腹部带蒂皮瓣联合自体掌长肌腱修复多指掌侧软组织缺损及功能重建

目的：探讨用腹部带蒂皮瓣联合自体掌长肌腱移植一期修复多指掌侧软组织缺损及功能重建的方法和临床疗效。方法从2007年5月~2012年7月应用腹部皮瓣修复治疗多指掌侧复合软组织缺损,自体掌长肌腱重建屈指功能共5例。5例患者获得随访,术后4周后皮瓣成活。肌腱移植重建伤手功能皮瓣范围为6cm×8cm～8cm×l0cm;自体掌长肌腱移植最多2指/人。结果术后5例皮瓣均成活,外形好;自体掌长肌腱移植效果满意,伤手功能恢复良好。结论腹部带蒂皮瓣自体掌长肌腱移植修复多指掌侧复合软组织缺损具有损伤小、皮瓣外形好、方法简便及伤手功能恢复满意等优点,是一种较好的治疗方法。     

冷冻干燥同种异体肌腱移植修复肌腱缺损

目的探讨应用异体肌腱移植修复手、足部肌腱缺损的疗效.方法手术切除缺损部位的瘢痕,移植异体肌腱,修复重建肌腱及其功能.结果本组12例,27根肌腱,术后均未见有急性排斥反应,半年后行肌腱松解术时与自体肌腱移植无明显差异.修复重建的肌腱功能均有不同程度的恢复.结论异体肌腱与残存肌腱愈合,功能恢复良好.     

带掌长肌腱的静脉皮瓣修复伸肌腱Ⅰ区复合组织缺损

目的:介绍应用带掌长肌腱的静脉皮瓣修复伸肌腱Ⅰ区复合组织缺损的治疗方法。方法:对11例11指中末节指背皮肤及伸肌腱缺损采用同侧前臂静脉皮瓣带掌长肌腱修复,并予以伸肌腱止点重建。结果:11例皮瓣成活,伤口Ⅰ期愈合。皮瓣供区直接缝合,术后随访4～26月,平均8月,手指外形及功能恢复良好。结论:应用静脉皮瓣带掌长肌腱修复伸肌腱Ⅰ区指背皮肤软组织及伸肌腱缺损,同时行伸肌腱止点重建,是Ⅰ期修复指背皮肤软组织及伸肌腱同时缺损的理想方法。     

插秧致中环指伸肌腱自发性断裂修复后早期疗效

目的总结肌腱移植修复插秧致中、环指伸肌腱自发性断裂的早期疗效。方法 2006年4月-2009年4月,采用肌腱移植修复21例(28指)插秧后发生中、环指伸肌腱自发性断裂。男5例,女16例;年龄35～44岁,平均42岁。均因单侧中指和(或)环指不能伸直2～19 d就诊,半均5.3 d。其中中指9例,环指5例,中、环指7例。结果术后患者切口均Ⅰ期愈合。除1例2指肌腱粘连严重影响关节功能外,其余患者经积极锻炼,关节功能均恢复良好。20例患者27指获6个月随访,1例1指失访。术后6个月随访,采用总主动活动度(TAM)系统评定手指功能:获优12指,良13指,可2指,优良率达92.6%。结论采取肌腱移植修复中、环指伸肌腱自发性断裂,术后手指关节功能恢复较好。     

双层人工真皮治疗手部皮肤缺损伴肌腱、骨质外露

目的 探讨双层人工真皮修复手部皮肤缺损伴肌腱、骨质外露的疗效。方法 采用双层人工真皮治疗24例手部皮肤缺损伴肌腱、骨质外露患者，术后根据创面缺损大小与位置选择是否再行中厚自体皮片移植。结果 患者均获得随访，时间2～12个月。术后3周，人工真皮全部获得血管化，并形成了淡红色类真皮样组织。11例未行自体皮片移植，术后20～37 d创面自然上皮化爬行愈合。13例采用中厚自体皮片移植，术后2周创面愈合良好，外形美观，质地柔软有弹性。末次随访时，24例患者指间关节及掌指关节活动均恢复正常，患者对治疗效果均满意。结论 双层人工真皮是修复手部皮肤缺损伴肌腱、骨质外露的良好方法，手术操作简便，创伤小，较小的缺损面积无需行游离皮片移植，避免了额外手术创伤及风险，能够较好地恢复患肢(指)外形及功能。     

同种异体肌腱移植修复手部肌腱缺损及指功能重建的疗效

目的探讨应用同种异体肌腱移植修复手部肌腱缺损及重建屈/伸指功能的临床效果。方法 2015年3月至2017年6月间,我科应用同种异体肌腱移植修复手部肌腱缺损18例22指,男12例,女6例;年龄为20-45岁,平均(32.9±8.3)岁。其中伸肌腱缺损6例8指,屈肌腱缺损12例14指。手部伸肌腱缺损范围6-10cm,平均(7.8±2.1)cm;屈肌腱缺损范围5-8cm,平均(6.6±1.3)cm。患者受伤至手术时间为1.5-8个月,平均(5.0±2.8)个月。术前皮肤软组织缺损者行皮瓣转移修复,骨折及骨缺损者行切开复位或植骨内固定术,手部各指间或掌指关节积极行锻炼至被动活动正常,若关节挛缩则行关节松解术。伸肌腱缝合方法采用编织缝合法,屈肌腱缝合方法采用津下套圈或编织缝合法,屈肌腱滑车缺损者在手术同时重建滑车。术后应用抗生素预防感染,伤口定期换药,所有病例均没有使用免疫抑制剂。术后3d-4周伸肌腱移植者以主动屈曲、被动伸直锻炼为主,屈肌腱移植者以主动伸直、被动屈曲锻炼为主,每天活动3次。4周后逐渐增加活动次数及强度,以主动伸屈活动为主。采用国际手外科联合会制定的手指关节总活动度(total active movement,TAM)评定标准评价手部功能。结果 3例术后出现伤口脂肪液化,细菌培养证实为无菌性渗出,予以伤口定期换药后均于术后20d内愈合;其余病例伤口均一期愈合。3例5指因屈肌腱黏连行肌腱松解术。术后随访8-24个月,平均(14.7±4.8)个月。TAM评价结果,优9指,良7指,可3指,差3指,优良率为72.7%。结论同种异体肌腱移植是代替自体肌建移植修复手部肌腱缺损及重建屈/伸指功能的较好方法之一,具有手部功能恢复满意、临床效果显著等优点,但仍存在术后肌腱黏连导致手功能优良率降低,伤口局部存在无菌性渗出导致愈合时间延长等问题,上述问题需在日后的临床应用过程中加以研究解决。     

自体静脉移植重建腱鞘防止肌腱粘连

１９９０年以来，应用显微外科技术，行自体大隐静脉移植重建腱鞘手术１７例，共修复２３根肌腱、鞘管。术后配合早期功能锻炼，经１０个月～４年随访，按ＴＡＭ法评定疗效，除３根肌腱因伤口感染、移植静脉及肌腱外露，形成瘢痕愈合，疗效差外，其余患者全部达优。详细介绍了自体大隐静脉移植重建腱鞘，防止肌腱粘连的手术方法，强调无损伤操作对预防肌腱粘连的重要性     

冷冻干燥同种异体肌健移植修复肌健缺损

目的 探讨应用异体肌腱移植修复手、足部肌腱缺损的疗效。方法 手术切除缺损部位的腋痕，移植异体肌腱，修复重建肌腱及其功能。结果 本组12例，27根肌腱，术后均未见有急性排斥反应，半年后行肌腱松解术时与自体肌腱移植无明显差异。修复重建的肌腱功能均有不同程度的恢复。结论 异体肌腱与残存肌腱愈合，功能恢复良好。     

同种异体肌腱联合股前外侧皮瓣一期修复手背软组织缺损

目的 评价同种异体肌腱加皮瓣对手背复合软组织缺损一期修复重建的临床疗效. 方法 2006年7月至2011年7月,对15例手背复合软组织缺损患者一期采用股前外侧皮瓣联合同种异体肌腱行手背伸肌腱修复和创面覆盖,皮瓣大小9 cm×5 cm ～ 14 cm×11 cm,每例修复手背肌腱缺损2～4条,术后2周皮瓣成活后利用被动伸指支具进行早期康复训练. 结果 15例皮瓣均成活,12例患者术后获得随访12 ～ 24个月,平均16个月.2例患者因肌腱粘连术后6个月行肌腱松解,其余10例患者手指屈伸良好.随访结束时,患手腕关节主动屈40°～ 70°,伸25°～50°,掌指关节60°～85°、指间关节80°～90°活动范围,总体优良率达92％. 结论 一期同种异体肌腱联合皮瓣修复手背皮肤及伸指肌腱缺损的方法安全可靠,疗效肯定.同期异体肌腱重建不仅可以避免自体肌腱移植引起的新创伤,而且可以确保及时的手指康复训练,避免了延期手术所致的伸指功能丢失.     

静脉动脉化前臂筋膜掌长肌腱移植的应用研究

静脉动脉化前臂筋膜掌长肌腱移植的应用研究冯承臣，陈沂民，杨殿玉，刘茂文，刘瑞军手部腱鞘区屈指肌腱损伤手术修复后均有不同程度的粘连，影响手功能恢复。我们采用带前臂静脉动脉化游离前臂筋膜掌长肌腱移植术，修复腱鞘区屈指肌腱损伤及腱鞘重建术，手功能恢复良好，...     

Active tendon implants in flexor tendon reconstruction

Forty-five active flexor tendon implants were evaluated after placement in scarred tendon beds of digits II through V. The implant is constructed of silicone rubber with a Dacron core, terminating in a loop proximally and a metal plate distally. Modification of the implant during the period of study has improved its reliability and longevity. The improvement in total active motion (TAM) averaged 72 degrees during implant functioning (stage I) in a group of digits that before operation were classified as 78% Boyes grade 5 (salvage). Complication rate during stage I was 11% (5 out of 45). Of the 27 digits evaluated after implant replacement by tendon autograft (stage II), there was an overall improvement in 62 degrees total active motion with 70% of digits being Boyes grade 5. Many of the complications were believed to be avoidable with experience. This study demonstrates the feasibility of an active tendon implant and the possibility of a permanent prosthesis.     

Experimental tendon grafting within intact tendon sheath

A chicken toe experimental model was used to study the fate of flexor tendon grafts, introduced into intact tendon sheaths. After perfusion of the limb by India Ink, the vascular pattern of the graft and the synovial sheath could be identified. The grafts showed no or few adhesions to the sheath. With time, there was a conversion from a diffuse superficial vascular pattern towards a concentration of vessels on the dorsal aspect of the graft. In a control group, where the sheath had been resected, adhesions were more apparent, and could be observed still after 16 weeks. These results are in complete agreement with previous experimental findings and further confirm the importance of an intact tube system in the digit.     

手指鞘管区异体滑膜肌腱与自体非滑膜肌腱移植的比较学研究

目的比较手指鞘管区异体滑膜肌腱与自体非滑膜肌腱移植结果并对异体滑膜肌腱在鞘管区的移植进行评估.方法对在手指屈肌腱鞘区内应用异体滑膜肌腱与自体非滑滑膜肌腱移植的病例,术后进行3个月以上的随访.评定标准为关节活动范围（TAM法）、力量,及二期肌腱松解率.结果异体滑膜肌腱移植280例,优良率达57.0%,较差或差为11.0%.松解率为32.0%,松解后总优良率达93.0%.自体非滑膜肌腱移植98例,优良率达43.0%,较差或差为9.0%.松解率为49.0%,松解后总优良率达94.2%.两者的最终结果无明显差异.结论肌腱表面结构影响肌腱的营养途径及肌腱愈合质量,滑膜肌腱表面结构则有益于肌腱营养与较快建立起血循环及组织液的渗透,是减少肌腱术后粘连再次松解的主要因素.     

Adenovirus-mediated gene transfer into tendon and tendon sheath

In this study, we successfully transferred the Escherichia coli β-galactosidase gene, LacZ, into the chicken tendon and tendon sheath by a recombinant adenovirus. The recombinant adenovirus Adv-βgal that carried the E. coli LacZ gene was constructed by homologous recombination in 293 cells (human transformed embryonic kidney) between the expressing vector and the ClaI large fragment of adenovirus 5 genome. Each chicken received a 10 μl injection, containing 10⁵ plaque-forming units of recombinant virus Adv-βgal, into the tendon sheath of the long toe. Samples of tendon and tendon sheath were harvested at 3, 30, and 75 days after the injection. The LacZ gene transfer was detected for its coding product β-galactosidase by staining with X-gal solution. The results showed that all tendon and tendon sheath samples from the three harvest times stained positive (blue). The tendon sheath samples were more extensively stained; staining of the tendon was limited to the epitenon layer. These data suggest that a functional exogenous gene can potentially be transferred into the tendon and tendon sheath by similar techniques; such techniques may be used to improve healing and reduce adhesion formation.