A systematic review of surgical intervention in the treatment of hamstring tendon ruptures: current evidence on the impact on patient outcomes

Hamstring injuries are among the most common muscle injuries. They have been reported in many different sports, such as running, soccer, track and field, rugby, and waterskiing. However, they are also present among the general population. Most hamstring injuries are mild strains, but also moderate and severe injuries occur. Hamstring injuries usually occur in rapid movements involving eccentric demands of the posterior thigh. Sprinting has been found to mainly affect the isolated proximal biceps femoris, whereas stretching-type injuries most often involve an isolated proximal injury of the semimembranosus muscle. The main cause of severe 2- or 3-tendon avulsion is a rapid forceful hip flexion with the ipsilateral knee extended. Most hamstring injuries are treated non-surgically with good results. However, there are also clear indications for surgical treatment, such as severe 2- or 3-tendon avulsions. In athletes, more aggressive recommendations concerning surgical treatment can be found. For a professional athlete, a proximal isolated tendon avulsion with clear retraction should be treated operatively regardless of the injured tendon. Surgical treatment has been found to have good results in severe injuries, especially if the avulsion injury is repaired in acute phase. In chronic hamstring injuries and recurring ruptures, the anatomical apposition of the retracted muscles is more difficult to be achieved. This review article analyses the outcomes of surgical treatment of hamstring ruptures. The present study confirms the previous knowledge that surgical treatment of hamstring tendon injuries causes good results with high satisfaction rates, both in complete and partial avulsions. Early surgical repair leads to better functional results with lower complication rates, especially in complete avulsions.

KEY MESSAGEs

• Surgical treatment of hamstring tendon ruptures leads to high satisfaction and return to sport rates.
• Both complete and partial hamstring tendon ruptures have better results after acute surgical repair, when compared to cases treated surgically later.
• Athletes with hamstring tendon ruptures should be treated more aggressively with operative methods.

     

股深动脉成形术治疗下肢动脉闭塞症疗效分析

目的观察股深动脉成形术治疗下肢动脉闭塞症的疗效。方法将2005年9月至2006年7月收治的26例下肢动脉闭塞症患者,随机分为股深动脉成形术组(治疗组)和传统血管旁路手术组(对照组),每组各13例,对两组的踝/肱指数、症状改善情况、住院时间及并发症发生情况进行比较。结果术后3个月随访,治疗组疗效优于对照组,两组治疗后踝/肱指数与治疗前比较,均有统计学意义;治疗后两组踝/肱指数、症状改善情况及住院时间比较均有统计学意义,治疗组并发症少于对照组,但无统计学意义。结论在股浅动脉广泛闭塞时,选用股深动脉成形术作为重建患肢血液循环的通道是一种有效的手术方法。手术创伤小,操作方便,更适宜老年患者。     

应用腹直肌-后鞘-腹膜复合瓣游离移植再造半舌的初步报告

目的　探讨应用腹直肌 后鞘 腹膜复合瓣修复舌癌术后半舌缺损的可行性。方法　采用带腹壁下动、静脉、胸神经的腹直肌 后鞘 腹膜复合瓣转移修复半舌缺损 ,将腹直肌与舌内肌缝合 ,后鞘 腹膜与舌黏膜缝合 ,腹壁下动、静脉与颈部血管吻合 ,胸神经与舌下神经吻合。结果　临床应用于 2例因舌癌行半舌切除的患者 ,转移之复合组织瓣均成活 ,再造外形良好。供瓣区愈合 ,瘢痕小。结论　该复合组织瓣用于舌再造 ,具有损伤小 ,外形好 ,有可能恢复神经支配的优点     

Reconstruction of large soft tissue defects of the lower torso with rectus abdominis musculocutaneous flaps

Summary Seven large defects of the lower torso were closed with rectus abdominis musculocutaneous flaps: two large roin defects, three abdominal wall defects, and two open lateral pelvic wounds. Five of the flaps were inferiorly based and two superiorly based. The donor site was closed primarily unless a large skin paddle was taken, in which case the donor site was skin grafted. The central location, excellent blood supply (superior and inferior epigastric arteries plus abundant cutaneous perforators), and length and thickness of the rectus abdominis muscle make it a versatile flap for abdominal wall and lower torso defects.     

闭合复位经皮空心钉内固定治疗股骨颈骨折

目的:探讨闭合复位经皮空心钉内固定治疗股骨颈骨折的疗效。方法:采取闭合复位经皮空心钉内固定治疗45例股骨颈骨折患者。观察骨折类型、受伤至手术时间、术中对骨折端复位程度等指标与术后发生股骨颈骨折不愈合、股骨头缺血性坏死的发生率及髋关节功能恢复情况的关系。结果:45例患者随访时间13～60月,平均36月。37例骨折愈合,愈合率82.22%,8例骨折不愈合。发生股骨头缺血性坏死9例,发生率20%。手术时间30～50 min,平均40 min。按照Harris功能评分标准:优30例,良5例,可1,差9例,优良率:77.78%。结论:闭合复位经皮空心钉内固定治疗股骨颈骨折具有创伤小、并发症少、骨折愈合率较高等优点,骨折的严重程度直接影响预后,伤后应早期手术,解剖复位,牢固固定。     

Effect of antagonist muscle fatigue on knee extension torque

The effect of hamstring fatigue on knee extension torque was examined at different knee angles for seven male subjects. Before and after a dynamic flexion fatigue protocol (180° s^–1, until dynamic torque had declined by 50%), maximal voluntary contraction extension torque was measured at four knee flexion angles (90°, 70°, 50° and 30°). Maximal torque generating capacity and voluntary activation of the quadriceps muscle were determined using electrical stimulation. Average rectified EMG of the biceps femoris was determined. Mean dynamic flexion torque declined by 48±11%. Extensor maximal voluntary contraction torque, maximal torque generating capacity, voluntary activation and average rectified EMG at the four knee angles were unaffected by the hamstring fatigue protocol. Only at 50° knee angle was voluntary activation significantly lower (15.7%) after fatigue (P<0.05). In addition, average rectified EMG before fatigue was not significantly influenced by knee angle. It was concluded that a fatigued hamstring muscle did not increase the maximal voluntary contraction extension torque and knee angle did not change coactivation. Three possible mechanisms may explain the results: a potential difference in recruited fibre populations in antagonist activity compared with the fibres which were fatigued in the protocol, a smaller loss in isometric torque generating capacity of the hamstring muscle than was expected from the dynamic measurements and/or a reduction in voluntary activation.     

Rectus sheath block for acute pain management after robot-assisted prostatectomy

BackgroundRobot-assisted laparoscopic prostatectomy (RALP) is a favored surgical approach for treating prostate cancer. However, RALP does not decrease postoperative pain significantly despite its minimal invasiveness. The pain associated with robot-assisted surgery is most severe during the immediate postoperative period. We aimed to demonstrate that preoperative rectus sheath block (RSB) can reduce acute pain after RALP.MethodsA prospective non-randomized study with two parallel groups was performed from June 2020 to August 2020. A total of 100 patients undergoing RALP were divided into two groups: the RSB group (n = 50) and the non-RSB group (n = 50). Ultrasound-guided RSB was performed preoperatively only in the RSB group. The primary outcome of the study was the visual analog scale (VAS) pain score during coughing (VAS-C) 1 h after surgery. In addition, the VAS pain score at rest (VAS-R) and the VAS-C were assessed up to 24 h after surgery. The doses of postoperative opioids consumed were also recorded.ResultsThe RSB group had a significantly lower VAS-C 1 h after RALP (58 [47–73] vs. 74 [63–83] mm, p = 0.001). In addition, the RSB group had significantly lower VAS-R and VAS-C scores, and postoperative opioid requirement, up to 6 h after surgery compared to the non-RSB group. Moreover, the VAS-R was significantly lower in the RSB group than in the non-RSB group 24 h after surgery.ConclusionPreoperative RSB significantly improved analgesia during the early period after RALP. The long-term analgesic efficacy of RSB needs further study.     

Heterogeneous neuromuscular activation within human rectus femoris muscle during pedaling

Introduction: We investigated the effect of workload and the use of pedal straps on the spatial distribution of neuromuscular activation within the rectus femoris (RF) muscle during pedaling movements. Methods: Eleven healthy men performed submaximal pedaling exercises on an electrically braked ergometer at different workloads and with or without pedal straps. During these tasks, surface electromyograms (SEMGs) were recorded from the RF using 36 electrode pairs, and central locus activation (CLA) was calculated along the longitudinal line of the muscle. Results: CLA moved markedly, indicating changes in spatial distribution of SEMG within the muscle, during a crank cycle under all conditions (P < 0.05). There were significant differences in CLA among different workloads and between those with and without pedal straps (P < 0.05). Conclusion: These results suggest that neuromuscular activation within the RF is regulated regionally by changes in workload and the use of pedal straps during pedaling. Muscle Nerve 52:404–411, 2015     

Acute choke zone effects: Lessons from radioactive and fluorescent microspheres in a pig model muscle flap

BACKGROUND:

Choke vessels dilate and contract to regulate blood flow between adjacent arterial angiosomes. In skin flap surgery, when arterial inflow to an angiosome is ligated, choke vessels allow blood supply from an adjacent angiosome. In muscle flap surgery, the vascular anatomy is analogous to skin flaps; however, while it is established that the choke vessels will fully dilate irreversibly after two to three days, no study has yet analyzed the acute changes in each vascular region immediately following ligation of one pedicle.

OBJECTIVE:

To establish whether the choke vessels open or close immediately following ligation of a pedicle, and how this change affects blood flow in the adjacent proximal and distal vascular regions.

METHODS:

Radioactive and fluorescent microspheres in a pig model were used to study the regional intramuscular blood flow in each anatomical zone of a rectus abdominis flap. Blood flow measurements for each zone were calculated relative to the entire muscle at preligation, ligation and various times (15 min to 90 min) postligation.

RESULTS:

There was no statistically significant difference in blood flow across choke zones as a result of ligation. This signifies that the choke vessels do not significantly dilate to produce a statistically significant measureable change in blood flow.

CONCLUSIONS:

Given these results and previous literature findings, the anatomical presence of choke vessels in a muscle is the strongest determining factor for acute flap viability in surgery.