To research the operative method and the cl inical efficacy of repairing and reconstructing tendon and l igament with allograft tendon. Methods From September 2000 to May 2007, 164 cases with tendon and l igament injuries were treated, including 116 males and 48 females aged 21-47 years old (average 31.5 years old). There were 126 cases of anterior cruciate l igament injury, 18 cases of complete acromioclavicular dislocation, 10 cases of old dislocation of radialhead, 4 cases of Achilles tendon rupture, 2 cases of tibial is anterior muscle rupture, 2 cases of patellar tendon rupture, and 2 cases of rectus femoris rupture. Time interval between injury and hospital admission was 4-345 days (average 75 days). Allograft tendon 10-26 cm in length with suture anchor or absorbable interference screw was used to reconstruct the l igament and tendon. Results All wounds healed by first intention, except one case of rectus femoris rupture. All patients were followed for 10-36 months (average 21 months). The international knee documentation commitee and the Lysholm score of patients with anterior cruciate l igament injury 12 months after operation were significantly higher than that of before operation (P lt; 0.01). According to the Lazzcano and Karlsson score standard, 13 cases of complete acromioclavicular dislocation at 10-12 months after operation were graded as excellent and 5 cases were good. According to Arner Lindholm score standard, 3 cases of Achilles tendon rupture at 8-16 months after operation were graded as excellent and 1 case was good. For the patients with tibial is anterior muscle rupture, at 10-17 months after operation, the limitation of dorsal extension in ankle joint was 5°, and the muscle strength in the anterior tibial is muscle was decreased. For the patients with patellar tendon rupture, one completely restored the motion range of the knee joint 14 months after operation, the other had knee extension l imitation of 10° at 13 months after operation. For the patients with rectus femoris rupture, one had 15° of extension limitation at 18 months after operation, the other suffered limitation of both extension and genuflex at 12 months after operation. According to the Broberg-Morrey score standard, 7 caseswith old dislocation of radial head were graded as excellent and 3 cases were good at 3-36 months after operation. Conclusion Allograft tendon is a good material for repairing and reconstructing tendon and ligament injuries, but attention should be paid to postoperatively early exercise under appropriate protection and early management of local rejection.
The purpose of this study was to find some solutions to the problem of tendon cell proliferation control. Under the condition of in vitro culture, several materials including IGF-1 receptor antibody and mRNA antisense oligonucleotide were added to the culture medium to block the IGF-1-Receptor system. The effect of the material on the tendon cell proliferation was judged by cell count after incubation of 48 hours. The results showed that both IGF-1 Receptor antibody (IGF-1R alpha) and IGF-1 Receptor mRNA antisense oligonucleotide had negative effect on tendon cell proliferation (P lt; 0.01 and P lt; 0.05). These findings lead us to think that the above two materials could be used in the experiment of tendon adhesion preventing and living ready-made tendon producing.
Because of the complicated causes and variable clinical signs, closed injury of tendons at wrist is difficult to diagnosis and treat. Twenty-six cases of tendon ruptur were reported. Among them, 11 cases were caused by bone fracture or dislocation, 8 cases were caused by rheumatoid synovitis, 5 cases were caused by synovial tuberculosis, and 2 cases caused by other. The pathogenesis and clinical signs were analyzed. Twenty-three cases were treated by tendon transfer and 3 cases were treated by tendon transplantation. By average follow-up of 16 months (ranged 6 months to 4 years), the results were as follows: the clip strength and both active and positive motion of fingers were restored in 19 caese, 75% of those were restored in 7 cases and 50% of those were restored in 2 cases. It was suggested that diagnosis, treatment and function rehabilitation should be carried out early, and tendon transfer or tendon transplatation were the method on priority.
OBJECTIVE To improve the clinical result of repair on flexor tendon injury, and recover the defected finger function in children as far as possible. METHODS From January 1990 to October 1997, 12 cases with flexor tendon injury were repaired by microsurgical technique, sutured by modified Kessler method with 3/0 or 5/0 nontraumatic thread and followed by invering suture of the gap edge with 7/0 or 8/0 nontraumatic thread after debridement. Appropriate functional practice was performed postoperatively. RESULTS All the defected fingers were healed by first intention. Followed up 6 months to 1 year, there was excellent in 7 cases, better in 4 cases, moderate in 1 case and 91.67% in excellent rate according to the TAM standard of International Hand Committee. CONCLUSION The important measures to improve the clinical result in children’s flexor tendon injury are prompt and accurate diagnosis and repair of the injured tendon by microsurgical technique, and effective postoperative functional practice.
Objective To assess an effect of 5-fluorouracil (5-FU) applied topically on the tendon adhesion and the healing process after the flexor tendon repair in Leghorn chickens. Methods Thirtytwo white Leghorn chickens, aged 4 months and weighing 1.5-1.7 kg, were randomly divided into 2 groups: Group A andGroup B, with 16 chickens in each group. The flexor digitorum profundus tendons of the 2nd, 3rd and 4th toes were transected and repaired. The repair site in Group A was given 5-FU in a concentration of 25 mg/ml with a soaked sponge that wascut into pieces 7 mm×20 mm×1 mm in size, and the synovial sheath of the repair site was wrapped with the 5-FU-soaked sponge for 1 min for 4 times. The repair site in Group B was served as a control, with no 5-FU but with the sterile normal saline. At 3 and 6 weeks postoperatively, the repaired tendons and the tendon adhesion formation were examined macroscopically and histologically，and the repaired tendons were tested biomechanically. The tissue blocks from the tendon repair site were examined under the transmission electron microscope. Results At 3 and 6 weeks postoperatively, the macroscopic and histological observation showed that the peritendinous adhesions in Group A were looser when compared with those in Group B. The length of the tendon gliding and the extent of yieldance to exercise were found to be 4.85±1.31 mm, 0.67±0.42 mm and 5.74±1.61 mm, 1.55±0.35 mm respectively at 3 and 6 weeks after operation in Group A，but 2.99±0.51mm，0.24±0.14 mm and 3.65±0.54 mm, 1.22±0.16 mm in Group B.Group A was significantly greater in the abovementioned parameters than Group B (P＜0.05).At 3 weeks after operation, the ultimate breaking strength was 20.28±4.92 N in Group A and 21.29±4.88 N in Group B, with no statistically significant difference found between the two groups (P＞0.05). At 6 weeks, the ultimate breaking strength was 47.12±6.76 N in Group A but 39.31±7.20 N in Group B, with a significant difference between the two groups (P＜0.05). Conclusion 5-fuorouracil, when appliedtopically, can reduce the tendon adhesion, with no inhibition of the intrinsic healing mechanism. It is an ideal treatment strategy to prevent peritendinous adhesion.
Objective By culturing tendon sheath fibroblasts, epitenon tenocytes and endotenon tenocytes of rabbits’ tendon in vitro, to study the effects of mannose-6-phosphate on transforming growth factor β (TGF-β) peptide and receptor expression, and to provide the experimental basis for preventing the tendon heal ing adhesion by mannose- 6-phosphate. Methods Eight adult New Zealand white rabbits, regardless of their gender and weighing 4.0-4.5 kg, were selected. Tendon sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes were isolated from rabbit flexor tendon and cultured separately. All 3 cells were divided into 2 groups at random after cells were adjusted to a concentration of 4 × 104 per well and 1 × 104/mL. The first was the control group without supplementation. The experimental group was supplemented withmannose-6-phosphate. The expressions of TGF-β and TGF-β receptor were quantified with enzyme-l inked immunosorbent assay. The expression of TGF-β1 mRNA was also assessed with in situ hybridization and the expression of TGF-β1 was assessed with immunohistochemistry. Results The expressions of TGF-β and TGF-β receptor in experimental group were significantly lower than that in control group (P lt; 0.05). The expression levels of TGF-β1 and TGF-β2 decreased in descending order of tendon sheath fibroblasts (36.1%, 37.9%), epitenon tenocytes (31.0%, 32.1%), and endotenon tenocytes (31.2%, 27.0%). The expression levels of TGF-β3 decreased in descending order of endotenon tenocytes (42.5%), tendon sheath fibroblasts (41.2%), and epitenon tenocytes (33.3%). The expression levels of TGF-β receptor 1 and TGF-β receptor 2 decreased in descending order of epitenon tenocytes (29.9%, 26.2%), endotenon tenocytes (27.8%, 23.5%), and tendon sheath fibroblasts (23.1%, 20.0%). The expression levels of TGF-β receptor 3 decreased in descending order of endotenon tenocytes (26.1%), epitenon tenocytes (19.2%), and tendon sheath fibroblasts (15.8%). In experimental group, the positive expression of TGF-β1 mRNA and the expression level of intracellular TGF-β1 mRNA in all 3 tendon cells were significantly lower than those in the control group (P lt; 0.05). Immunohistochemical staining showed the expressions of TGF-β1 in all 3 tendon cells were significantly lower in theexperimental group than in the control group. Conclusion Mannose-6-phosphate can significantly decrease the expressions of TGF-β peptide, TGF-β receptor, and TGF-β1 mRNA. Modulation of mannose-6-phosphate levels may provide a mean of modulating the effects of TGF-β on adhesion formation in flexor tendon wound heal ing.
【Abstract】 Objective To compare the therapeutic effect of anterior cruciate l igament (ACL) reconstruction bymeans of four-strand semitendinosus tendon autograft and l igament advanced reinforcement system (LARS) by arthroscopy. Methods From July 2002 to April 2005, 42 patients underwent ACL reconstruction by arthroscopy. Twenty-seven patients were treated by four-strand semitendinosus tendon autograft (semitendinosus tendon autograft group), including 22 males and 5 females, with the age from 20 years to 52 years. Among these patients, there were 12 sports injuries, 8 traffic accidents and 7 other injuries. There were 16 cases of left knees and 11 of right knees. The pre-operation Lysholm score was 50.70 ± 6.68, and the course of the disease was 2 to 12 months. Other 15 patients were treated by LARS artificial l igament (LARS group), including 12 males and 3 females, with the age from 17 years to 40 years. Among these patients, there were 8 sports injuries, 4 traffic accidents and 3 other injuries. There were 6 cases of left knees and 9 of right knees. The pre-operation Lysholm score was 50.20 ± 6.22, and the course of the disease was 3 to 12 months. There was no statistically significant difference between the two groups (P gt; 0.05). The ranges of motion, stabil ity and compl ication of the knee were evaluated during the follow-up. Results All incisions healed at the first stage. The patients in the semitendinosus tendon autograft group were followed up for 22 months to 43 months, while 18 months to 40 months in the LARS group. There were 5 patients (19%) whose tensile gap was more than3 mm when the max tensile force text was done in the semitendinosus tendon autograft group, and 3 patients (20%) in the LARS group. The Lysholm score was 87.80 ± 3.41 in the semitendinosus tendon autograft autograft group, and 88.90 ± 3.30 in the LARS group. There was no statistically significant difference between the two groups (P gt; 0.05). The final evaluation based on the improved Lysholm classification standard showed the choiceness rate was 92.6% (18 excellent cases, 7 good cases and 2 faircases) in the semitendinosus tendon autograft group, and 93.3% (11 excellent cases, 3 good cases, 1 fair case) in the LARS group. There was no statistically significant difference between the two groups (P gt; 0.05). The joint motion capabil ity evaluation, according to the Tegner standard, showed 3 to 6 class (with the average class of 4.93) in the semitendinosus tendon autograft group, and 3 to 7 class (with the average class of 5.03) in the LARS group. There was no statistically significant difference (P gt; 0.05). The knee extension in 2 cases was 5° less than the normal, and in 5 cases 5-10° less than the normal in the semitendinosus tendon autograft group. But in all cases in the LARS group, joint motion recovered to the normal (P lt; 0.05). There was no sign of synovitis in both groups. Conclusion The recent cl inical result of ACL reconstruction with the four-strand semitendinosus tendon autograft or LARS artificial l igament by arthroscopy is satisfactory without significant difference. LARS can shorten the recovery time without compl ications such as synovitis in 2-year follow-up.
Through dissection of 12 fresh finger specimens, the anatomy of the distal part of dorsal aponeurosis and its function was closely observed. A direct reparative procedure of the terminal tendon by using tendon flap graft was deseribed for the treatment of chronic mallet finger deformity. Correction of deformity, restoration of active motion of DIP and avoidance of residual pain were observed in three clinical cases.
Objective To study the adhesion-preventing effect of basic fibroblast growth factor(bFGF) combined slow-releasing degradable membrane.Methods The bFGF combined slow-releasing degradable membrane was made from bFGF and the reagent which could promote fibrinogen synthesize. Sixty-six SD rats were divided into groups A,B,C randomly (22 rats each group). In group A, sutured achilles tendon were encapsulated with bFGF combined slow-releasing degradable membrane;in group B, sutured achilles tendon were encapsulated with degradable membrane without any drug; in group C, achilles tendon were only sutured. Ninety days later, light-microscope, electronmicroscopoe, figureanalysing, hydroxyproline content, extent of peritendon adhesion and biomechanic test were evaluated.Results ①The amount of fibroblast and fibrinogen inside the sutured tendon in group A was larger than that inits peripheral connective tissue and in groups B and C (P＜0.05). Thecontent of hydroxyproline and the ultimate tensile strength in group A was higher than those in groups B and C(P＜0.01).② The peripheral tissue in group A almostremains the formal loose connective tissue, but it became dense connective tissue in groups B and C and grew into the tendon. Moreover, the extent of adhesion in group A was lesser than that in groups B, C according to the mensuration of peritendon adhesion.Conclusion The bFGF combined slow-releasing degradable membrane can make the intrinsic healing of tendon faster than peripheral
Flexion tendons in fibrous sheath of 36 New Zealand white rabbits was repaired, after excision of fibrous sheath and vinculum, with microsurgical technique. Histological examination was made. The results showed that as the prolongation of the postoperative time, the adhesion around the tendon became more and more dense. 7 days after operation, tendon was connected by hemocyte and fibroid materials. Following 7 days after operation, fibroblaste origined from extrinsic memberance of tendon obviously produced,and strentched to tendon stump. The synthesis of collage fibers began at 21 days after operation .28 days,connective tissure between tendon stumps was tendency of reconstruction. The experiment demonstrated that pattern of tendon healing belinged to extrinsic repair . That was related to destroy of tendon nutrition systems in fibrous sheath.