some found application and some are tested up to day. The classical surgical methods do not prevent adhesions of tendons to the surrounding tissues. Therefore studies were undertaken to proof the usefullnes and the specific properties of silicone fluids in the reconstructive tendon surgery. Examinations were done on 48 mongrel rabbits of both sexes on surgically exposed tendon of the gastrocnemius muscle. The animals were divided into two groups. In group I the tendon of the right extremity was covered with Medical Fluid 360, and in group II - with Silol F 350. Each group was divided into two subgroups. In subgroups IA and IIA the tendinous sheath was removed whereas in subgroups IB and IIB the tendon was also cut and sutured. The silicone fluids were spread in amount up to 1 ccm, and uniform coat on tendon surface resulted. On the left tendons 0.9% natrium chloride solution was spread for control. In both groups the dissections were performed 14, 30, 90, 180 days after the operation. The following criteria were applied to evaluate the results: - the appearance of extremities, the range of motility in knee and ankle joint, wound healing, - the macroscopic appearance of isolated tendons, - the degree of excursion measured in millimeters, - the appearance and degree of adhesion between the tendon and surrounding tissues. 800 histological preparations were made. They were evaluated in biological microscope with special attention to the dimension of tissue reaction. In histological examinations the differences in tissue reaction were stated between subgroups A and B of both groups. However, no differences were found dependent from the applied silicone in groups I and II. In the early period, around the siliconized tendon poorly cellular, not significant exudative reaction was found. This reaction changed afterwards into proliferative one, which led to the development of a new tendon sheath. These changes did not discriminate distinctly the flexibility of the examined tendon. After applying 0.9% natrium chloride solution to uncovered tendon (control), adhesions of the tendon to surroundings were observed, which resulted in discrimination of tendon's flexibility. It was proved that silicone fluids applied to the sutured tendon (groups IB and IIB) did not handicap the healing process. The peritendinous adhesions were more intensive around the tendon's anastomosis than in the remaining tendon part. These adhesions were significantly smaller in comparison with the control extremities whose tendons were covered by0.9% natrium chloride solution. The application of small quantity of silicone fluids according to both up to day and own investigations do not cause local or general pathological changes...     

Reconstruction of the flexor pollicis longus tendon ruptured, but untreated, during infancy

We treated 3 patients who had ruptured the flexor pollicis longus (FPL) tendon during infancy and which had not been repaired. A two-stage surgical procedure, using a silicone rod, was performed to reconstruct the tendon, and favorable thumb flexion was obtained. A favorable outcome was obtained, even if the gliding of the silicone rod had been poor after the first stage procedure. When the scar of the tendon sheath is available, it should be used as a pulley. When the tendon sheath has completely disappeared, it should be reconstructed. At the second stage of surgery, the flexor digitorum superficialis muscle of the injured finger can be used as a motor source when the muscle is conserved in good condition because its distal stump adheres to the bone. If the muscle is not in good condition, transfer of the flexor digitorum superficialis muscle of the ring finger should be performed.     

骨形态发生蛋白结合自体腱重建开放性指伸肌腱止点断裂的临床观察

目的 探讨骨形态发生蛋白(BMP)与自体掌长肌腱移植结合骨隧道重建开放性指伸肌腱止点断裂,为临床治疗伸肌腱止点断裂提供一种安全有效的选择.方法 取5 cm自体掌长肌腱组织,腱粗2 mm.用2.0 mm钻头于末节指骨近端钻一横孔,再用3.0 mm钻头于指骨背侧钻一单皮质垂直孔,肌腱穿过横孔并从垂直孔抽出形成3束,与伸肌腱近侧断端吻合,骨道处置入BMP 2 mg,指伸位铝板外固定制动4周后去除铝板康复锻炼.结果 术后随访6~12个月,平均8个月,23例患者中21例患者获得术后随访,按手指总主动活动度(TAM)评定法评定:优13例,良6例,可2例,优良率为90%.结论 该术式对伸肌腱止点行解剖重建,达到腱骨愈合,疗效满意,为伸肌腱止点重建提供了一种可靠的选择,值得临床推广应用.     

小针刀联合中药熏洗治疗屈指肌腱狭窄性腱鞘炎的临床疗效观察

目的 观察小针刀联合中药熏洗治疗屈指肌腱狭窄性腱鞘炎的临床疗效.方法 按照随机数字表法将111例屈指肌腱狭窄性腱鞘炎患者随机分为观察组（56例）和对照组（55例）,对照组患者给予小针刀治疗,观察组在对照组治疗的基础上在给予患者中药熏洗治疗.结果 治疗后1个月,观察组总有效率（92.86％）与对照组总有效率（87.27％）差异无统计学意义（P＞0.05）;治疗后24个月,观察组总有效率（85.71％）显著高于对照组总有效率（61.82％）（P＜0.05）.结论 小针刀联合中药熏洗治疗屈指肌腱狭窄性腱鞘炎疗效确定,且能显著改善患者的预后,值得临床借鉴.     

湿润烧伤膏结合bFGF治疗骨与肌腱外露创面

目的观察湿润烧伤膏(MEBO)结合重组人成纤维细胞生长因子(bFGF)治疗骨与肌腱外露创面的疗效。方法36例骨与肌腱外露创面外用MEBO与bFGF,作为治疗组。回顾性选择32例骨与肌腱外露的创面,用含庆大霉素的油纱常规换药治疗,作为对照组。比较两组创面愈合时间。结果MEBO结合bFGF治疗骨与肌腱外露创面,能明显缩短创面愈合时间(P<0.01)。结论MEBO结合bFGF能促进骨与肌腱外露创面的愈合。     

钩型小针刀治疗屈指肌腱狭窄性腱鞘炎200例临床观察

目的：观察钩型小针刀治疗屈指肌腱狭窄性腱鞘炎的疗效。方法将Ⅲ度及Ⅳ度的屈指肌腱狭窄性腱鞘炎患者200例,随机分为小针刀组和封闭组,进行治疗效果临床对比分析。结果经6~12个月随访,小针刀组优良率99.11%,封闭组优良率82.86%,两组经χ2检验,χ2=17.91,两组优良率比较差异有统计学意义（P〈0.01）。结论钩型小针刀疗法治疗狭窄性腱鞘炎,治疗简单,费用低,一般一次即可治愈,无毒副作用,符合中医的简、便、廉、验的特点,可作为首选方法,值得临床推广。