培养处理与冷冻保存同种异体肌腱的临床研究

目的建立经培养处理与冷冻保存的同种异体肌腱库,该腱临床应用已获得初步成功。方法将新鲜人体肌腱在含脱氧鸟苷的培养液中培养后,置入冷冻保护剂中,经超深低温无创冻存。１９９６年８月至１９９８年１２月,临床对１２例患者应用３０根同种异体肌腱。术前经快速复温及洗涤后将复苏肌腱作腱细胞活力测定、组织学检测。结果经培养处理与冻存的异体肌腱细胞活力为（７０．５±４．５）％（ｘ±ｓｘ,下同）。复苏后冷冻处理肌腱的组织学结果,与新鲜异体肌腱无显著性差异。１２例患者术后屈指功能良好,初步观察不必作粘连松解术。结论（１）脱氧鸟苷培养及无创冻存处理的人体肌腱,复苏后仍保存７０．５％的活力,是“活体”肌腱。（２）临床应用获得初步成功,粘连发生较少     

Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases.

Traumatic rupture of the tendon of the subscapularis muscle was documented as an isolated lesion in the shoulders of 16 men. The injury was caused either by forceful hyperextension or external rotation of the adducted arm. The patients complained of anterior shoulder pain and weakness of the arm when it was used above and below the shoulder level. They did not experience shoulder instability. The injured shoulders exhibited increased external rotation and decreased strength of internal rotation. A simple clinical manoeuvre called the 'lift-off test', reliably diagnosed or excluded clinically relevant rupture of the subscapularis tendon. Confirmation of the clinical diagnosis was best achieved by ultrasonography or MRI, but arthrography or CT arthrography were also useful. Surgical exploration confirmed the diagnosis in every case. Repair of the ruptured tendon was technically demanding and required good exposure to identify and protect the axillary nerve.     

微孔聚已内酯膜对异体肌腱移植后粘连的预防作用

目的研究微孔聚己内酯(PCL)薄膜对同种异体肌腱移植后粘连的预防作用,并探讨其对肌腱愈合的影响。方法选用在-84℃冰箱冻存10d的兔同种异体肌腱移植于30只受体兔右下肢肌腱缺损处,随机分为2组,A组在腱移植处包裹微孔PCL薄膜作为实验组,B组在腱移植处不包裹薄膜作为对照组。术后不同时间,切取腱移植部位,进行大体观察,常规制成光、电镜标本,镜下观察;对移植腱段、吻合口进行羟脯氨酸(HyP)含量及腱周粘连定量测定。结果镜下微孔PCL包膜组腱移植段内部的成纤维细胞数和胶原纤维量与不包膜组无明显差别,但不包膜组腱周组织成纤维细胞数和胶原纤维量明显较微孔PCL包膜组多;HyP含量不包膜组与微孔PCL组差异无统计学意义(P>0.05),移植腱段和吻合口的羟脯氨酸含量,微孔PCL组分别为(27.3±3.5)mg/g体重,(19.2±3.8)mg/g体重;未包膜组为(28.4±3.6)mg/g体重,(20.1±3.2)mg/g体重;不包膜组比微孔PCL组粘连程度重(P<0.05)。结论微孔PCL膜有预防肌腱粘连的作用,对肌腱愈合无影响,临床可作为一种预防肌腱粘连措施。     

跟腱断裂48例临床分析

目的　探讨跟腱断裂的治疗方法及误诊原因、预防措施。方法　回顾 4 8例跟腱断裂的手术方法 ,分析其中 17例误诊的原因并提出预防对策。结果　急性跟腱断裂 2 5例 ,陈旧性跟腱断裂 2 3例 ,其中因误诊导致陈旧性跟腱断裂 17例、术后再次跟腱断裂合并感染及软组织缺损 2例。 17例中误诊为踝部软组织挫伤 8例、踝关节扭伤 9例。 4 8例患者采用不同的方法进行修复重建 ,疗效优 2 8例 ,良 18例 ,差 2例。结论　跟腱断裂后早期手术治疗效果良好 ,应根据跟腱断裂部位、缺损多少选择不同的手术方法。对疑有跟腱断裂的患者未进行认真的体检是导致跟腱断裂误诊的重要原因。避免误诊、尽早手术及循序渐进的术后康复锻炼是提高疗效的有效措施。     

手指鞘管区异体滑膜肌腱与自体非滑膜肌腱移植的比较学研究

目的比较手指鞘管区异体滑膜肌腱与自体非滑膜肌腱移植结果并对异体滑膜肌腱在鞘管区的移植进行评估.方法对在手指屈肌腱鞘区内应用异体滑膜肌腱与自体非滑滑膜肌腱移植的病例,术后进行3个月以上的随访.评定标准为关节活动范围（TAM法）、力量,及二期肌腱松解率.结果异体滑膜肌腱移植280例,优良率达57.0%,较差或差为11.0%.松解率为32.0%,松解后总优良率达93.0%.自体非滑膜肌腱移植98例,优良率达43.0%,较差或差为9.0%.松解率为49.0%,松解后总优良率达94.2%.两者的最终结果无明显差异.结论肌腱表面结构影响肌腱的营养途径及肌腱愈合质量,滑膜肌腱表面结构则有益于肌腱营养与较快建立起血循环及组织液的渗透,是减少肌腱术后粘连再次松解的主要因素.     

异体胫前肌Y型双束双隧道移植重建后交叉韧带的临床研究

目的探讨异体胫前肌Y型双束双隧道重建后交叉韧带（PCL）的临床效果及手术技术改进的方法。方法自2001年3月至2008年1月,采用成人异体胫前肌编制成“Y”型双束,长度为130mm,A端为长束（A束）,B端为两短束（B1、B2束）。韧带安装时两端均从膝前内侧工作通道的切口进入,即：外（膝前内侧工作通道）→内（股骨、胫骨隧道内口）→外（股骨、胫骨隧道外口）。可吸收界面钉先固定胫骨隧道侧,然后再固定股骨侧：固定前外侧束时屈膝90°,固定后内侧束时屈膝30°。术后予膝关节角度锁定助行器辅助锻炼8～10周,3个月后行走基本正常。结果本组47例患者均获得随访,平均随访49．5个月,平均手术时间（45±15）min。Lachmann后向试验术前均阳性,术后38例阴性、5例弱阳性、4例阳性。KT-1000试验术前（9．0±4．0）mm,术后（3．0±1．5）mm,差异有统计学意义（t=3．12,P〈0．01）;Lysholm评分术前（51．4±5．2）分,术后（93．3±4．1）分,差异有统计学意义（t=3．13,P〈0．01）;Tegner活动水平术后（6．9±1．3）分,术前（3．5±0．7）分,差异有统计学意义（t=3．12,P〈0．01）。结论异体胫前肌编制双束有足够的长度和直径重建PCL,其抗拉力强;改进后的韧带过隧道方法,韧带通过隧道时顺畅,简单易操作,省时;准确的隧道内口、正常的张力（角度）固定是效果的保证;动静结合的早期功能锻炼有利于早期功能恢复。     

Posterolateral reconstruction using split achilles tendon allograft

Injury to the cruciate ligaments of the knee commonly occurs in association with posterolateral instability, which can cause severe functional disability including varus, posterior translation, and external rotational instability. Failure to diagnose and treat an injury of the posterolateral corner in a patient who has a tear of the cruciate ligament can also result in the failure of the reconstructed cruciate ligament. Unlike isolated posterior cruciate ligament injury, there seems to be a consensus of opinion that injury to the posterolateral corner, whether isolated or combined, is best treated by reconstructing the posterolateral corner along with the coexisting cruciate ligament injury, if combined. Commonly proposed methods of reconstructing the posterolateral corner have focused on the reconstruction of the popliteus, the popliteofibular ligament, and the lateral collateral ligament. We introduce a new technique for reconstructing the posterolateral corner using a split Achilles tendon allograft. Our method reasonably addresses the several pitfalls in the reconstruction of the posterolateral corner, including (1) concurrent reconstruction of important posterolateral structures, (2) regaining the isometry of the lateral collateral ligament, (3) repositioning the reconstructed popliteus into its original position, and (4) providing a secure fixation method.     

Arthroscopic reconstruction of the anterior cruciate ligament using allograft tendon

Treatment of the anterior cruciate ligament (ACL)-deficient knee using an arthroscopic technique and freeze-dried allograft tendons in 23 patients was studied prospectively. Accurate placement of drill holes and anchoring positions for the allografts was effected through a standard arthroscopic approach combined with a 3 cm incision on the medial tibial flare. Candidates for reconstruction were those who were unable to tolerate brace therapy and who had no degenerative arthritis. The 23 patients were drawn from a group of 60 treated patients because their follow-up had been greater than or equal to 1 year. Their knees were assessed preoperatively and postoperatively with a Lysholm knee rating scale, Lachman test with KT-1000 arthrometric quantitation, pivot shift, Biodex test, and radiographs. Knee rating values improved in all knees, and only one patient had a significant deterioration in the KT-1000 reading. All patients with at least 20 months follow-up have resumed their preinjury activity levels.     

Reconstruction of chronic ruptures of the distal biceps tendon with use of an achilles tendon allograft

BACKGROUND: Chronic ruptures of the distal biceps tendon are uncommon and are complicated by the retraction and poor quality of the muscle and tendon. Surgical procedures that have been described for the treatment of this injury are limited by the quality and availability of the structures used for augmentation. The purpose of the present study was to describe the surgical technique for reconstruction of the tendon with an Achilles tendon allograft and to report our preliminary experience with this procedure. METHODS: An Achilles tendon allograft was used to reconstruct a chronic rupture of the distal biceps tendon in four patients. The patients were evaluated with regard to subjective satisfaction, pain, range of motion, and strength in flexion and supination. The results were graded with use of the Mayo elbow performance score. RESULTS: After an average duration of follow-up of 2.8 years (range, 2.0 to 3.7 years), all four patients had a satisfactory subjective result, a full range of motion, and an excellent Mayo elbow performance score. The strength of flexion and supination was comparable with that on the contralateral side in two patients and was slightly decreased in the other two. CONCLUSIONS: Reconstruction of chronic disruptions of the distal biceps tendon with an Achilles tendon allograft appears to offer a satisfactory technical solution for this challenging problem and has provided satisfactory clinical results to date.     

Primary ACL reconstruction: comparison of Achilles tendon allograft with tibial anatomical fixation and patellar tendon allograft with external aperture fixation

Purpose  

The purpose of this study was to compare the outcome of primary anterior cruciate ligament (ACL) reconstruction between Achilles tendon allograft with tibial anatomical bifixation and bone-patellar tendon-bone (BPTB) allograft with tibial external aperture fixation.     

Rupture of the distal biceps tendon. Report of five cases.

Five cases of rupture of the distal biceps tendon are described. Three were operated on--two in the acute stage and one after 3 months--and the other two were managed conservatively. The literature on this condition is reviewed and alternative forms of treatment are discussed.