核磁共振成像技术在跟腱外伤诊断中的应用评价

目的探讨核磁共振成像技术（MRI）在跟腱外伤中的应用价值,为临床诊断提供更准确依据。方法应用核磁共振成像技术进行回顾性分析,本院2013年2月-2013年12月期间11例有跟腱外伤病例的患者进行过核磁共振成像的检查,查看11例跟腱外伤患者各自的核磁共振成像的表现,并归纳总结核磁共振成像技术在诊断跟腱外伤中的特征性表现。结果有3例患者跟腱完全性损伤,其中此患者MRI图像表现特征主要为跟腱肌腱普遍增粗,而且呈现不规则的形态,肌腱束的连续性全部分开中断,肌腱内T1wI、T2WI上呈混杂性信号;有7例患者为跟腱部分性损伤,其中此类患者MRI图像表现特征为肌腱广泛增粗,在T1WI、T2WI上,肌腱内呈局限性高信号,跟腱肌腱束内毛糙而且呈现不规则形态。经过手术病理证实：完全性损伤有5例,部分性损伤为6例。结论核磁共振成像能清晰显示跟腱的图像,通过图像能清楚看到跟腱肌腱内的形态及其病变,能准确评估跟腱损伤的位置、范围、程度,判断跟腱损伤的性质,为临床诊断治疗提供准确、可靠的依据。     

Nerve and tendon injury with percutaneous fibular pinning: A cadaveric study

ObjectiveThe purposes of this study were to measure the average distance from a percutaneous pin in each quadrant of the distal fibula to the sural nerve and nearest peroneal tendon, and define the safe zone for percutaneous pin placement as would be used during surgery.MethodTen fresh-frozen cadavers underwent percutaneous pin fixation into four quadrants of the distal fibula. The sural nerve and peroneal tendon were identified as they coursed around the lateral ankle. Distances from the K-wire in each quadrant to the anatomic structure of interest were measured.ResultsAverage distances (mm) from the K-wire to the sural nerve in the anterolateral, anteromedial, posterolateral, and posteromedial quadrants were 19.1 ± 8.9 (range, 5.1–35.5), 12.8 ± 8.2 (range, 0.3–27.8), 12.6 ± 6.8 (range, 3.0–27.8), and 5.9 ± 5.5 (range, 0.1–19.9), respectively. Average distances from the K-wire to the nearest peroneal tendon in the anterolateral, anteromedial, posterolateral, and posteromedial quadrants were 15.7 ± 4.4 (range, 9.5–23.1), 11.9 ± 5.2 (range, 3.2–21.7), 6.3 ± 3.9 (range, 0.1–14.4), and 1.0 ± 1.6 (range, 0–5.6), respectively.ConclusionsPercutaneous pinning of distal fibula fractures is a successful treatment option with minimal complications. Our anatomical study found the safe zone of percutaneous pin placement to be in the anterolateral quadrant. The sural nerve can be as close as 5.1 mm and the peroneal tendons as near as 15.7 mm. In contrast, the posteromedial quadrant was associated with the greatest risk of injury to both the sural nerve and peroneal tendons.     

The Incidence of Acute Traumatic Tendon Injuries in the Hand and Wrist: A 10-Year Population-based Study

Background

Acute traumatic tendon injuries of the hand and wrist are commonly encountered in the emergency department. Despite the frequency, few studies have examined the true incidence of acute traumatic tendon injuries in the hand and wrist or compared the incidences of both extensor and flexor tendon injuries.

Methods

We performed a retrospective population-based cohort study of all acute traumatic tendon injuries of the hand and wrist in a mixed urban and rural Midwest county in the United States between 2001-2010. A regional epidemiologic database and medical codes were used to identify index cases. Epidemiologic information including occupation, year of injury, mechanism of injury and the injured tendon and zone were recorded.

Results

During the 10-year study period there was an incidence rate of 33.2 injuries per 100,000 person-years. There was a decreasing rate of injury during the study period. Highest incidence of injury occurred at 20-29 years of age. There was significant association between injury rate and age, and males had a higher incidence than females. The majority of cases involved a single tendon, with extensor tendon injuries occurring more frequently than flexor tendons. Typically, extensor tendon injuries involved zone three of the index finger, while flexor tendons involved zone two of the index finger. Work-related injuries accounted for 24.9% of acute traumatic tendon injuries. The occupations of work-related injuries were assigned to major groups defined by the 2010 Standard Occupational Classification structure. After assigning these patients'' occupations to respective major groups, the most common groups work-related injuries occurred in construction and extraction occupations (44.2%), food preparation and serving related occupations (14.4%), and transportation and material moving occupations (12.5%).

Conclusions

Epidemiology data enhances our knowledge of injury patterns and may play a role in the prevention and treatment of future injuries, with an end result of reducing lost work time and economic burden.     

筋痹论述对筋伤疾病诊治的思考

“筋痹”一名,在《黄帝内经》中即有记载,属于五体痹的一种.在临床多将颈椎病、颈肩背筋膜炎、强直性脊柱炎等归属于“筋痹”范畴[1-3].笔者通过查阅检索期刊文献发现,现代医家对“筋痹”的概念、病因病机、证治方药、转归预后及与现代相关疾病关系的论述并不多.本文通过整理古代文献,从古代医家对“筋痹”的理解认识入手,讨论“筋痹”与“筋伤”关系,为丰富治疗“筋伤”疾病手段,提高治疗效果提供新的思路.     

负压封闭引流联合Lando ®人工真皮并结合自体皮移植应用于手足部骨肌腱外露伴骨折创面的临床研究

目的探讨应用负压封闭引流联合Lando^?人工真皮并结合自体皮移植修复手足部骨肌腱外露伴骨折创面的临床效果。 方法选取2017年11月至2019年2月郑州仁济医院创伤显微外科收治的手足部骨肌腱外露伴骨折的35例患者(手部23例,足部12例)。一期先行骨折复位,彻底清创和止血后,使用负压封闭引流装置进行创面床准备。二期行Lando^?人工真皮移植,待创面完全血管化后,揭除硅胶膜,移植自体皮。术后随访6～12个月,观察植皮成活情况和远期外观恢复情况。 结果35例患者人工真皮覆盖术后10～15 d拆除负压装置,支架血管化良好,完全覆盖裸露的骨肌腱。自体皮移植术后除1例因未及时引流而导致植皮部分坏死,经换药后再次植皮创面愈合,其余患者移植的自体皮片基本存活。术后6～12个月随访发现,移植区无破溃,皮肤颜色与周围正常皮肤颜色接近,无明显瘢痕和挛缩形成,未发生肌腱粘连,功能恢复满意。 结论负压封闭引流联合Lando^?人工真皮并结合自体皮移植修复手足部骨肌腱外露创面,可直接覆盖外露骨肌腱,术后移植区外观恢复平整,功能恢复良好,值得推广。     

人工真皮支架联合灌洗式负压封闭引流在肌腱或骨外露创面修复中的应用

目的探讨人工真皮支架联合灌洗式负压封闭引流修复肌腱或骨外露创面的疗效。 方法选择2018年1月至2020年1月安徽医科大学第一附属医院烧伤科收治的肌腱或骨外露创面39例,其中急性创面26例(外伤10例,烧伤11例,热压伤4例,虫咬伤1例);慢性创面13例(糖尿病足皮肤溃疡2例,烧伤后期创面7例,瘢痕溃疡4例)。在全身麻醉或神经阻滞下行创面清创,在肌腱或骨外露处植入加强型人工真皮支架,外加负压封闭引流敷料覆盖,术后使用不同冲洗液进行间歇性灌洗,直至组织红润,达到二期植皮手术要求。观察并记录人工真皮支架使用次数,清创后人工真皮支架植入与二期植皮间隔时间和植皮成活情况。 结果39例肌腱或骨外露的急慢性创面经清创后覆盖人工真皮支架,术后经不同冲洗液间歇性灌洗式负压封闭引流治疗,均形成新鲜肉芽组织,二期经刃厚皮片植皮手术,植皮均100%成活,未出现感染等并发症。 结论人工真皮支架植入联合灌洗式负压封闭引流可有效地覆盖外露的肌腱和骨,是急慢性创面合并肌腱、骨外露的有效修复方式之一。     

Application of stem cells derived from the periodontal ligament or gingival tissue sources for tendon tissue regeneration

Tendon injuries are often associated with significant dysfunction and disability due to tendinous tissue's very limited self-repair capacity and propensity for scar formation. Dental-derived mesenchymal stem cells (MSCs) in combination with appropriate scaffold material present an alternative therapeutic option for tendon repair/regeneration that may be advantageous compared to other current treatment modalities. The MSC delivery vehicle is the principal determinant for successful implementation of MSC-mediated regenerative therapies. In the current study, a co-delivery system based on TGF-β3-loaded RGD-coupled alginate microspheres was developed for encapsulating periodontal ligament stem cells (PDLSCs) or gingival mesenchymal stem cells (GMSCs). The capacity of encapsulated dental MSCs to differentiate into tendon tissue was investigated in vitro and in vivo. Encapsulated dental-derived MSCs were transplanted subcutaneously into immunocompromised mice. Our results revealed that after 4 weeks of differentiation in vitro, PDLSCs and GMSCs as well as the positive control human bone marrow mesenchymal stem cells (hBMMSCs) exhibited high levels of mRNA expression for gene markers related to tendon regeneration (Scx, DCn, Tnmd, and Bgy) via qPCR measurement. In a corresponding in vivo animal model, ectopic neo-tendon regeneration was observed in subcutaneous transplanted MSC-alginate constructs, as confirmed by histological and immunohistochemical staining for protein markers specific for tendons. Interestingly, in our quantitative PCR and in vivo histomorphometric analyses, PDLSCs showed significantly greater capacity for tendon regeneration than GMSCs or hBMMSCs (P < 0.05). Altogether, these findings indicate that periodontal ligament and gingival tissues can be considered as suitable stem cell sources for tendon engineering. PDLSCs and GMSCs encapsulated in TGF-β3-loaded RGD-modified alginate microspheres are promising candidates for tendon regeneration.     

The behavior of neuronal cells on tendon-derived collagen sheets as potential substrates for nerve regeneration

Peripheral nervous system injuries result in a decreased quality of life, and generally require surgical intervention for repair. Currently, the gold standard of nerve autografting, based on the use of host tissue such as sensory nerves is suboptimal as it results in donor-site loss of function and requires a secondary surgery. Nerve guidance conduits fabricated from natural polymers such as collagen are a common alternative to bridge nerve defects. In the present work, tendon sections derived through a process named bioskiving were studied for their potential for use as a substrate to fabricate nerve guidance conduits. We show that cells such as rat Schwann cells adhere, proliferate, and align along the fibrous tendon substrate which has been shown to result in a more mature phenotype. Additionally we demonstrate that chick dorsal root ganglia explants cultured on the tendon grow to similar lengths compared to dorsal root ganglia cultured on collagen gels, but also grow in a more oriented manner on the tendon sections. These results show that tendon sections produced through bioskiving can support directional nerve growth and may be of use as a substrate for the fabrication of nerve guidance conduits.     

聚乳酸防粘连膜在Ⅱ区屈肌腱损伤修复中的临床应用

目的观察可吸收性防粘连膜预防肌腱粘连的临床应用效果。方法对23例手部屈肌腱II区损伤修复后的患者随访,分为置膜组(A组)和对照组(B组),A组用粘克聚-DL-乳酸可吸收医用膜包绕肌腱缝合端,B组不放置防粘连膜,4~6周后均行主动屈伸指锻炼。采用MRC(Medical Research Council)、TAM(Total Active Motion)、Strickland System和Buck-Gramcko System 4种评价方法对屈指深肌腱修复后的功能进行评定。结果术后随访时间1.5~12个月,平均3个月。在屈肌腱肌力MRC评定中,A组优良率为66.6%,B组优良率为58.3%;对于TAM评级,A组优良率为66.6%,B组优良率为50.0%;在Strickland评级中,A组优良率为80.0%,B组优良率为58.3%;在Buck-Gramcko系统评定中,A组优良率为86.7%,B组优良率为41.7%。前三项评级0.05;Buck-Gramcko系统评定中,0.05,A组和B组有统计学差异。结论在II区屈肌腱损伤修复中,聚乳酸防粘连膜具有良好的预防肌腱粘连的作用。     

Lysyl oxidase-mediated collagen crosslinks may be assessed as markers of functional properties of tendon tissue formation

Mechanical property elaboration of engineered tissues is often assumed on the basis of gene and protein characterizations, rather than mechanical testing. However, we recently demonstrated that mechanical properties are not consistently correlated with matrix content and organization during embryonic tissue development. Based on this, mechanical properties should be assessed independently during natural or engineered tissue formation. Unfortunately, mechanical testing is destructive, and thus alternative means of assessing these properties are desirable. In this study, we examined lysyl oxidase (LOX)-mediated crosslinks as markers for mechanical properties during embryonic tendon formation and the potential to detect them non-destructively. We used tandem mass spectrometry (LC-MS/MS) to quantify changes in hydroxylysyl pyridinoline (HP) and lysyl pyridinoline (LP) crosslink density in embryonic chick tendon as a function of developmental stage. In addition, we assessed a multiphoton imaging approach that exploits the natural fluorescence of HP and LP. With both techniques, we quantified crosslink density in normal and LOX-inhibited tendons, and correlated measurements with mechanical properties. HP and LP crosslink density varied as a function of developmental stage, with HP-to-dry mass ratio correlating highly to elastic modulus, even when enzymatic crosslink formation was inhibited. Multiphoton optical imaging corroborated LC-MS/MS data, identifying significant reductions in crosslink density from LOX inhibition. Taken together, crosslink density may be useful as a marker of tissue mechanical properties that could be assessed with imaging non-destructively and perhaps non-invasively. These outcomes could have significant scientific and clinical implications, enabling continuous and long-term monitoring of mechanical properties of collagen-crosslinked tissues or engineered constructs.