BACKGROUND To treat flexor pollicis longus(FPL)muscle function loss,the 4th flexor digitorum superficialis(FDS)to the FPL tendon transfer is preferred as a reconstruction method.Various complications can occur during ...BACKGROUND To treat flexor pollicis longus(FPL)muscle function loss,the 4th flexor digitorum superficialis(FDS)to the FPL tendon transfer is preferred as a reconstruction method.Various complications can occur during transfer.However,median nerve neuropathy has not been reported yet.We present a case of median nerve neuropathy caused by irritation of suture knots of the 4th FDS to the FPL tendon transfer with a review of the literature.CASE SUMMARY A 52-year-old male patient presented with paresthesia along median nerve distribution of right hand after tendon transfer.He complained of right thumb flexion limitation due to FPL function loss so authors performed the 4th FDS to FPL transfer using Pulvertaft weave technique.FPL function loss was due to adhesion resulting from repeated surgery of radius shaft.He had a history of radius shaft open fracture 9 years ago and nonunion 7 years ago.During surgery,FPL muscle was severely adhered and indistinguishable.However,tendon continuity remained intact.After tendon transfer,he experienced paresthesia along median nerve distribution upon movement of thumb.He was diagnosed with median nerve neuropathy caused by irritation of tendon suture knots.Exploration was then performed.The median nerve was irritated by suture knots of transferred tendon.Thus,knots were removed.Twelve months later,he demonstrated thumb flexion of 80°.Additionally,median nerve neuropathy symptoms fully resolved.CONCLUSION Median nerve neuropathy can occur after tendon transfer from irritation of suture knots.Covering knots using surrounding tissue is recommended.展开更多
Background:Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture.Although early passive mobilization limits rupture,it often compromises the functional recovery.Recent appr...Background:Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture.Although early passive mobilization limits rupture,it often compromises the functional recovery.Recent approaches favor early active mobilization with strong,multi-stranded core sutures to enhance outcomes.This study evaluated early active mobilization after eight-strand core repair in a tertiary care setting.Methods:In this prospective study,143 tendons from 30 patients who underwent surgery were followed up.The injured tendons were repaired using an eight-strand cross-locked cruciate technique with a double-stranded 4-0 suture,providing the tensile strength of eight strands with the same number of suture passes as in traditional four-core repairs,thereby reducing operative time without increasing bulk.Early active mobilization was initiated on postoperative day 2.The patients underwent digitally supervised physiotherapy and were monitored using a dedicated WhatsApp group,which enabled real-time guidance and compliance monitoring.The outcomes were measured in terms of total active motion,grip strength,pinch strength,time to return to work,postoperative pain,and complications.Results:Of the 30 patients,28(93.3%)had fair-to-excellent outcomes,whereas only 2(6.7%)had poor outcomes.Most patients(93.3%)returned to work within 12 weeks postoperatively.Four(13.3%)patients had complications,such as wound infection and skin necrosis.The patients showed significant changes in grip strength(45.2%)and pinch strength(70.7%)between weeks 8 and 12.No tendon ruptures were observed.Conclusion:The eight-core suturing technique used for flexor tendon repair withstood the forces of early active mobilization,which began on the second day after surgery,resulting in fair-to-excellent outcomes.It supports digitally supervised physiotherapy through app-based monitoring,enhancing patient compliance,and reducing reliance on in-person therapy sessions.This combination led to excellent functional recovery with minimal complications.展开更多
Although the flexor pollicis longus is known to show the additional head of the origin, the occurrence of its additional tendons in the carpal tunnel are seldom reported. The presence of such additional tendons in the...Although the flexor pollicis longus is known to show the additional head of the origin, the occurrence of its additional tendons in the carpal tunnel are seldom reported. The presence of such additional tendons in the carpal tunnel cannot be overlooked during the radiological and surgical procedures in this region. Herein, we report a rare case of additional muscle belly of flexor pollicis longus. The additional muscle belly after a short course divided into three tendons. All three tendons entered the carpal tunnel along with flexor pollicis longus, passing deep to the flexor retinaculum. Within the carpal tunnel, two of these tendons fused and terminated by merging with the undersurface of the flexor retinaculum. The third tendon terminated by joining the flexor digitorum superficialis tendon for the index finger, in the palm. An additional slip of the first lumbrical muscle took origin from the third tendon of the additional muscle belly of flexor pollicis longus. Further, the embryological basis and clinical significance of current case is discussed.展开更多
BACKGROUND Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook.Only one case of a closed rupture of the finger flexor te...BACKGROUND Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook.Only one case of a closed rupture of the finger flexor tendon caused by osteochondroma in the hamate has been reported.Here,we present a case study to highlight the possibility of hamate osteochondroma as a rare cause of finger closed flexor tendon rupture based on our clinical experience and literature review.CASE SUMMARY A 48-year-old man who had been a rice-field farmer for 7–8 h a day for the past 30 years visited our clinic due to the loss of right little finger and ring finger flexion involving both the proximal and distal interphalangeal joints.The patient was diagnosed with a complete rupture of the ring and little finger flexors because of the hamate and was pathologically diagnosed with an osteochondroma.Exploratory surgery was performed,and a complete rupture of the ring and little finger flexors due to an osteophyte-like lesion of the hamate was observed,which was pathologically diagnosed as an osteochondroma.CONCLUSION One should consider that osteochondroma in the hamate may be the cause of closed tendon ruptures.展开更多
Acute calcific tendinitis of the shoulder is a well-known condition, but it is rare in the hand or finger. It is often misdiagnosed when it occurs outside the shoulder. We report an unusual case of acute calcific tend...Acute calcific tendinitis of the shoulder is a well-known condition, but it is rare in the hand or finger. It is often misdiagnosed when it occurs outside the shoulder. We report an unusual case of acute calcific tendinitis of the flexor digitorum superficialis insertion of the 4th finger in a young female martial art athlete after minor trauma history, and discuss with a review of the literature.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
Flexor tendon repair has conventionally been done by suturing techniques. However, in recent times, there have been attempts of using fibrous braided structures for the repair of ruptured tendons. In this regard, the ...Flexor tendon repair has conventionally been done by suturing techniques. However, in recent times, there have been attempts of using fibrous braided structures for the repair of ruptured tendons. In this regard, the numerical analysis of the flexural stiffness of a braided structure under bending moments is vital for understanding its capabilities in the repair of flexor tendons. In this paper, the bending deflection, curvature, contact stresses and flexural bending stiffness in the braided structure due to bending moments are simulated using Finite Element (FE) techniques. Three dimensional geometry and FE models of five sets of biaxial braided structures were developed using a python programming script. The FE models of the hybrid biaxial braids were imported into ABAQUS (v17) for post-processing and analysis. It was established that the braided fabric with largest braid angle, <em>θ</em> = 52.5<span style="white-space:nowrap;">°</span> had the highest flexural deflection while the lowest deflection was seen in the results of the braided structure with the least braid angle, <em>θ</em> = 38.5<span style="white-space:nowrap;">°</span>. The results in this study also portrayed that the curvature in biaxial braids will increase with a decrease in the angle between the braided yarns. This was also consistent with the change of bending angle of the biaxial structures under a bending moment. The deformation of the structures increased with increase in the braid angles. This implies that the flexural bending stiffness decreased with increase in braid angle. The stress limits during bending of the braided structures were established to be within the range that could be handled by flexor tendons during finger bending.展开更多
Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the t...Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the tendinous portion have been described in association with distinct underlying pathologies. We report a case of flexor tendon rupture of the index finger which seems to be associated with previous trauma occurred more than 40 years ago and abnormal healing.展开更多
In the present paper, the authors treated 26 cases of tenovaginitis of flexor di gitorum with acupunctomy (needle-knife technique). After 1～3 treatments , 2 0 cases were cured, 5 experienced improvement and one faile...In the present paper, the authors treated 26 cases of tenovaginitis of flexor di gitorum with acupunctomy (needle-knife technique). After 1～3 treatments , 2 0 cases were cured, 5 experienced improvement and one failed, the total cure ra te was 76.92%, improvement rate 96.15%, and the failure rate 0.04%.展开更多
Objective:To explore the application effect and clinical value of musculoskeletal ultrasound in the rehabilitation of hand function after flexor tendon rupture repair.Methods:In this study,72 patients were selected fr...Objective:To explore the application effect and clinical value of musculoskeletal ultrasound in the rehabilitation of hand function after flexor tendon rupture repair.Methods:In this study,72 patients were selected from among patients who underwent flexor tendon rupture repair of the hand in Yancheng Third People’s Hospital from May 2018 to May 2020;the patients were randomly divided into the control group(routine hand rehabilitation training)and the experimental group(musculoskeletal ultrasound and targeted hand rehabilitation training based on examination results)by die roll,with 34 cases in each group;the hand rehabilitation of the two groups were compared.Results:The excellent and good rate of the total active motion(TAM)of the experimental group(94.44%)was significantly higher than that of the control group(69.44%)(P<0.05);before treatment,there was no significant difference in the diameter and degree of stenosis of the artery in the finger between the two groups(P>0.05);after treatment,the degree of stenosis and the diameter of the artery of the experimental group were significantly better than those of the control group(P<0.05).Conclusion:For patients treated with flexor tendon rupture repair of the hand,the use of musculoskeletal ultrasound in the rehabilitation process can significantly improve the functional recovery of the hand;therefore,it is worthy of in-depth research,promotion,and application in clinical rehabilitation.展开更多
Aim: The ideal flexor tendon repair should be reliable, simple and strong enough without impairing the tendon healing. Based on these requirements, we have imagined the use of a single barbed intra-tendinous suture fo...Aim: The ideal flexor tendon repair should be reliable, simple and strong enough without impairing the tendon healing. Based on these requirements, we have imagined the use of a single barbed intra-tendinous suture for stumps connection. The aim of our research is to quantify the stress that the suture and barbs should withstand in order to ensure perfect stumps connections. Methods: Seven different cross-section sutures were selected for the research study. One circular and 6 different elliptical shapes were defined according to the ratio of their minor and major axes (ρ = b/a). Barbs were designed with 3 different depths and 3 different cut angles. Thus, 9 different situations were considered for each suture geometry. Finally, 2 loading conditions were applied on each barb and tested in ANSYS Workbench using a finite element analysis technique. Results: Studies showed that a barbed suture with 0.18-mm depth, 150° cut angle and ρ = 3 produced the lowest stresses within the barb itself, while a barbed suture with 0.18-mm depth, 160° cut angle and ρ = 4 demonstrated lowest stress within the entire suture. Conclusion: The stress values in these two configurations are observed to be very close and both can fit a single barbed suture for tendon insertion and repair.展开更多
Aim: Use of barbed sutures for fiexor tendon repair is a promising technique. These sutures lie within the substance of the tendon, avoiding the need of external knots and so improving tendon gliding. The load is disp...Aim: Use of barbed sutures for fiexor tendon repair is a promising technique. These sutures lie within the substance of the tendon, avoiding the need of external knots and so improving tendon gliding. The load is dispersed equally along the length of the barbed suture, decreasing the possibility of rupture. The purpose of this article is to propose enhanced suture geometry by comparing different cross-sectional configurations, barb cut angles and cut depths using the finite element method. Methods: lnspired by the geometry of fiexor tendons, an elliptical cross-sectional wire was investigated. Mechanical behavior of five different aspect ratios (ρ = 1/3, 1/2, 1, 2, 3), three different cut angles (150°, 154°, 160°) and three cut depths (0.07-mm, 0.12-mm, 0.18-mm) were studied via extended finite element analysis using ABAQUS, for two different loading conditions: one to assess the strength of the suture and the second to evaluate the strength of a single barb. An extended finite element method has been implemented on ABAQUS to predict crack growth in viscoelastic material. Results: Based on these results, an elliptical suture having an aspect ratio of 1/2, 160° of cut angle, and 0.12-mm of cut depth is recommended. Conclusion: Barbed sutures are a good option for tendon repair. Our experiments assessed the mechanical performance of barbed sutures and suggested an optimized suture geometry for a single-stranded repair technique.展开更多
The flexor carpi radialis(FCR)is one of the long flexors,which is important in flexing and abducting the hand at the wrist.It originates at the medial epicondyle of the humerus and attaches at the base of the second m...The flexor carpi radialis(FCR)is one of the long flexors,which is important in flexing and abducting the hand at the wrist.It originates at the medial epicondyle of the humerus and attaches at the base of the second metacarpal.Closed rupture of the long flexors of the finger is well-described,especially in association with rheumatoid hands.However,rupture of the FCR is rare;only 11 cases reported in the literature,most of them associated with scaphotrapezial-trapezoidal osteoarthritis.We describe 1 case of complete FCR rupture secondary to trauma,showing that long-term disability following FCR rupture is minimal.展开更多
BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of t...BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.展开更多
目的探究单腿站立姿势控制与踝跖屈肌力稳定性的相关性,为提升人体姿势控制能力提供新的理论依据。方法随机选取20名健康男性大学生作为实验对象。采用iBalance平衡测试仪与训练系统测试单腿站立的足底压力中心(center of pressure,COP...目的探究单腿站立姿势控制与踝跖屈肌力稳定性的相关性,为提升人体姿势控制能力提供新的理论依据。方法随机选取20名健康男性大学生作为实验对象。采用iBalance平衡测试仪与训练系统测试单腿站立的足底压力中心(center of pressure,COP)轨迹数据;采用CON-TREX MJ多关节等速测试与训练系统测试踝跖屈肌收缩期间的力矩振幅数据。采用单因素重复测量方差分析组间踝跖屈肌力矩振幅的标准偏差数据;采用Pearson相关系数进行相关性研究。结果踝跖屈肌执行的肌力稳定任务强度越大,力矩振幅的标准偏差越大;无干扰单腿站立下,C90面积与10%踝跖屈肌最大任意收缩(maximum voluntary contraction,MVC)力矩振幅的变异系数(coefficient of variation,CV)(r=0.761,P<0.05)呈正相关。干扰视觉单腿站立下,C90面积与30%踝跖屈肌MVC力矩振幅CV(r=0.632,P<0.05)呈正相关。干扰本体感觉单腿站立下,C90面积与20%踝跖屈肌MVC力矩振幅CV(r=0.583,P<0.05)呈正相关。结论随着踝跖屈肌执行的肌力稳定任务难度加大,肌力稳定性降低;踝跖屈肌力稳定性与单腿站立姿势控制能力存在正相关关系。相较于无干扰情况,在视觉、本体感觉干扰下,额外的信息传入减少或受到干扰,人体维持身体平衡的难度加大,踝跖屈肌需要更高发力模式下的肌力稳定性来参与人体单腿站立的姿势控制。展开更多
文摘BACKGROUND To treat flexor pollicis longus(FPL)muscle function loss,the 4th flexor digitorum superficialis(FDS)to the FPL tendon transfer is preferred as a reconstruction method.Various complications can occur during transfer.However,median nerve neuropathy has not been reported yet.We present a case of median nerve neuropathy caused by irritation of suture knots of the 4th FDS to the FPL tendon transfer with a review of the literature.CASE SUMMARY A 52-year-old male patient presented with paresthesia along median nerve distribution of right hand after tendon transfer.He complained of right thumb flexion limitation due to FPL function loss so authors performed the 4th FDS to FPL transfer using Pulvertaft weave technique.FPL function loss was due to adhesion resulting from repeated surgery of radius shaft.He had a history of radius shaft open fracture 9 years ago and nonunion 7 years ago.During surgery,FPL muscle was severely adhered and indistinguishable.However,tendon continuity remained intact.After tendon transfer,he experienced paresthesia along median nerve distribution upon movement of thumb.He was diagnosed with median nerve neuropathy caused by irritation of tendon suture knots.Exploration was then performed.The median nerve was irritated by suture knots of transferred tendon.Thus,knots were removed.Twelve months later,he demonstrated thumb flexion of 80°.Additionally,median nerve neuropathy symptoms fully resolved.CONCLUSION Median nerve neuropathy can occur after tendon transfer from irritation of suture knots.Covering knots using surrounding tissue is recommended.
文摘Background:Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture.Although early passive mobilization limits rupture,it often compromises the functional recovery.Recent approaches favor early active mobilization with strong,multi-stranded core sutures to enhance outcomes.This study evaluated early active mobilization after eight-strand core repair in a tertiary care setting.Methods:In this prospective study,143 tendons from 30 patients who underwent surgery were followed up.The injured tendons were repaired using an eight-strand cross-locked cruciate technique with a double-stranded 4-0 suture,providing the tensile strength of eight strands with the same number of suture passes as in traditional four-core repairs,thereby reducing operative time without increasing bulk.Early active mobilization was initiated on postoperative day 2.The patients underwent digitally supervised physiotherapy and were monitored using a dedicated WhatsApp group,which enabled real-time guidance and compliance monitoring.The outcomes were measured in terms of total active motion,grip strength,pinch strength,time to return to work,postoperative pain,and complications.Results:Of the 30 patients,28(93.3%)had fair-to-excellent outcomes,whereas only 2(6.7%)had poor outcomes.Most patients(93.3%)returned to work within 12 weeks postoperatively.Four(13.3%)patients had complications,such as wound infection and skin necrosis.The patients showed significant changes in grip strength(45.2%)and pinch strength(70.7%)between weeks 8 and 12.No tendon ruptures were observed.Conclusion:The eight-core suturing technique used for flexor tendon repair withstood the forces of early active mobilization,which began on the second day after surgery,resulting in fair-to-excellent outcomes.It supports digitally supervised physiotherapy through app-based monitoring,enhancing patient compliance,and reducing reliance on in-person therapy sessions.This combination led to excellent functional recovery with minimal complications.
文摘Although the flexor pollicis longus is known to show the additional head of the origin, the occurrence of its additional tendons in the carpal tunnel are seldom reported. The presence of such additional tendons in the carpal tunnel cannot be overlooked during the radiological and surgical procedures in this region. Herein, we report a rare case of additional muscle belly of flexor pollicis longus. The additional muscle belly after a short course divided into three tendons. All three tendons entered the carpal tunnel along with flexor pollicis longus, passing deep to the flexor retinaculum. Within the carpal tunnel, two of these tendons fused and terminated by merging with the undersurface of the flexor retinaculum. The third tendon terminated by joining the flexor digitorum superficialis tendon for the index finger, in the palm. An additional slip of the first lumbrical muscle took origin from the third tendon of the additional muscle belly of flexor pollicis longus. Further, the embryological basis and clinical significance of current case is discussed.
文摘BACKGROUND Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook.Only one case of a closed rupture of the finger flexor tendon caused by osteochondroma in the hamate has been reported.Here,we present a case study to highlight the possibility of hamate osteochondroma as a rare cause of finger closed flexor tendon rupture based on our clinical experience and literature review.CASE SUMMARY A 48-year-old man who had been a rice-field farmer for 7–8 h a day for the past 30 years visited our clinic due to the loss of right little finger and ring finger flexion involving both the proximal and distal interphalangeal joints.The patient was diagnosed with a complete rupture of the ring and little finger flexors because of the hamate and was pathologically diagnosed with an osteochondroma.Exploratory surgery was performed,and a complete rupture of the ring and little finger flexors due to an osteophyte-like lesion of the hamate was observed,which was pathologically diagnosed as an osteochondroma.CONCLUSION One should consider that osteochondroma in the hamate may be the cause of closed tendon ruptures.
文摘Acute calcific tendinitis of the shoulder is a well-known condition, but it is rare in the hand or finger. It is often misdiagnosed when it occurs outside the shoulder. We report an unusual case of acute calcific tendinitis of the flexor digitorum superficialis insertion of the 4th finger in a young female martial art athlete after minor trauma history, and discuss with a review of the literature.
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.
文摘Flexor tendon repair has conventionally been done by suturing techniques. However, in recent times, there have been attempts of using fibrous braided structures for the repair of ruptured tendons. In this regard, the numerical analysis of the flexural stiffness of a braided structure under bending moments is vital for understanding its capabilities in the repair of flexor tendons. In this paper, the bending deflection, curvature, contact stresses and flexural bending stiffness in the braided structure due to bending moments are simulated using Finite Element (FE) techniques. Three dimensional geometry and FE models of five sets of biaxial braided structures were developed using a python programming script. The FE models of the hybrid biaxial braids were imported into ABAQUS (v17) for post-processing and analysis. It was established that the braided fabric with largest braid angle, <em>θ</em> = 52.5<span style="white-space:nowrap;">°</span> had the highest flexural deflection while the lowest deflection was seen in the results of the braided structure with the least braid angle, <em>θ</em> = 38.5<span style="white-space:nowrap;">°</span>. The results in this study also portrayed that the curvature in biaxial braids will increase with a decrease in the angle between the braided yarns. This was also consistent with the change of bending angle of the biaxial structures under a bending moment. The deformation of the structures increased with increase in the braid angles. This implies that the flexural bending stiffness decreased with increase in braid angle. The stress limits during bending of the braided structures were established to be within the range that could be handled by flexor tendons during finger bending.
文摘Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the tendinous portion have been described in association with distinct underlying pathologies. We report a case of flexor tendon rupture of the index finger which seems to be associated with previous trauma occurred more than 40 years ago and abnormal healing.
文摘In the present paper, the authors treated 26 cases of tenovaginitis of flexor di gitorum with acupunctomy (needle-knife technique). After 1～3 treatments , 2 0 cases were cured, 5 experienced improvement and one failed, the total cure ra te was 76.92%, improvement rate 96.15%, and the failure rate 0.04%.
文摘Objective:To explore the application effect and clinical value of musculoskeletal ultrasound in the rehabilitation of hand function after flexor tendon rupture repair.Methods:In this study,72 patients were selected from among patients who underwent flexor tendon rupture repair of the hand in Yancheng Third People’s Hospital from May 2018 to May 2020;the patients were randomly divided into the control group(routine hand rehabilitation training)and the experimental group(musculoskeletal ultrasound and targeted hand rehabilitation training based on examination results)by die roll,with 34 cases in each group;the hand rehabilitation of the two groups were compared.Results:The excellent and good rate of the total active motion(TAM)of the experimental group(94.44%)was significantly higher than that of the control group(69.44%)(P<0.05);before treatment,there was no significant difference in the diameter and degree of stenosis of the artery in the finger between the two groups(P>0.05);after treatment,the degree of stenosis and the diameter of the artery of the experimental group were significantly better than those of the control group(P<0.05).Conclusion:For patients treated with flexor tendon rupture repair of the hand,the use of musculoskeletal ultrasound in the rehabilitation process can significantly improve the functional recovery of the hand;therefore,it is worthy of in-depth research,promotion,and application in clinical rehabilitation.
文摘Aim: The ideal flexor tendon repair should be reliable, simple and strong enough without impairing the tendon healing. Based on these requirements, we have imagined the use of a single barbed intra-tendinous suture for stumps connection. The aim of our research is to quantify the stress that the suture and barbs should withstand in order to ensure perfect stumps connections. Methods: Seven different cross-section sutures were selected for the research study. One circular and 6 different elliptical shapes were defined according to the ratio of their minor and major axes (ρ = b/a). Barbs were designed with 3 different depths and 3 different cut angles. Thus, 9 different situations were considered for each suture geometry. Finally, 2 loading conditions were applied on each barb and tested in ANSYS Workbench using a finite element analysis technique. Results: Studies showed that a barbed suture with 0.18-mm depth, 150° cut angle and ρ = 3 produced the lowest stresses within the barb itself, while a barbed suture with 0.18-mm depth, 160° cut angle and ρ = 4 demonstrated lowest stress within the entire suture. Conclusion: The stress values in these two configurations are observed to be very close and both can fit a single barbed suture for tendon insertion and repair.
文摘Aim: Use of barbed sutures for fiexor tendon repair is a promising technique. These sutures lie within the substance of the tendon, avoiding the need of external knots and so improving tendon gliding. The load is dispersed equally along the length of the barbed suture, decreasing the possibility of rupture. The purpose of this article is to propose enhanced suture geometry by comparing different cross-sectional configurations, barb cut angles and cut depths using the finite element method. Methods: lnspired by the geometry of fiexor tendons, an elliptical cross-sectional wire was investigated. Mechanical behavior of five different aspect ratios (ρ = 1/3, 1/2, 1, 2, 3), three different cut angles (150°, 154°, 160°) and three cut depths (0.07-mm, 0.12-mm, 0.18-mm) were studied via extended finite element analysis using ABAQUS, for two different loading conditions: one to assess the strength of the suture and the second to evaluate the strength of a single barb. An extended finite element method has been implemented on ABAQUS to predict crack growth in viscoelastic material. Results: Based on these results, an elliptical suture having an aspect ratio of 1/2, 160° of cut angle, and 0.12-mm of cut depth is recommended. Conclusion: Barbed sutures are a good option for tendon repair. Our experiments assessed the mechanical performance of barbed sutures and suggested an optimized suture geometry for a single-stranded repair technique.
文摘The flexor carpi radialis(FCR)is one of the long flexors,which is important in flexing and abducting the hand at the wrist.It originates at the medial epicondyle of the humerus and attaches at the base of the second metacarpal.Closed rupture of the long flexors of the finger is well-described,especially in association with rheumatoid hands.However,rupture of the FCR is rare;only 11 cases reported in the literature,most of them associated with scaphotrapezial-trapezoidal osteoarthritis.We describe 1 case of complete FCR rupture secondary to trauma,showing that long-term disability following FCR rupture is minimal.
文摘BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.
文摘目的探究单腿站立姿势控制与踝跖屈肌力稳定性的相关性,为提升人体姿势控制能力提供新的理论依据。方法随机选取20名健康男性大学生作为实验对象。采用iBalance平衡测试仪与训练系统测试单腿站立的足底压力中心(center of pressure,COP)轨迹数据;采用CON-TREX MJ多关节等速测试与训练系统测试踝跖屈肌收缩期间的力矩振幅数据。采用单因素重复测量方差分析组间踝跖屈肌力矩振幅的标准偏差数据;采用Pearson相关系数进行相关性研究。结果踝跖屈肌执行的肌力稳定任务强度越大,力矩振幅的标准偏差越大;无干扰单腿站立下,C90面积与10%踝跖屈肌最大任意收缩(maximum voluntary contraction,MVC)力矩振幅的变异系数(coefficient of variation,CV)(r=0.761,P<0.05)呈正相关。干扰视觉单腿站立下,C90面积与30%踝跖屈肌MVC力矩振幅CV(r=0.632,P<0.05)呈正相关。干扰本体感觉单腿站立下,C90面积与20%踝跖屈肌MVC力矩振幅CV(r=0.583,P<0.05)呈正相关。结论随着踝跖屈肌执行的肌力稳定任务难度加大,肌力稳定性降低;踝跖屈肌力稳定性与单腿站立姿势控制能力存在正相关关系。相较于无干扰情况,在视觉、本体感觉干扰下,额外的信息传入减少或受到干扰,人体维持身体平衡的难度加大,踝跖屈肌需要更高发力模式下的肌力稳定性来参与人体单腿站立的姿势控制。
