肌腱缺损治疗的研究进展

肌腱缺损治疗的研究重点在于获得理想的移植材料.目前临床应用的肌腱移植材料主要有以下几类:自体肌腱、同种异体肌腱、人工肌腱和组织工程化肌腱,但均存在各自不足.笔者就肌腱移植的研究现状及进展作一综述.     

肌腱粘连及其防治的研究进展

简述了肌腱结构及其营养供应、肌腱损伤的愈合机制及粘连原因。详细介绍了临床防治肌腱粘连的措施 ,特别对手术技术作了较详尽比较。对术后活动、康复理疗及中医中药也作了介绍。     

应用股前外侧皮瓣修复手背软组织和指伸肌腱缺损

目的 探讨股前外侧皮瓣修复手背软组织和指伸肌腱缺损的临床应用.方法 对17例手背软组织和指伸肌腱缺损患者行急诊清创、负压封闭引流(VSD)覆盖创面,7～10天后应用股前外侧皮瓣移植修复创面,同时将缺损指伸肌腱近、远端分别与阔筋膜编织缝合.Ⅱ期将阔筋膜修成肌腱形状并行手指功能锻炼.结果 17例皮瓣移植术后完全成活,Ⅱ期手...     

干细胞促进肌腱损伤修复研究进展

肌腱损伤在体育运动及其他剧烈活动中均十分常见,肌腱损伤后往往愈合不理想,必然影响患者的运动功能.肌腱自身再生能力较差,自然愈合常形成瘢痕组织,导致机械性能下降,且容易再次损伤.肌腱损伤的常规治疗方法包括非手术治疗及手术治疗,但这些治疗方法均疗效有限,不能恢复肌腱的自然结构及机械性能.目前仍没有理想、有效的治疗方法,临床...     

屈指肌腱修复术后锻炼性治疗效果观察

我院1991～1994年采用术后由专业医护人员实施早期完全被动活动的方法，促进“Ⅱ”区（“无人区”）屈指肌健断裂修复手术后的功能恢复，并进行广临床对照试验，经随访半年以上，效果满意。1对象和方法1．1对象108例，182指。男72例，女36例。年龄15～61岁，其中19～35岁占85％、本组屈指肌肤损伤中，示指67指，中指55指，环指17指，小指43指。合并指神经损伤67指，伤闲多为切割和挤轧伤，均为急性损伤一期修复。按就诊顺序，随机分为A、B两组。A组：术后完全由医护人员实施早期完全被动仲用捐活动；B组：术后指尖以橡皮筋固定，早期由病…     

复合足背皮瓣修复手背部复合组织缺损

外伤致手背皮肤、肌腱缺损并不少见，如果不能正确处理将导致手功能严重障碍。1999～2006年我科运用带伸趾肌腱及皮神经的足背游离复合皮瓣修复手部皮肤肌腱缺损7例，外形及功能恢复满意，报道如下。     

应用足背分叶皮瓣携带趾伸肌腱移植修复多手指皮肤合并肌腱组织缺损

目的探讨应用足背分叶皮瓣携带趾伸肌腱移植同期修复多手指皮肤合并肌腱组织缺损的临床效果。方法 2011年5月~2013年10月治疗12例(27指)多手指皮肤合并伸、屈肌腱缺损患者。根据伤指创面大小、形状设计以足背血管为主干的跗内侧、第一跖背、跗外侧血管为分支构成的足内侧、第1跖背、足外侧三叶或以第一跖背、跗外侧血管为分支构成的第1跖背、足外侧双叶皮瓣移植,切取皮瓣同时携带趾伸肌腱,一次性修复2~3指的皮肤合并1指或2指的屈、伸肌腱缺损。结果移植皮瓣全部成活。其中3例发生动脉危象,2例经静脉使用抗血管痉挛药物后皮瓣成活,1例经血管探查,切除血栓段血管,重新吻合动脉后皮瓣成活。12例经8~19个月随访,皮瓣外形和质地良好,18指屈伸功能正常,5指屈曲轻度受限,伸直正常,4指屈曲有较明显受限,伸直轻微受限。供皮瓣和肌腱足无明显瘢痕挛缩,行走正常。结论应用足背分叶皮瓣携带趾伸肌腱游离移植方法,一次手术能修复多个手指皮肤合并肌腱缺损,皮瓣外形和质地良好,手指获得良好的功能恢复,是修复多手指皮肤合并腱肌组织缺损的有效方法。     

改良示指背侧皮瓣联合示指固有伸肌腱一次性修复拇长伸肌腱及皮肤缺损

目的探讨改良示指背侧皮瓣联合示指固有伸肌腱一次性修复拇长伸肌腱及皮肤缺损的方法及临床疗效。方法选取2012年5月至2014年1月,我科收治的17例拇指指背侧皮肤缺损伴拇长伸肌腱部分缺失患者,均行改良的示指背侧皮瓣联合示指固有伸肌腱转移一次性修复术,通过观察皮瓣成活率、外形、皮瓣感觉和总主动活动(TAM)系统评定法评定疗效。结果本组17例患者手术顺利,可评价疗效。术后平均随访(15.3±5.1)个月,患者术后皮瓣全部成活,外形及感觉良好,拇指功能按照TAM系统评定方法评为优12例(70.6%)、良5例(29.4%)、中0例、差0例。结论改良示指背侧皮瓣联合示指固有伸肌腱转移可一次修复拇长伸肌腱及皮肤缺损,手术操作简捷,供区损伤小,随访效果好。     

带前臂筋膜掌长肌腱游离移植修复屈指肌腱术

我们首先用掌长肌带前臂筋膜进行屈指肌腱移植及腱鞘重建，术后早期被动活动取得良好效果。现介绍如下。临床资料１９８４～１９９０年共用带筋膜的掌长肌移植修复屈指肌腱２３例，其中男１４例，女９例；年龄１５～４３岁，平均２５例。１指肌腱损伤１２例，２指６例，３...     

Diagnosis and treatment of chronic tendon disorders in sports

Sports and physical activity are becoming more important and more emphasized in the lives of the average person as the health benefits of maintaining an active lifestyle are recognized. In the past most people were primarily active in sports during their time in school. The trend is for more people to continue vigorous activity through middle age and beyond. In addition, as high level athletes continue to reach higher levels of performance more amateur athletes attempt to reach similar levels of intensity, which they may not be able to handle with their level or method of training. This has led to an increase in overuse injuries and chronic tendon injuries. It has been estimated that overuse type injuries account for 30–50% of sports injuries (1).     

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.     

Repair of distal biceps tendon rupture with suture anchors

We retrospectively evaluated six cases of distal biceps tendon rupture that were treated by a two-incision operative repair using suture anchor attachment to the radial tuberosity for clinical outcome and strength testing. All patients had repair performed by the same surgeon. The average age of the patients, all male, was 43 years (range, 32–57 years). Average time from injury to operative repair was 22 days (range, 9–54 days). Follow-up time averaged 24 months after definitive treatment (range, 11–46 months). At follow-up no patient had limitation of activity and all patients were able to return to their previous employment, although three noted some minor antecubital fossa discomfort. No patient developed a synostosis. Cybex (Medway, Mass.) isokinetic testing revealed elbow flexion strength return for peak torque, total work, and average power, of 107%, 103%, and 110% of the uninjured arm, respectively. Elbow flexion endurance was 2% less in the injured arm. Forearm supination strength measured by peak torque, total work, and average power, was 97%, 85%, and 88% of the uninjured arm, respectively. Forearm supination endurance was 10% less in the injured arm. Our results using suture anchor repair are similar to those previously reported in the literature from bone tunnel repair. Based on our data, we believe that a two-incision repair with suture anchor attachment is a safe and effective method for treatment of distal biceps tendon ruptures. Received: 15 April 1998 Accepted: 13 October 1998     

MEBO治疗肌腱外露及皮肤坏死创面

目的：探讨肌腱外露及皮肤坏死创面的治疗方法。方法：30例肌腱外露的皮肤坏死创面，全部采用湿润烧伤膏(MEBO)治疗。结果：肌腱上可见肉芽生长，肌腱无坏死，无感染加重及败血症发生，创面自行愈合，无关节僵直。结论：MEBO对肌腱外露及皮肤坏死创面有较好治疗作用。     

Diagnosis, treatment and rehabilitation principles in complete tendon ruptures in sports

Complete tendon ruptures may occur in any tendor subjected to athletic stress. This article discusses diagnostic, treatment and rehabilitation principles that are common to all tendon ruptures. The most common tendon ruptures are then discussed more specifically, presenting pertinent diagnostic tests, treatment considerations and principles of rehabilitation.     

Anterior cruciate ligament reconstruction in females: a comparison of hamstring tendon and patellar tendon autografts

This study compared hamstring (HS) and patellar tendon (PT) anterior cruciate ligament (ACL) reconstruction in females. Sixty-five patients (43 HS, 22 PT) were evaluated at a mean 3.8-year postoperatively. Evaluation included IKDC 2000, SF-36, Cincinnati sports activity scores, anterior knee pain (AKP), kneeling pain, range of motion and anterior knee laxity. One PT patient sustained a traumatic graft rupture. There were no differences between the two grafts in terms of anterior knee laxity or IKDC scores. The HS group had higher sports activity scores and higher scores on the Physical Functioning and General Health subscales of the SF-36. Despite no difference in AKP, there was greater kneeling pain in the PT patients, who also had greater extension deficits. Both HS and PT are satisfactory ACL grafts in females, but HS grafts were associated with less morbidity, greater return to preinjury level of activity and higher quality of life scores.     

深低温冷冻保存同种异体肌腱移植修复陈旧性跟腱断裂研究

目的：探讨深低温冷冻保存同种异体肌腱移植修复陈旧性跟腱断裂的临床效果。方法2010年1月-2012年9月收治急性创伤所致跟腱断裂一期未行修复导致的陈旧性跟腱断裂患者共32例,缺损长度3-6（4.6±1.0）cm,手术所用肌腱为经过深低温处理的同种异体胫前肌肌腱。在跟腱远端和近端用2-0可吸收抗菌薇乔采用双束 Kessler 法端端吻合,术后常规跖屈20-30°位固定踝关节,足背肢具或石膏板固定4-6 w。3例合并皮肤缺损者,行腓肠神经营养皮瓣转移覆盖创面。术后采用美国足踝外科协会（ AOFAS）踝与后足评分行疗效评价。结果术后32例均获随访1年以上,平均随访（15.0±3.5）个月,其中29例切口Ⅰ期愈合,2例切口Ⅱ期愈合,1例因为排异反应取出移植肌腱由于疤痕愈合未行再次肌腱移植,目前可以正常行走。术后踝关节功能恢复良好,AOFAS 足踝评分从术前（50.5±5.5）分提高到术后（90.5±6.5）分。结论修复陈旧性跟腱断裂可用深低温冷冻保存同种异体肌腱,手术效果可,并可避免取自体腱造成二次损伤和并发症,患者更容易接受,移植物可长期保存,但长期效果仍需长期随访。     

Reconstruction of neglected Achilles tendon rupture using the flexor hallucis tendon

Neglected ruptures of the Achilles tendon (AT) are not common and have a greater tendency to cause complications and to produce poorer functional results than fresh ruptures. Numerous surgical procedures have been described for the reconstruction of neglected AT ruptures. However, no report has been issued about an AT rupture neglected for more than 2 years. The authors reported about three patients (four tendons) with a neglected AT rupture of mean duration of 5 years, who were treated by interposed scar tissue repair combined with flexor hallucis longus tendon transfer. All patients experienced good clinical results and were satisfied with surgery. None of the authors received financial support for this study.     

Operative treatment of peroneusbrevis and peroneus longus tendon tears

The peroneal tendons provide important functions to the foot and ankle including stabilization of the lateral ankle and plantar flexion of the first ray. Injury to the peroneal tendons might occur as a result of an ankle or peroneal tendon instability or a local degenerative process. Conservative management for peroneal tendon tears is not uniformly successful and surgical management remains a common method for treatment. The peroneal tendon rupture might be treated by simple repair of isolated longitudinal rupture, by excision of degenerative tendon and longitudinal repair of the remaining tendon, or by excision of degenerative tendon and side-to-side tenodesis for extensive tendon damage. Stability of the tendons also is addressed by bony and or soft tissue stabilization procedures.