Tendon is a mechanosensitive tissue that transmits force from muscle to bone.Physiological loading contributes to maintaining the homeostasis and adaptation of tendon,but aberrant loading may lead to injury or failed ...Tendon is a mechanosensitive tissue that transmits force from muscle to bone.Physiological loading contributes to maintaining the homeostasis and adaptation of tendon,but aberrant loading may lead to injury or failed repair.It is shown that stem cells respond to mechanical loading and play an essential role in both acute and chronic injuries,as well as in tendon repair.In the process of mechanotransduction,mechanical loading is detected by mechanosensors that regulate cell differentiation and proliferation via several signaling pathways.In order to better understand the stem-cell response to mechanical stimulation and the potential mechanism of the tendon repair process,in this review,we summarize the source and role of endogenous and exogenous stem cells active in tendon repair,describe the mechanical response of stem cells,and finally,highlight the mechanotransduction process and underlying signaling pathways.展开更多
Active Achilles tendon kinesitherapy facilitates the functional recovery of a ruptured Achilles tendon However, protein expression during the healing process remains a controversial issue. New Zealand rabbits, aged 14...Active Achilles tendon kinesitherapy facilitates the functional recovery of a ruptured Achilles tendon However, protein expression during the healing process remains a controversial issue. New Zealand rabbits, aged 14 weeks, underwent tenotomy followed immediately byAchilles tendon microsurgery to repair the Achilles tendon rupture. The tendon was then immobilized or subjected to postoperative early motion treatment （kinesitherapy）. Mass spectrography results showed that after 14 days of motion treatment, 18 protein spots were differentially expressed, among which, 12 were up-regulated, consisting of gelsolin isoform b and neurite growth-related protein collapsing response mediator protein 2. Western blot analysis showed that gelsolin isoform b was up-regulated at days 7-21 of motion treatment. These findings suggest that active Achilles tendon kinesitherapy promotes the neurite regeneration of a ruptured Achilles tendon and gelsolin isoform b can be used as a biomarker for Achilles tendon healing after kinesitherapy.展开更多
Objective To investigate the methods and significance of early mobilization to the function rehabilitation after flexor tendon repair.Methods 286 complete flexor tendon amputation in 116 cases which was not combined w...Objective To investigate the methods and significance of early mobilization to the function rehabilitation after flexor tendon repair.Methods 286 complete flexor tendon amputation in 116 cases which was not combined with fractures were repaired.From the third day after operation,the digits were mobilized with a combination of assisted passive flexion and active extension simultaneously in the first 4 weeks.The digits flexing and extending scope was increased gradually controlled by doctors.Unassisted active flexion extension exercises begun 4 weeks after operation.The injured fingers were given physical therapy of voice band therapy 4 weeks postoperatively,ultrashort wave treatment 4 weeks and wax hot therapy 6 week postoperatively.Patients were followed up once weekly to be instructed how to go on functional training after they were discharged.Results Patients were followed up from 6 to 18 months.The function recovery of the corresponding fingers was evaluated by TAM method which included 192 excellent digits(77.1%),25 fine digits(10.0%),15 normal digits(6.0%) and 17 bad digits (6.8%).Conclusion It was inevitable for the repaired tendon to be adhered to the around tissue.Early mobilization of relevant injured fingers could enhance formation of non limited adhesion,increase excursion of the reconditioned tendon and revert tendon intensity at early time.Early mobilization should begin at 3 days after operation.展开更多
Despite early cautions against the primary repair of zone II flexor tendon injuries, recent advances in surgical technique and suture materials have allowed such repairs to become commonplace. The 6-strand repair tech...Despite early cautions against the primary repair of zone II flexor tendon injuries, recent advances in surgical technique and suture materials have allowed such repairs to become commonplace. The 6-strand repair technique is rarely applied to the young pediatric population, however, to our knowledge, no English-language articles have described this method of primary repair in zone II of children less than 2 years old. A 13-month-old male presented flexor digitorum profundus repair after lacerating it in zone II on a sharp aluminum can. The tendon was repaired with a 6-strand technique, using a 4.0 Fiberloop for the core suture and 6.0 Prolene for the epitendinous suture. Approximately four months after surgery, the patient developed a palmar collection at the level of his middle phalanx and a serosanguinous sinus tract at the distal interphalangeal crease. During the revision surgery, the inspection of the repaired tendon revealed a small gap filled with scar tissue. There was no evidence of new fistula formation at his final visit one month after the second procedure. After the revision, the patient could move his digit with minimal loss of range of motion at the distal interphalangeal joints. Unfortunately, he was subsequently lost to follow up. This surgical technique was selected to provide a strong repair that would allow the early postoperative movement. In retrospect, a 6-strand repair with braided suture is not ideal in young children as the bulky suture can cause a foreign-body reaction and possibly extrude through the skin. Additionally, the immobilization with a long-arm cast remains a valuable tool after tendon repair in infants who cannot voluntarily restrict their movements.展开更多
Repairing Achilles tendon has emerged as a long-standing challenge in the orthopaedic surgeries.Although suture is the gold standard for re-attaching and repairing the fractured Achilles tendons in clinical surgeries,...Repairing Achilles tendon has emerged as a long-standing challenge in the orthopaedic surgeries.Although suture is the gold standard for re-attaching and repairing the fractured Achilles tendons in clinical surgeries,it is still subjected to numerous adverse side-effects,including chronic inflammatory,tendon tissue re-rupture,scar formation,and post-surgical peritendinous adhesion.In this work,we develop a class of hydrogel bioadhesives with tailored nanoscale phase separation for Achilles tendon repairing.To address the existing limitations of sutures,our hydrogel bioadhesives encompass three core functionalities:(i)instant and tough adhesion to Achilles tendon tissues,(ii)extraordinary long-term adhesion robustness under wet and dynamic in vivo conditions,and(iii)anti-postsurgical peritendinous adhesion.Combining our hydrogel bioadhesives with sutures,such kind of integrated approach enables a conformable yet robust biointerface with the tendon tissues,and prevents the fibroblast migration and formation of connective tissues,thus facilitating the tendon repairing.The hydrogel bioadhesives reported here open up new opportunities for the repairing of fractured Achilles tendons in diverse and complicated clinical scenarios.展开更多
Purpose: We investigated whether percutaneous suturing of Achilles tendon ruptures showed better results and superiority in terms of clinical outcomes when compared to open suturing. Methods: We conducted a case-contr...Purpose: We investigated whether percutaneous suturing of Achilles tendon ruptures showed better results and superiority in terms of clinical outcomes when compared to open suturing. Methods: We conducted a case-control study. Between 2009 and 2014, we performed surgical revisions of closed acute Achilles tendon ruptures in our hospital in 146 patients, of which 71 patients (2012-2014) received percutaneous suturing using Dresden instruments, and 75 patients (2009-2012) underwent open suturing. After a minimum period of 1 year post surgery, we performed clinical follow-up in 25 patients of each of the groups using the AOFAS hind foot score and the SF-12 questionnaire. Furthermore, we implemented a clinical questionnaire with a reference population of 200 healthy individuals. Results: Mean age in the total population of 146 patients was 47 years (range 21 to 83 years) at the time of surgery. The duration of the surgical procedure with percutaneous suturing was significantly shorter (24 versus 43 minutes, p < 0.0001), the complication rate was significantly lower (2.81% versus 10.7%, p < 0.0001), and the time of hospitalisation was significantly shorter (3 versus 4 days, p < 0.0001) when compared to open suturing. During follow-up, no significant differences between the two groups were observed in terms of descriptive parameters. Furthermore, ultrasound examinations of both follow-up populations did not show any significant difference. From a clinical perspective, the good to very good results achieved with open suturing (as measured with the AOFAS hind foot score and the SF-12 questionnaire) have not been significantly improved with percutaneous suturing. The additional use of a new clinical score (with the reference population) demonstrated good to very good consistency with the established scores. Conclusion: In our population, percutaneous Achilles tendon suturing showed significantly lower complication rates and significantly shorter procedure times when compared to open suturing. However, percutaneous suturing did not show clinical improvements of the good to very good results that were achieved with open suturing (as measured with the AOFAS back foot score and the SF-12 questionnaire). The implementation of a new and simple score for the clinical evaluation of Achilles tendon injuries resulted in good to very good consistency with the established questionnaires and, thus, offered a straightforward and rapid alternative when compared to the more elaborate scores.展开更多
Aim: The aims of this study were: 1) to estimate the prevalence and pattern of complications after Achilles tendon (AT) repair, and 2) to determine the significant predictors of post-operative infection. Methods: A re...Aim: The aims of this study were: 1) to estimate the prevalence and pattern of complications after Achilles tendon (AT) repair, and 2) to determine the significant predictors of post-operative infection. Methods: A retrospective cohort study of all patients who were operated at Hamad General Hospital (HGH) between June 2010 and June 2012 for AT rupture (n = 102), was conducted. Data was collected on 1) patient’ characteristics such as age, sex;2) disease characteristics such as mechanism of rupture, type of rupture (partial or complete), whether an anterior or posterior slab was applied, number of suture materials, number of antibiotics, surgical time, time to surgery and length of hospital stay (LOS), number of follow up visits, and 3) complications. Descriptive and analytical statistical analyses were applied. Receiver operating characteristic curve was applied to identify the validity of different LOS values, with a significance level at p ≤ 0.05. Results: Of the 102 patients with Achilles rupture, almost males (96.1%), with a mean age 31.07 ± 9.71 years, 52% with complete rupture, the majority were open ruptures (81.4%) and bathroom-related (70.6%). Anterior slab was applied to 58.2% and 2 types of suture materials to 71.6% of cases. Fifteen cases (14.7%, 95% CI: 7.8% - 21.6%) presented with one or more complications (9.8% post-operative infections, 5.9% stiffness and 2% re-rupture). Post-operative infections were significantly associated with: old age (z = 2.11, p = 0.035), longer LOS (z = 2.01, p = 0.04), and presence of diabetes (Fisher exact test: p = 0.003). After adjustment for age, LOS (p = 0.04) and diabetes (p = 0.017) remained as significant predictors of post-operative infections. LOS of 2.5 days was the optimum cut-off point above which post-operative infection is more likely to occur, with sensitivity of 80% and specificity of 54%. Conclusion: Achilles repair post operative infection ranks first as a complication of AT surgical repair, and its incidence is relatively higher in HGH than the counterpart figures in the literature. The展开更多
The preferred treatment of distal biceps tendon ruptures is by operative repair. However, the best approach for repair(single vs double incision) is still subject of debate. Grewal and colleagues recently presented th...The preferred treatment of distal biceps tendon ruptures is by operative repair. However, the best approach for repair(single vs double incision) is still subject of debate. Grewal and colleagues recently presented the results of a randomized clinical trial evaluating two different surgical approaches for the repair of distal biceps tendon ruptures. Despite the fact that this article currently presents the highest level of evidence for the surgical repair of distal biceps tendon ruptures, we have some comments on the study that might be interesting to discuss. We think that some of the results and conclusions presented in this study need to be interpreted in the light of these comments.展开更多
目的探讨行通道辅助微创修复系统缝合术修复急性闭合性跟腱断裂的临床疗效。方法将2017年3月至2021年9月收入成都体育学院附属体育医院的90例急性闭合性跟腱断裂患者进行回顾性分析。根据术前医患沟通结果,分为微创组(45例)和开放组(45...目的探讨行通道辅助微创修复系统缝合术修复急性闭合性跟腱断裂的临床疗效。方法将2017年3月至2021年9月收入成都体育学院附属体育医院的90例急性闭合性跟腱断裂患者进行回顾性分析。根据术前医患沟通结果,分为微创组(45例)和开放组(45例)。微创组采用微创跟腱断裂通道吻合器吻合术,开放组采用切开改良Kessler断端吻合术。比较两组患者的手术时间、切口长度、并发症;分别比较两组患者术后1、6、12个月的疼痛视觉模拟评分(visual analogue scale,VAS)、美国骨科足踝协会后足与踝评分(American Orthopaedic Foot and Ankle Society,AOFAS)和足跖屈-背伸活动度(range of motion,ROM)。结果微创组及开放组患者均获12~24个月的随访,平均为(18.4±5.6)个月。微创组的手术时间较开放组手术时间明显少,微创组手术切口长度较开放组手术切口长度明显短,两组比较差异有统计学意义(P<0.05)。微创组术中、术后并发症明显低于开放组,两组比较差异有统计学意义(P<0.05),微创组及开放组患者术后1个月的VAS评分,差异有统计学意义(P<0.05);术后6、12个月的VAS评分,差异无统计学意义(P>0.05)。两组患者术后1、6个月的AOFAS评分,差异有统计学意义(P<0.05);术后12个月AOFAS评分比及术后6、12个月的足跖屈-背伸活动度比较,差异无统计学意义(P>0.05)。结论采用微创跟腱断裂通道吻合器修复急性闭合性跟腱断裂,具有微创、并发症少、早期康复等优势。展开更多
Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repa...Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymalstem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair.展开更多
基金Supported by National Natural Science Foundation of China,No.81871848 and No.81702171and Shenzhen Double Chain Project for Innovation and Development Industry,No.201806081018272960.
文摘Tendon is a mechanosensitive tissue that transmits force from muscle to bone.Physiological loading contributes to maintaining the homeostasis and adaptation of tendon,but aberrant loading may lead to injury or failed repair.It is shown that stem cells respond to mechanical loading and play an essential role in both acute and chronic injuries,as well as in tendon repair.In the process of mechanotransduction,mechanical loading is detected by mechanosensors that regulate cell differentiation and proliferation via several signaling pathways.In order to better understand the stem-cell response to mechanical stimulation and the potential mechanism of the tendon repair process,in this review,we summarize the source and role of endogenous and exogenous stem cells active in tendon repair,describe the mechanical response of stem cells,and finally,highlight the mechanotransduction process and underlying signaling pathways.
基金supported by the National Natural Science Foundation of China,No.30760256
文摘Active Achilles tendon kinesitherapy facilitates the functional recovery of a ruptured Achilles tendon However, protein expression during the healing process remains a controversial issue. New Zealand rabbits, aged 14 weeks, underwent tenotomy followed immediately byAchilles tendon microsurgery to repair the Achilles tendon rupture. The tendon was then immobilized or subjected to postoperative early motion treatment （kinesitherapy）. Mass spectrography results showed that after 14 days of motion treatment, 18 protein spots were differentially expressed, among which, 12 were up-regulated, consisting of gelsolin isoform b and neurite growth-related protein collapsing response mediator protein 2. Western blot analysis showed that gelsolin isoform b was up-regulated at days 7-21 of motion treatment. These findings suggest that active Achilles tendon kinesitherapy promotes the neurite regeneration of a ruptured Achilles tendon and gelsolin isoform b can be used as a biomarker for Achilles tendon healing after kinesitherapy.
文摘Objective To investigate the methods and significance of early mobilization to the function rehabilitation after flexor tendon repair.Methods 286 complete flexor tendon amputation in 116 cases which was not combined with fractures were repaired.From the third day after operation,the digits were mobilized with a combination of assisted passive flexion and active extension simultaneously in the first 4 weeks.The digits flexing and extending scope was increased gradually controlled by doctors.Unassisted active flexion extension exercises begun 4 weeks after operation.The injured fingers were given physical therapy of voice band therapy 4 weeks postoperatively,ultrashort wave treatment 4 weeks and wax hot therapy 6 week postoperatively.Patients were followed up once weekly to be instructed how to go on functional training after they were discharged.Results Patients were followed up from 6 to 18 months.The function recovery of the corresponding fingers was evaluated by TAM method which included 192 excellent digits(77.1%),25 fine digits(10.0%),15 normal digits(6.0%) and 17 bad digits (6.8%).Conclusion It was inevitable for the repaired tendon to be adhered to the around tissue.Early mobilization of relevant injured fingers could enhance formation of non limited adhesion,increase excursion of the reconditioned tendon and revert tendon intensity at early time.Early mobilization should begin at 3 days after operation.
文摘Despite early cautions against the primary repair of zone II flexor tendon injuries, recent advances in surgical technique and suture materials have allowed such repairs to become commonplace. The 6-strand repair technique is rarely applied to the young pediatric population, however, to our knowledge, no English-language articles have described this method of primary repair in zone II of children less than 2 years old. A 13-month-old male presented flexor digitorum profundus repair after lacerating it in zone II on a sharp aluminum can. The tendon was repaired with a 6-strand technique, using a 4.0 Fiberloop for the core suture and 6.0 Prolene for the epitendinous suture. Approximately four months after surgery, the patient developed a palmar collection at the level of his middle phalanx and a serosanguinous sinus tract at the distal interphalangeal crease. During the revision surgery, the inspection of the repaired tendon revealed a small gap filled with scar tissue. There was no evidence of new fistula formation at his final visit one month after the second procedure. After the revision, the patient could move his digit with minimal loss of range of motion at the distal interphalangeal joints. Unfortunately, he was subsequently lost to follow up. This surgical technique was selected to provide a strong repair that would allow the early postoperative movement. In retrospect, a 6-strand repair with braided suture is not ideal in young children as the bulky suture can cause a foreign-body reaction and possibly extrude through the skin. Additionally, the immobilization with a long-arm cast remains a valuable tool after tendon repair in infants who cannot voluntarily restrict their movements.
基金support by Natural Science Foundation of Guangdong Province(Nos.2022A1515010152 and 2021A1515110735)the Basic Research Program of Shenzhen(Nos.JCYJ20210324105211032 and GJHZ20210705141809030)+1 种基金the Scientific Research Platforms and Projects of University of Guangdong Provincial Education Office(No.2022ZDZX3019)supported in part by the Science,Technology,and Innovation Commission of Shenzhen Municipality(No.ZDSYS20200811143601004).
文摘Repairing Achilles tendon has emerged as a long-standing challenge in the orthopaedic surgeries.Although suture is the gold standard for re-attaching and repairing the fractured Achilles tendons in clinical surgeries,it is still subjected to numerous adverse side-effects,including chronic inflammatory,tendon tissue re-rupture,scar formation,and post-surgical peritendinous adhesion.In this work,we develop a class of hydrogel bioadhesives with tailored nanoscale phase separation for Achilles tendon repairing.To address the existing limitations of sutures,our hydrogel bioadhesives encompass three core functionalities:(i)instant and tough adhesion to Achilles tendon tissues,(ii)extraordinary long-term adhesion robustness under wet and dynamic in vivo conditions,and(iii)anti-postsurgical peritendinous adhesion.Combining our hydrogel bioadhesives with sutures,such kind of integrated approach enables a conformable yet robust biointerface with the tendon tissues,and prevents the fibroblast migration and formation of connective tissues,thus facilitating the tendon repairing.The hydrogel bioadhesives reported here open up new opportunities for the repairing of fractured Achilles tendons in diverse and complicated clinical scenarios.
文摘Purpose: We investigated whether percutaneous suturing of Achilles tendon ruptures showed better results and superiority in terms of clinical outcomes when compared to open suturing. Methods: We conducted a case-control study. Between 2009 and 2014, we performed surgical revisions of closed acute Achilles tendon ruptures in our hospital in 146 patients, of which 71 patients (2012-2014) received percutaneous suturing using Dresden instruments, and 75 patients (2009-2012) underwent open suturing. After a minimum period of 1 year post surgery, we performed clinical follow-up in 25 patients of each of the groups using the AOFAS hind foot score and the SF-12 questionnaire. Furthermore, we implemented a clinical questionnaire with a reference population of 200 healthy individuals. Results: Mean age in the total population of 146 patients was 47 years (range 21 to 83 years) at the time of surgery. The duration of the surgical procedure with percutaneous suturing was significantly shorter (24 versus 43 minutes, p < 0.0001), the complication rate was significantly lower (2.81% versus 10.7%, p < 0.0001), and the time of hospitalisation was significantly shorter (3 versus 4 days, p < 0.0001) when compared to open suturing. During follow-up, no significant differences between the two groups were observed in terms of descriptive parameters. Furthermore, ultrasound examinations of both follow-up populations did not show any significant difference. From a clinical perspective, the good to very good results achieved with open suturing (as measured with the AOFAS hind foot score and the SF-12 questionnaire) have not been significantly improved with percutaneous suturing. The additional use of a new clinical score (with the reference population) demonstrated good to very good consistency with the established scores. Conclusion: In our population, percutaneous Achilles tendon suturing showed significantly lower complication rates and significantly shorter procedure times when compared to open suturing. However, percutaneous suturing did not show clinical improvements of the good to very good results that were achieved with open suturing (as measured with the AOFAS back foot score and the SF-12 questionnaire). The implementation of a new and simple score for the clinical evaluation of Achilles tendon injuries resulted in good to very good consistency with the established questionnaires and, thus, offered a straightforward and rapid alternative when compared to the more elaborate scores.
文摘Aim: The aims of this study were: 1) to estimate the prevalence and pattern of complications after Achilles tendon (AT) repair, and 2) to determine the significant predictors of post-operative infection. Methods: A retrospective cohort study of all patients who were operated at Hamad General Hospital (HGH) between June 2010 and June 2012 for AT rupture (n = 102), was conducted. Data was collected on 1) patient’ characteristics such as age, sex;2) disease characteristics such as mechanism of rupture, type of rupture (partial or complete), whether an anterior or posterior slab was applied, number of suture materials, number of antibiotics, surgical time, time to surgery and length of hospital stay (LOS), number of follow up visits, and 3) complications. Descriptive and analytical statistical analyses were applied. Receiver operating characteristic curve was applied to identify the validity of different LOS values, with a significance level at p ≤ 0.05. Results: Of the 102 patients with Achilles rupture, almost males (96.1%), with a mean age 31.07 ± 9.71 years, 52% with complete rupture, the majority were open ruptures (81.4%) and bathroom-related (70.6%). Anterior slab was applied to 58.2% and 2 types of suture materials to 71.6% of cases. Fifteen cases (14.7%, 95% CI: 7.8% - 21.6%) presented with one or more complications (9.8% post-operative infections, 5.9% stiffness and 2% re-rupture). Post-operative infections were significantly associated with: old age (z = 2.11, p = 0.035), longer LOS (z = 2.01, p = 0.04), and presence of diabetes (Fisher exact test: p = 0.003). After adjustment for age, LOS (p = 0.04) and diabetes (p = 0.017) remained as significant predictors of post-operative infections. LOS of 2.5 days was the optimum cut-off point above which post-operative infection is more likely to occur, with sensitivity of 80% and specificity of 54%. Conclusion: Achilles repair post operative infection ranks first as a complication of AT surgical repair, and its incidence is relatively higher in HGH than the counterpart figures in the literature. The
文摘The preferred treatment of distal biceps tendon ruptures is by operative repair. However, the best approach for repair(single vs double incision) is still subject of debate. Grewal and colleagues recently presented the results of a randomized clinical trial evaluating two different surgical approaches for the repair of distal biceps tendon ruptures. Despite the fact that this article currently presents the highest level of evidence for the surgical repair of distal biceps tendon ruptures, we have some comments on the study that might be interesting to discuss. We think that some of the results and conclusions presented in this study need to be interpreted in the light of these comments.
文摘目的探讨行通道辅助微创修复系统缝合术修复急性闭合性跟腱断裂的临床疗效。方法将2017年3月至2021年9月收入成都体育学院附属体育医院的90例急性闭合性跟腱断裂患者进行回顾性分析。根据术前医患沟通结果,分为微创组(45例)和开放组(45例)。微创组采用微创跟腱断裂通道吻合器吻合术,开放组采用切开改良Kessler断端吻合术。比较两组患者的手术时间、切口长度、并发症;分别比较两组患者术后1、6、12个月的疼痛视觉模拟评分(visual analogue scale,VAS)、美国骨科足踝协会后足与踝评分(American Orthopaedic Foot and Ankle Society,AOFAS)和足跖屈-背伸活动度(range of motion,ROM)。结果微创组及开放组患者均获12~24个月的随访,平均为(18.4±5.6)个月。微创组的手术时间较开放组手术时间明显少,微创组手术切口长度较开放组手术切口长度明显短,两组比较差异有统计学意义(P<0.05)。微创组术中、术后并发症明显低于开放组,两组比较差异有统计学意义(P<0.05),微创组及开放组患者术后1个月的VAS评分,差异有统计学意义(P<0.05);术后6、12个月的VAS评分,差异无统计学意义(P>0.05)。两组患者术后1、6个月的AOFAS评分,差异有统计学意义(P<0.05);术后12个月AOFAS评分比及术后6、12个月的足跖屈-背伸活动度比较,差异无统计学意义(P>0.05)。结论采用微创跟腱断裂通道吻合器修复急性闭合性跟腱断裂,具有微创、并发症少、早期康复等优势。
文摘Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymalstem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair.
