Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients.Most injuries are open injuries to the flexor or extensor tendons,but less frequent in...Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients.Most injuries are open injuries to the flexor or extensor tendons,but less frequent injuries,e.g.,damage to the functional system tendon sheath and pulley or dull avulsions,also need to be considered.After clinical examination,ultrasound and magnetic resonance imaging have proved to be important diagnostic tools.Tendon injuries mostly require surgical repair,dull avulsions of the distal phalanges extensor tendon can receive conservative therapy.Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair.In the postoperative course offlexor tendon injuries,the principle of early passive movement is important to trigger an"intrinsic"tendon healing to guarantee a good outcome.Many substances were evaluated to see if they improved tendon healing;however,little evidence was found.Nevertheless,hyaluronic acid may improve intrinsic tendon healing.展开更多
Disabled shoulders of throwing athletes typically present with extended undersurface partial tears of the rotator cuff, which include the posterior supraspinatus and the anterior infraspinatus tendon to a variable ext...Disabled shoulders of throwing athletes typically present with extended undersurface partial tears of the rotator cuff, which include the posterior supraspinatus and the anterior infraspinatus tendon to a variable extent. We propose a modified transtendon repair technique to adequately treat this subset of patients. The repair includes two double-loaded anchors, at the anterior and the posterior end of the tear, respectively. With the help of an angulated penetrator we create a medial and a lateral band of sutures on top of the cuff, producing a broad contact in the tendon-to-bone interface. All the 9 so far operated patients were young men, 7 of them base-ball pitchers, and 5 active in competitive sports. The Constant Score rose from 72 points preoperatively to 99 points at 12 months follow-up. Three of the still active pitchers were able to return to their previous level in sports after one year. The improved footprint contact of our novel repair construct should allow for better healing and, therefore, a higher chance of return to competition.展开更多
目的探讨磁共振成像(MRI)下肩胛下肌(SSC)损伤与肱二头肌长头肌腱(LHBT)病变的相关性及临床特点。方法选择2020年9月至2021年12月在贵州中医药大学第一附属医院因肩痛就诊,同时行肩关节MRI检查提示存在SSC损伤合并LHBT病变的128例患者,...目的探讨磁共振成像(MRI)下肩胛下肌(SSC)损伤与肱二头肌长头肌腱(LHBT)病变的相关性及临床特点。方法选择2020年9月至2021年12月在贵州中医药大学第一附属医院因肩痛就诊,同时行肩关节MRI检查提示存在SSC损伤合并LHBT病变的128例患者,根据Lafosse分型、Slatis and Aalto分型,在MRI下对SSC损伤合并LHBT病变进行分级评估,采用Spearman等级相关分析探讨SSC损伤分型和LHBT病变分型的相关性。结果SSC损伤分型结果为28例Ⅰ型、22例Ⅱ型、36例Ⅲ型、18例Ⅳ型、24例V型,LHBT病变分型结果为85例Ⅰ型、16例Ⅱ型、27例Ⅲ型。Spearman等级相关分析结果显示,SSC损伤分型和LHBT病变分型呈正相关(r=0.662,P=0.000)。结论MRI有助于识别SSC损伤及LHBT病变,SSC损伤分型和LHBT病变分型呈正相关,临床上针对肩痛患者应注重MRI检查,以评估患者肩袖损伤、肱二头肌腱病变情况,并根据不同的分型诊断选择相应的治疗方式。展开更多
目的分析肱二头肌长头肌腱(long head of the biceps brachii tendon,LHBT)病变与肩袖损伤的相关性及临床意义。方法分析2010～2017年间西南医科大学附属中医医院经关节镜修复的126例肩袖损伤患者,术中对LHBT进行检查和评价,记录LHBT病...目的分析肱二头肌长头肌腱(long head of the biceps brachii tendon,LHBT)病变与肩袖损伤的相关性及临床意义。方法分析2010～2017年间西南医科大学附属中医医院经关节镜修复的126例肩袖损伤患者,术中对LHBT进行检查和评价,记录LHBT病变种类,分析LHBT病变与肩袖撕裂时间、撕裂大小和累及肌腱的相关性。结果发现LHBT Ⅰ型病变(肌腱炎)51例(40.5%),Ⅱ型病变(半脱位)12例(9.5%),Ⅲ型病变(全脱位)12例(9.5%),Ⅳ型病变(部分撕裂)15例(11.9%),Ⅴ型病变(完全撕裂)6例(4.8%),30例(23.8%)无明显LHBT病理改变;病史超过12周的慢性肩袖撕裂患者均伴有LHBT病变;伴肩胛下肌(subscapularis,SSC)撕裂的肩袖损伤患者更易出现LHBT病变,且SSC撕裂程度越大,LHBT病变发生率越高,差异有统计学意义(P<0.05)。结论 LHBT病变与肩袖损伤特别是合并SSC撕裂者密切相关,LHBT病变与SSC撕裂程度呈正相关;检查肩袖损伤的病例时,应注意LHBT的情况,避免漏诊;肩袖损伤的早期识别与修复可防止LHBT病变进一步恶化。展开更多
AIM To examine the evidence behind the use of concentrated bone marrow aspirate(c BMA) in cartilage, bone, and tendon repair; establish proof of concept for the use of cB MA in these biologic environments; and provide...AIM To examine the evidence behind the use of concentrated bone marrow aspirate(c BMA) in cartilage, bone, and tendon repair; establish proof of concept for the use of cB MA in these biologic environments; and provide the level and quality of evidence substantiating the use of cB MA in the clinical setting.METHODS We conducted a systematic review according to PRISMA guidelines. EMBASE, MEDLINE, and Web of Knowledge databases were screened for the use of cB MA in the repair of cartilage, bone, and tendon repair. We extracted data on tissue type, cB MA preparation, cB MA concentration, study methods, outcomes, and level of evidence and reported the results in tables and text.RESULTS A total of 36 studies met inclusion/exclusion criteria and were included in this review. Thirty-one of 36(86%) studies reported the method of centrifugation and preparation of cB MA with 15(42%) studies reporting either a cell concentration or an increase from baseline. Variation of c BMA application was seen amongst the studies evaluated. Twenty-one of 36(58%) were level of evidence Ⅳ, 12/36(33%) were level of evidence Ⅲ, and 3/36(8%) were level of evidence Ⅱ. Studies evaluated full thickness chondral lesions(7 studies), osteochondral lesions(10 studies), osteoarthritis(5 studies), nonunion or fracture(9 studies), or tendon injuries(5 studies). Significant clinical improvement with the presence of hyaline-like values and lower incidence of fibrocartilage on T2 mapping was found in patients receiving cB MA in the treatment of cartilaginous lesions. Bone consolidation and time to bone union was improved in patients receiving cB MA. Enhanced healingrates, improved quality of the repair surface on ultrasound and magnetic resonance imaging, and a decreased risk of re-rupture was demonstrated in patients receiving cB MA as an adjunctive treatment in tendon repair. CONCLUSION The current literature demonstrates the potential benefits of utilizing c BMA for the repair of cartilaginous lesions, bony defects, and tendon injuries in the clinical setting. This study also demonstrates discrepancies between the literature with regards to various methods of centrifugation, variable cell count concentrations, and lack of standardized outcome measures. Future studies should attempt to examine the integral factors necessary for tissue regeneration and renewal including stem cells, growth factors and a biologic scaffold.展开更多
文摘Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients.Most injuries are open injuries to the flexor or extensor tendons,but less frequent injuries,e.g.,damage to the functional system tendon sheath and pulley or dull avulsions,also need to be considered.After clinical examination,ultrasound and magnetic resonance imaging have proved to be important diagnostic tools.Tendon injuries mostly require surgical repair,dull avulsions of the distal phalanges extensor tendon can receive conservative therapy.Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair.In the postoperative course offlexor tendon injuries,the principle of early passive movement is important to trigger an"intrinsic"tendon healing to guarantee a good outcome.Many substances were evaluated to see if they improved tendon healing;however,little evidence was found.Nevertheless,hyaluronic acid may improve intrinsic tendon healing.
文摘Disabled shoulders of throwing athletes typically present with extended undersurface partial tears of the rotator cuff, which include the posterior supraspinatus and the anterior infraspinatus tendon to a variable extent. We propose a modified transtendon repair technique to adequately treat this subset of patients. The repair includes two double-loaded anchors, at the anterior and the posterior end of the tear, respectively. With the help of an angulated penetrator we create a medial and a lateral band of sutures on top of the cuff, producing a broad contact in the tendon-to-bone interface. All the 9 so far operated patients were young men, 7 of them base-ball pitchers, and 5 active in competitive sports. The Constant Score rose from 72 points preoperatively to 99 points at 12 months follow-up. Three of the still active pitchers were able to return to their previous level in sports after one year. The improved footprint contact of our novel repair construct should allow for better healing and, therefore, a higher chance of return to competition.
文摘目的探讨磁共振成像(MRI)下肩胛下肌(SSC)损伤与肱二头肌长头肌腱(LHBT)病变的相关性及临床特点。方法选择2020年9月至2021年12月在贵州中医药大学第一附属医院因肩痛就诊,同时行肩关节MRI检查提示存在SSC损伤合并LHBT病变的128例患者,根据Lafosse分型、Slatis and Aalto分型,在MRI下对SSC损伤合并LHBT病变进行分级评估,采用Spearman等级相关分析探讨SSC损伤分型和LHBT病变分型的相关性。结果SSC损伤分型结果为28例Ⅰ型、22例Ⅱ型、36例Ⅲ型、18例Ⅳ型、24例V型,LHBT病变分型结果为85例Ⅰ型、16例Ⅱ型、27例Ⅲ型。Spearman等级相关分析结果显示,SSC损伤分型和LHBT病变分型呈正相关(r=0.662,P=0.000)。结论MRI有助于识别SSC损伤及LHBT病变,SSC损伤分型和LHBT病变分型呈正相关,临床上针对肩痛患者应注重MRI检查,以评估患者肩袖损伤、肱二头肌腱病变情况,并根据不同的分型诊断选择相应的治疗方式。
文摘目的分析肱二头肌长头肌腱(long head of the biceps brachii tendon,LHBT)病变与肩袖损伤的相关性及临床意义。方法分析2010～2017年间西南医科大学附属中医医院经关节镜修复的126例肩袖损伤患者,术中对LHBT进行检查和评价,记录LHBT病变种类,分析LHBT病变与肩袖撕裂时间、撕裂大小和累及肌腱的相关性。结果发现LHBT Ⅰ型病变(肌腱炎)51例(40.5%),Ⅱ型病变(半脱位)12例(9.5%),Ⅲ型病变(全脱位)12例(9.5%),Ⅳ型病变(部分撕裂)15例(11.9%),Ⅴ型病变(完全撕裂)6例(4.8%),30例(23.8%)无明显LHBT病理改变;病史超过12周的慢性肩袖撕裂患者均伴有LHBT病变;伴肩胛下肌(subscapularis,SSC)撕裂的肩袖损伤患者更易出现LHBT病变,且SSC撕裂程度越大,LHBT病变发生率越高,差异有统计学意义(P<0.05)。结论 LHBT病变与肩袖损伤特别是合并SSC撕裂者密切相关,LHBT病变与SSC撕裂程度呈正相关;检查肩袖损伤的病例时,应注意LHBT的情况,避免漏诊;肩袖损伤的早期识别与修复可防止LHBT病变进一步恶化。
文摘AIM To examine the evidence behind the use of concentrated bone marrow aspirate(c BMA) in cartilage, bone, and tendon repair; establish proof of concept for the use of cB MA in these biologic environments; and provide the level and quality of evidence substantiating the use of cB MA in the clinical setting.METHODS We conducted a systematic review according to PRISMA guidelines. EMBASE, MEDLINE, and Web of Knowledge databases were screened for the use of cB MA in the repair of cartilage, bone, and tendon repair. We extracted data on tissue type, cB MA preparation, cB MA concentration, study methods, outcomes, and level of evidence and reported the results in tables and text.RESULTS A total of 36 studies met inclusion/exclusion criteria and were included in this review. Thirty-one of 36(86%) studies reported the method of centrifugation and preparation of cB MA with 15(42%) studies reporting either a cell concentration or an increase from baseline. Variation of c BMA application was seen amongst the studies evaluated. Twenty-one of 36(58%) were level of evidence Ⅳ, 12/36(33%) were level of evidence Ⅲ, and 3/36(8%) were level of evidence Ⅱ. Studies evaluated full thickness chondral lesions(7 studies), osteochondral lesions(10 studies), osteoarthritis(5 studies), nonunion or fracture(9 studies), or tendon injuries(5 studies). Significant clinical improvement with the presence of hyaline-like values and lower incidence of fibrocartilage on T2 mapping was found in patients receiving cB MA in the treatment of cartilaginous lesions. Bone consolidation and time to bone union was improved in patients receiving cB MA. Enhanced healingrates, improved quality of the repair surface on ultrasound and magnetic resonance imaging, and a decreased risk of re-rupture was demonstrated in patients receiving cB MA as an adjunctive treatment in tendon repair. CONCLUSION The current literature demonstrates the potential benefits of utilizing c BMA for the repair of cartilaginous lesions, bony defects, and tendon injuries in the clinical setting. This study also demonstrates discrepancies between the literature with regards to various methods of centrifugation, variable cell count concentrations, and lack of standardized outcome measures. Future studies should attempt to examine the integral factors necessary for tissue regeneration and renewal including stem cells, growth factors and a biologic scaffold.
