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.
In order to seek a good method to treat the severe, complex damage of the digital flexor tendon, an anatomical study based on 30 cadavers was done, and the result showed that the source of the blood supply to the palmaris longus tendon was from the radial and ulnar arteries. Three cases of severe complex digital flexor tendon injuries were satisfactory. Its main advantages were: (1) The tendon transplant had its own blood supply and had no need to the revascularization, therefore the adhesion formed between the tendon and adjacent tisues might be less;(2) Besides reparing the tendon defect, it can simultaneously solve the problem of the defect of the soft tissues and the skin.
Objective To evaluate the effectiveness of flexor hallucis longus tendon harvested using a minimally invasive technique in reconstruction of chronic Achilles tendon rupture. Methods Between July 2006 and December 2009, 22 patients (22 feet) with chronic Achilles tendon rupture were treated, including 16 males and 6 females with a median age of 48 years (range, 28-65 years). The disease duration was 27-1 025 days (median, 51 days). Twenty-one patients had hoofl ikemovement’s history and 1 patient had no obvious inducement. The result of Thompson test was positive in 22 cases. The score was 53.04 ± 6.75 according to American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. MRI indicated that the gap of the chronic Achilles tendon rupture was 4.2-8.0 cm. A 3 cm-long incision was made vertically in the plantar aspect of the midfoot and a 1 cm-long transverse incision was made in a plantar flexor crease at the base of the great toe to harvest flexor hallucis longus tendon. The flexor hallucis longus tendon was 10.5-13.5 cm longer from tuber calcanei to the end of the Achilles tendon, and then the tendon was fixed to the tuber calcanei using interface screws or anchor nail after they were woven to form reflexed 3-bundle and sutured. Results Wound healed by first intention in all patients and no early compl ication occurred. Twenty-two patients were followed up 12-42 months (mean, 16.7 months). At 12 months after operation, The AOFAS ankle and hindfoot score was 92.98 ± 5.72, showing significant difference when compared with that before operation (t= —40.903, P=0.000). The results were excellent in 18 cases, good in 2 cases, and fair in 2 cases with an excellent and good rate of 90.9%. No sural nerve injury, posterior tibial nerve injury, plantar painful scar, medial plantar nerve injury, and lateral plantar nerve injury occurred. Conclusion Chronic Achilles tendon rupture reconstruction with flexor hallucis longus tendon harvested using a minimally invasive technique offers a desirable outcome in operative recovery, tendon fixation, and complications.
Objective To analyze the effectiveness and advantages of the microsurgical repair of flexor tendon rupture with non-knot Kessler suture method in anastomotic stoma by comparing with the method of traditional Kessler suture. Methods Between February 2005 and February 2010, 122 patients (163 fingers with 243 flexor digital tendons) with flexor tendon rupture, were treated with microsurgical repair by non-knot Kessler suture method (treatment group); flexor tendon was sutured, and sodium hyaluronate was used to repair tendon membrane, tendon sheaths, and the tissue surroundingtendons. The cl inical data were analysed, and were compared with ones from 96 patients (130 fingers with 186 flexor digital tendons) with flexor tendon rupture treated with traditional Kessler suture between February 2001 and February 2005 (control group). There was no significant difference in gender, age, cause of injury, injury site, duration, and other general information between 2 groups (P gt; 0.05). Kleinert elastic traction therapy (dynamic-protection) was performed at 3 weeks after surgery, and the finger function exercise was done after 24 hours. Results Infection of incision occurred in 2 cases of the treatment group and in 5 cases of the control group, and were cured after 2 weeks of dressing change; the other incisions healed by first intention. The patients were followed up 6 to 14 months (mean, 9 months). In the treatment group, the total active movement (TAM) was (192.0 ± 13.1)°; the results were excellent in 54 cases, good in 58 cases, moderate in 8 cases, and poor in 2 cases with an excellent and good rate of 92%. In the control group, TAM was (170.0 ± 15.2)°; the results were excellent in 23 cases, good in 30 cases, moderate in 22 cases, and poor in 21 cases with an excellent and good rate of 55%. Significant difference in TAM was found between 2 groups (P lt; 0.01). Conclusion The microsurgical repair of flexor tendon with non-knot Kessler suture method in anastomotic stoma with repair of tendon membrane, tendon sheaths, and the tissue surrounding tendons is more effective than the traditional Kessler suture, but long-term effectiveness still needs further observation.
OBJECTIVE: To investigate availability of deep freeze stored allogenic tendon with sheath grafting in repairing the tendon and sheath defect in the II area of flexor digitorum tendon. METHODS: Sixty chickens with tendon and sheath defect were divided into 2 groups randomly, group A was treated with allogenic grafting and group B was treated with autogenic grafting, these two groups were divided into two subgroups respectively, they were, group A1 allogenic tendon with whole sheath grafting, group A2 allogenic tendon with partial sheath grafting, group B1 autogenic tendon with whole sheath grafting and group B2 autogenic tendon with whole sheath grafting. All the allogenic grafts were treated by deep freeze. Histomorphological study, histoimmunological study and slipping function of the grafts were measured after operation. RESULTS: In group A1 and B1, the local reaction was sever, the nutrition of tendon graft was barricaded by the whole sheath resulting in adhesion, degeneration and necrosis. In group A2 and B2, the tendon graft healed well and little adhesion existed between tendon and sheath. The results showed that there were significant differences between tendon grafting with whole sheath and tendon grafting with partial sheath. CONCLUSION: Deep freeze store can reduce the immunogenicity of allogenic tendon with sheath. Allogenic tendon with partial sheath grafting can be used as a new biological material for repairing the tendon and sheath defect.
To evaluate the effect of 5-fluorouracil (5-FU) appl ied topically on preventing adhesion andpromoting functional recovery after tendon repair. Methods From August 2003 to June 2007, 48 patients with flexor tendonrupture of the fingers by sharp instrument were treated and randomly divided into two groups. In 5-FU group, 39 fingers of 26 patients included 17 males and 9 females, aged (29.3 ± 9.8) years; the locations were zone I in 19 fingers and zone II in 20 fingers; single finger was involved in 12 cases and more than 2 fingers were involved in 14 cases; and the time from injury to operation was (2.4 ± 1.6) hours. In control group, 36 fingers of 22 patients included 14 males and 8 females; aged (26.1 ± 8.7) years; the locations were zone I in 16 fingers and zone II in 20 fingers; single finger was involved in 10 cases and more than 2 fingers were involved in 12 cases; and the time from injury to operation was (2.1 ± 1.8) hours. No statistically significant difference was found in constituent ratio of age, gender, injured fingers and their zones, between two groups (P gt; 0.05). The repair site in 5-FU group was given 5-FU at a concentration of 25 mg/mL with a soaked sponge, and the synovial sheath of the repaired site was wrapped with the 5-FU-soaked sponge for 1 minute for 4 times after the tendons were repaired; normal sal ine was used in the control group. Results Wound healed by first intention and no infection and tendon rupture occurred in two groups. The patients were followed up for 3-8 months (mean 4.1 months) and 3-8 months (mean 3.9 months) in 5-FU group and in control group respectively. The functional recovery degrees of the fingers were evaluated with total active movement (TAM) evaluation system. In 5-FU group, the results were excellent in 22 fingers, good in 13 fingers, fair in 3 fingers and poor in 1 finger; the excellentand good rate was 89.7%. In control group, the results were excellent in 11 fingers, good in 15 fingers, fair in 9 fingers andpoor in 1 finger; the excellent and good rate was 72.2%. There was statistically significant difference in the functional recovery degrees of fingers between two groups (P lt; 0.05). The 2 fingers which had a poor result in 5-FU group and control group were served with tenolysis was performed in 2 cases having poor results after 6 months of operation and had an excellent result at last. Conclusion 5-FU appl ied topically can reduce tendon adhesions after the ruptured tendon repair.
ObjectiveTo investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach.MethodsBetween January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Among them, 2 cases had no definite local trauma and 7 cases had a history of sprain of foot and ankle. The disease duration ranged from 6 to 30 months, with a median of 12 months. Rozansky classification of talocalcaneal coalition for the 9 patients: 5 cases (5 feet) were type Ⅰ, 2 cases (2 feet) type Ⅱ, and 2 cases (2 feet) type Ⅲ. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films and CT scans of the ankle joint during follow-up. The visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score were used to evaluate the effectiveness.ResultsThe operation time was 60-90 minutes (mean, 76 minutes). All patients were followed up 12-24 months (mean, 18 months). All the incisions healed by first intention, without infection, skin necrosis, lower extremity deep vein thrombosis, vascular nerve and tendon injury, bone bridge recurrence, and other complications. The ankle function recovered well and the pain was relieved obviously after operation, and the patients returned to work at 3-5 months after operation, with an average of 3.9 months. At last follow-up, the VAS score was 0.7±0.5, which was significantly improved (t=20.239, P=0.000) when compared with preoperative score (4.2±0.5); the AOFAS ankle-hind foot score was 94±4, which was significantly improved (t=−27.424, P=0.000) when compared with preoperative score (62±2). According to AOFAS ankle-hindfoot scoring system, the results were excellent in 7 cases and good in 2 cases at last follow-up.ConclusionIt is more intuitive, more space, and more flexibility for operation via the modified posterior malleolus high lateral observation approach combined with the lower medial operation approach in talocalcaneal coalition. It is feasible to remove talocalcaneal coalition programmatically according to the specific anatomic signs during the operation.