带腱周组织掌长肌腱游离移植修复手部屈肌腱缺损

目的：探讨肌腱移植的肌腱粘连防治办法。方法：回顾性对10例15指带腱周组织的掌长肌腱游离移植修复手部屈肌腱缺损。结果：术后随访3－6个月，按照TAM法评价，优10指，良5指。结论：带腱周组织的肌腱游离移植防止肌腱粘连效果肯定，特别是术后不配合功能练习者，尤为首选的术式。     

腱缝合后鞘内置入法在Ⅱ区屈肌腱修复中的临床应用

目的介绍用腱缝合后鞘内置入法，治疗Ⅱ区屈肌腱损伤的方法和疗效。方法按该法治疗屈肌腱损伤４６例７７指。伸直型１２例２６指：经原腱鞘伤口缝合肌腱，术毕将肌腱缝合部置于近侧健康鞘管内。屈曲型３４例５１指：在肌腱远断端以远约０．５ｃｍ处另作腱鞘切口，经此切口将损伤腱近端拉出进行缝合，术毕将腱缝合口置于远端切口和原伤口间的完整鞘管内。结果术后随访到３８例５９指，随访时间为２个月～３年，平均１年８个月。按ＴＡＭ评定法评定疗效，优级：３０指，良级：１７指，余为中差级；总优良率达到７９．７％。锐器切割伤４３指，疗效优良者４２指占９７．７％；合并腱鞘及周围组织损伤１６指，疗效优良者５指占３１．３％。结论该术式对单纯指屈肌腱损伤疗效满意，这可能和术时腱鞘损伤轻，肌腱缝合口被健康鞘管包绕后，有利于肌腱的内源性愈合并减少了外源性愈合的参与有关     

肌腱缝合后鞘内置入法预防Ⅱ区屈肌腱粘连的实验研究

目的 探讨一种屈肌腱修复新方法即腱缝合后鞘内置入法，并观察其在鸡Ⅱ区屈肌腱损伤修复中的疗效，揭示其预防屈肌腱术后粘连机理，为临床应用提供依据。方法 选用健康白色纯种Leghorn鸡40只，以第三趾趾深屈肌腱屈曲型损伤为实验模型，随机分组，左右足配对设计，一侧为实验组，用腱缝合后鞘内置入法修复肌腱；另一侧为对照组，切开腱鞘修复肌腱，缝合腱鞘。分别于术后1、2、4、8周进行大体观察、组织学观察、生物力学测定。结果 1周后大体观察、肌腱滑动距离，实验组与对照组间无显著性统计学意义。2、4、8周后大体观察粘连情况、肌腱滑动距离、各是关节屈曲角度、组织学观察结果，两组间有显著性差异，4周后腱及鞘缝合口间距与肌腱粘连带宽度比，两组间均有显著性差异。结论 腱缝合后鞘内置入法在Ⅱ区屈肌腱修复中能有效减轻肌腱术后粘连，尤其是致密粘连的形成，在提高肌腱术后功能上优于单纯腱鞘闭合，可以适用于临床。     

可吸收防粘连膜在肌腱修复中的应用疗效观察

目的观察可吸收防粘连膜预防肌腱修复术后粘连的临床应用效果。方法将38例急性手部肌腱损伤患者随机分为两组,肌腱缝合后分别采用包绕成都迪康公司生产的聚-DL-乳酸可吸收防粘连膜和早期使用动力性支具两种方法治疗。试验组15例65腱,涉及屈肌腱10例51腱,7例伴血管神经损伤;伸肌腱5例14腱。对照组23例76腱,涉及屈肌腱11例32腱,6例伴血管神经损伤;伸肌腱12例44腱。对损伤肌腱均采用5-0肌腱缝线行改良Kessler法修复。试验组术后以石膏托固定伤手于屈腕、屈掌指关节位(屈肌腱损伤者)或伸腕、伸指位(伸肌腱损伤者),鼓励患者早期行手指活动,对照组术后第3天改用动力性支具。4周后拆除石膏托或动力性支具,行主动屈伸锻炼,辅以中药熏洗。结果试验组1例伤口延迟愈合,2例肌腱修复处皮肤出现局限性硬结,其余伤口均一期愈合。术后随访6～14个月,平均8.7个月。术后屈肌腱功能用TAM法评定,伸肌腱功能用Miller法评定。试验组综合优良率为93.85%(61/65),对照组综合优良率为90.79%(69/76)(P>0.05),两组间无显著性差异。结论可吸收防粘连膜能有效防止肌腱损伤修复术后粘连的形成,同时避免了动力性支具安装的繁琐操作,消除了医患双方在使用支具过程中对可能发生肌腱断裂的担忧,具有良好的应用前景。     

显微缝合肌腱的抗拉力强度实验

手部损伤中,屈肌腱修复术后粘连严重影响手的功能。传统的缝合方法和术后制动造成肌腱缝合处腱痂形成是导致粘连的主要原因。如何防止粘连已有一些研究,主要集中在对肌腱修复后的愈合过程的认识,改进缝合方法及早期治疗3方面。我们对24条屈肌腱采用改良Kessler缝合法修复后,立即进行抗拉强度实验,为临床提倡肌腱缝合后早期功能锻炼提供参考数据。     

抗张力缝合早期运动预防肌腱粘连

屈指肌腱损伤术后粘连问题至今仍未很好的解决。崔胜杰等［１］认为指屈肌腱缝合早期主动活动预防肌腱粘连主要有三点,即断端的确切平整光滑的缝合,有利于其在腱鞘内的滑动;采取一定的抗拉力缝合方法;早期主动活动预防肌腱粘连;均无再断裂病例发生,优良率９７．８％。笔者于１９８９年前曾采用肌腱内“８”字缝合加周边连续缝合法,术后４８小时开始主动屈伸活动,发生腱再断裂病例,总结后感觉丝线抗拉力不够。于１９９１年设想一种“抗张力缝合早期运动预防肌腱粘连”共２５例３５指,通过随访效果满意,现报告如下。１ 资料与方法…     

异体硬脊膜预防手部屈肌腱粘连的临床应用

目的 观察异体硬脊膜预防肌健粘连的作用。方法 一期修复鞘管区屈肌腱损伤21例26指，术中用酒精保存的异体硬脊膜修复腱鞘，并向修复段鞘管内注入透明质酸钠溶液0.2ml－0.4ml，缝合皮肤，一24小时开始行功能锻炼。结果 经6－28（平均13月）个月随访，按TAM法评定疗效：优15腱，良9腱，中2腱，优良率为92.3%。结论 异体硬脊膜与透明质酸钠联合使用有较好的预防肌腱粘连的作用。     

临床经验：抗张力缝合早期运动预防肌腱粘连

屈指肌腱损伤术后粘连问题至今仍未很好的解决。崔胜杰等认为指屈肌腱缝合早期主动活动预防肌腱粘连主要有三点，即断端的确切平整光滑的缝合，有利于其在腱鞘内的滑动；采取一定的抗拉力缝合方法；早期主动活动预防肌腱粘连；均无再断裂病例发生，优良率97．8％。笔于1989年前曾采用肌腱内“8”字缝合加周边连续缝合法．术后48小时开始主动屈伸活动，发生腱再断裂病例，总结后感觉丝线抗拉力不够。于1991年设想一种“抗张力缝合早期运动预防肌腱粘连”共25例35指，通过随访效果满意．现报告如下。     

显微外科技术在屈指腱Ⅱ区急诊损伤修复中的应用

显微外科技术在屈指腱Ⅱ区急诊损伤修复中的应用汪冬生，廖中东，万荣林，陈华清，汪惠安手的功能活动除需有良好的肌力，其肌腱的滑动功能尤为重要。因此，肌腱损伤修复的缝合技术，术后防止肌腱粘连，手指的功能锻炼，促进手的功能恢复一直认为是肌腱损伤的修复重点。自...     

改良王氏肌腱腱内单线显微缝合法

肌腱缝合术是手部严重创伤、手功能重建的基本内容,肌腱的缝合方式直接影响临床效果和预后,对手功能的恢复具有决定性的影响,因此,对于肌腱缝合方法的研究,探索肌腱缝合后愈合快、粘连轻、功能恢复好的方法甚为重要,我们自1995年以来,采用自行设计的改良王氏肌腱腱内单线显微缝合方法修复指屈肌腱断裂伤68例,共134条,临床获得满意疗效。1 资料与方法1.1 临床资料本组68例,共134条指屈肌腱,其     

扩张皮瓣的纤维包膜包绕缝合预防屈肌腱粘连的临床应用

目的　观察扩张皮瓣的纤维包膜包绕缝合预防屈肌腱粘连的临床效果。方法　在手重度烧伤后畸形的治疗中 ,完全切除手掌瘢痕和肌腱附近的瘢痕组织 ,彻底松解肌键粘连 ,应用扩张皮瓣的纤维包膜包绕缝合手掌Ⅲ区的屈肌腱 ,以预防术后屈肌腱的粘连。结果　从 1999～ 2 0 0 1年 ,手术 6例 11只手共 33指 ,随访 1～ 3年 ,按TAM评定方法 ,33指中 18指优 ,11指良 ,3指可 ,1指差 ,总优良率为 87 88%。结论　纤维包膜是阻止和预防术后肌键粘连的理想材料。     

Effects of increased in vivo excursion on digital range of motion and tendon strength following flexor tendon repair.

Postoperative rehabilitation is an important factor in determining functional outcome following intrasynovial flexor tendon repair. We hypothesized that a rehabilitation protocol that produced increased in vivo excursion would lead to increased digital range of motion and tendon strength and decreased adhesion formation in a canine model. Ninety-six flexor digitorum profundus tendons from 48 dogs were cut transversely and repaired by a multistrand suture technique. Postoperative rehabilitation was performed daily with a low excursion-low force (1.7-mm average excursion; < 10 N force) or a high excursion-low force (3.6 mm excursion; < 10 N force) protocol. After death of the dogs at 10, 21, or 42 days, specimens were evaluated for digital range of motion, tensile mechanical properties, elongation of the repair site, and adhesion formation. Our data indicate that the range of motion of digits whose tendons were at low or high excursion was similar to that of controls. Increased in vivo tendon excursion due to synergistic wrist motion did not significantly affect ex vivo flexion of the distal and proximal interphalangeal joints or tendon displacement (p > 0.05). Similarly, tensile properties (ultimate load, repair site rigidity, and repair site strain at 20 N and at failure) and length of the gap at the repair site were not significantly affected by increased excursion (p > 0.05). Severity of adhesion formation was reduced slightly by increased excursion (p = 0.04). Our findings indicate that 1.7 mm of tendon excursion is sufficient to prevent adhesion formation following sharp transection of the canine flexor tendon and that additional excursion provides little added benefit.     

Functional outcome of the hand following flexor tendon repair at the 'no man's land'

PURPOSE: To evaluate the functional outcome of the hand following flexor tendon repair at 'no man's land' using 2 strands of a modified Kessler core suture and combined controlled motion rehabilitation protocol. METHODS: Records of 31 zone-2 flexor tendon injuries in 21 digits of 16 patients between July 2000 and June 2005 were reviewed retrospectively. The injured tendons were repaired within 24 hours using 2 strands of a modified Kessler core suture, reinforced by a continuous circumferential epitendon suture. All patients completed a rehabilitation protocol that included active extension against a rubber band, passive flexion, and controlled passive extension and passive flexion exercises. Functional outcome of the fingers was assessed using the Buck-Gramcko II score. Hand grip strength, rehabilitation period, and rupture rate were also measured. RESULTS: 17 (81%) out of 21 digits in 15 out of 16 patients achieved an excellent-to-good functional grade. The remaining patient with concomitant injuries to 4 (19%) digits attained a poor functional grade, attributable to poor compliance with the rehabilitation protocol. The mean rehabilitation period was 130 days and the mean grip strength was 78% that of the uninjured side. Concomitant digital nerve injury did not adversely affect the final outcome. Only one (4.8%) patient experienced a rupture. CONCLUSION: The surgical method and rehabilitation protocol used for zone-2 flexor tendon injury is safe and results in a reasonably good functional outcome.     

透明质酸钠在同种异体肌腱移植中的临床应用

目的 探讨透明质酸钠（Sodium hyaluronate Product,SHP)在同种异体肌腱移植后防止肌腱粘连的作用。方法 对23例37指屈肌腱损伤，行异体屈肌腱移植后，均匀涂SHP2mL-4mL，修复腱鞘，术后72小时开始手指功能锻炼。另选20例35指屈肌腱损伤，用同样方法治疗，术中不用SHP作对照。结果 两组经过平均1年8个月的随访，按TAM（Total active movement,TAM)标准评定疗效，SHP组37指，疗效优良33指，优良率89．2％，显高于对照组的62．9％（P＜0．05）。结论 透明质酸钠能防止或减轻异体肌腱移植后肌腱粘连，促进肌腱愈合。     

Results of primary tendon repair with closure of the tendon sheath

This study reports the results of primary flexor tendon repair combined with closure of the tendon sheath in 31 Zone 2 injuries. In 3 digits, the profundus tendon alone was divided. In a further 7 digits, one tendon was completely divided and the other was incompletely divided. The remaining 21 digits involved complete division of both tendons. Assessment of the results according to the total active motion (TAM) system found 86% of the repairs in the excellent, good and fair categories. Two ruptures occurred (6%). A second assessment employed the criteria of Strickland, excluding the motion of the metacarpophalangeal joint. The results obtained following suture of both tendons were: excellent (39%); good (36%); fair (14%); poor (4%); and rupture (7%). These results lend support to the belief that closure of the tendon sheath decreases external adhesion formation and improves motion without increasing the risks of rupture.     

Flexor tendon grafting to the hand: an assessment of the intrasynovial donor tendon-A preliminary single-cohort study

We report the results of a pilot study using intrasynovial donor tendons for flexor tendon reconstruction in 8 patients (10 digits) at a mean follow-up time of 3.8 years for neglected or failed primary repair of zone 2 lacerations and for neglected flexor digitorum profundus avulsions. The flexor digitorum longus to the second toe was used as the donor tendon graft. Four patients (4 digits) underwent single-stage reconstruction and 4 patients (6 digits) had multistage reconstruction. The overall patient satisfaction using a standardized visual analog reporting scale was excellent. There was 1 excellent, 1 good, 1 fair, and 1 poor result in the single-stage reconstruction group, including 1 repair site rupture and 1 digit requiring tenolysis. In the multistage reconstruction group there was 1 excellent, 3 good, 1 fair, and no poor results, including 1 digit requiring tenolysis. One patient was lost to follow-up. There was no donor site morbidity. The average active motion recovery was 64% and 56% for single-stage and multistage reconstructions, respectively, and was 73% overall for single digit reconstructions. The results of this pilot study suggest that intrasynovial tendon grafting may offer an improved alternative for tendon grafting to the synovial spaces of the digit.     

动力型结合静力型支具预防指屈肌腱修复术后肌腱粘连

目的探讨动力型结合静力型支具预防指屈肌腱修复术后肌腱粘连的临床疗效。方法2010年1月-2019年1月,对50例81指指屈肌腱断裂修复术后应用动力型结合静力型支具预防肌腱粘连。结果术后50例获随访3~16个月,平均9个月。肌力恢复4~5级。按照TAM法评定患指功能:优51指占63%,良27指占33.3%,可3指占3.7%,优良率96.3%。结论指屈肌腱修复术后应用动力型结合静力型支具预防肌腱粘连,功能恢复的优良率明显提高,值得推广。     

Functional outcome in patients with zone V flexor tendon injuries

Introduction Zone V flexor tendon injuries may involve major nerves and arteries as well as the wrist and finger flexors. Although these injuries are not infrequent, few studies have reported functional outcomes. The purpose of this study was to evaluate the functional outcome in patients with flexor tendon repairs in zone V.Materials and methods Eighteen patients with repaired zone V flexor tendon injuries were followed up for an average of 20 months. The postoperative rehabilitation program consisted of a combined regime of modified Kleinert and modified Duran techniques. Outcome parameters were hand function according to the Buck-Gramcko assessment system, grip and key pinch strength values, and return to work status.Results Functional results were excellent in 92.8% of the digits, good in 1.4%, and poor in 5.8%. Grip strength recovered to an average of 77% and pinch strength to 74% of the uninjured hand. Two tendon ruptures occurred in a patient, and tenolysis was required in 3 patients. Of 15 patients who were employed at the time of injury, 13 returned to their original occupations.Conclusion Satisfactory functional results can be obtained when proper surgical technique is coupled with careful postoperative management in patients with zone V flexor tendon injuries.     

Optimizing independent finger flexion with zone V flexor repairs using the Massachusetts General Hospital flexor tenorrhaphy and early protected active motion

PURPOSE: Independent FDS action has been cited to be problematic with repair of multiple tendons in zone V owing to adhesion formation between the flexor digitorum superficialis (FDS) and the flexor digitorum profundus (FDP) tendons. Of the several described flexor repair techniques the ideal tendon repair should be strong enough to allow for early active motion to minimize adhesion formation and maximize tendon healing. Biomechanical studies have proven the Massachusetts General Hospital (MGH) repair to be strong enough to allow for early active motion. The purpose of this study was to examine the use of the MGH technique for zone V flexor tendon injuries to allow for early protected active motion to achieve independent finger flexion through better differential gliding of the tendons. METHODS: We performed a retrospective review 168 zone V finger flexor tendon repairs for 29 patients performed consecutively over 4 years when early active motion was not contraindicated. The same early protected active motion protocol was used for all of these patients. We reviewed total active motion, independent flexion, rupture, and need for tenolysis. These injuries involved 103 FDS and 65 FDP tendons to 103 fingers. The median follow-up period was 24 weeks. Of these 29 patients 19 were men and 10 were women. The average patient age was 28 years. RESULTS: The total active motion for these zone V repairs was 236 degrees +/- 5 degrees Overall 97 of 103 digits attained good to excellent function and 88 of 103 developed some differential glide. One of these patients required a tenolysis. Three repairs ruptured in 1 patient owing to suture breakage that was associated with noncompliance with the dorsal extension block splint. CONCLUSIONS: Our retrospective review of 168 consecutive flexor tendon repairs showed that the MGH technique allowed for early protected active motion, which provided good to excellent functional outcomes with 88 of 103 developing independent finger flexion at an acceptably low complication risk.     

Results of flexor tendon surgery in zone II

In this article we have attempted to analyze the results of Zone II flexor tendon repair, staged flexor tendon reconstruction, and tenolysis based on cases taken from a single hand surgical practice. Formulas have been offered to determine the percentage return of motion at the PIP and DIP joints utilizing the total active and passive motion measurements. Variation in the formulas for each procedure are necessitated by the preoperative active and passive motion. A common classification system based on the percentage return following each procedure has also been utilized. By employing these assessment methods on digits of our patients who underwent flexor tendon repairs, we achieved the following results: Digits undergoing primary flexor tendon repair in Zone II with postoperative controlled passive motion techniques returned 56 per cent excellent or good function, with 13 per cent in the poor category and 4 per cent experiencing tendon rupture. Staged flexor tendon reconstruction returned 40 per cent excellent or good results with 66 per cent categorized as excellent, good, or fair. Twenty-eight per cent remained in the poor classification, with 7 per cent having ruptures. These results were substantially upgraded by tenolysis of the tendon grafts following Stage II in 47 per cent of all digits. Tenolysis was an effective procedure following a repair or graft and was found to return 67 per cent excellent or good results when carried out for adherent tendon repairs, with 10 per cent in the poor category and an 8 per cent rupture rate. A 65 per cent excellent or good return followed tenolysis of flexor tendon grafts, with 12 per cent judged poor and 8 per cent incidence of rupture. An analysis of the theoretical results of 100 consecutive Zone II flexor tendon repairs following multiple procedures for those digits that had unsatisfactory initial results indicated that, under ideal circumstances, as high as 96 per cent of all digits might be expected to return flexor performance in the excellent or good categories. I acknowledge that the results of flexor tendon procedures are strongly influenced by a wide array of factors, including the patient's age and motivation, the preoperative status of the digit, surgical technique, and postoperative management. An effort has been made here to minimize the variables by including patients taken from a single hand surgical practice and managed, to a large extent, by the same surgeon.(ABSTRACT TRUNCATED AT 400 WORDS)