Résumé
BACKGROUND:The incidence of complications folowing conventional repairing for the ruptured tendon is up to 73%, such as delayed healing, adhesion, secondary rupture. These complications severely affect ankle joint function of the patients. OBJECTIVE:To reduce the complications folowing the repair and investigate the role of hernia repair materials in the repairing of ruptured Achiles tendon. METHODS:Eleven patients who underwent repair of ruptured Achiles tendon were retrospectively studied. Among them there were eight males and three females with the mean age of 42 years (26-58 years). Three cases were injured in left side and eight cases were in right side; four cases were open injury by sickle-induced damage and seven cases were closed injury by exercise-induced damage. The hernia repair materials after pruning was applied with a “wrap” method to strengthen the anastomosis repair of Achiles tendon after the conventional repair surgery had been completed. At the time of folow-up, al patients were observed for postoperative local appearance and function recovery, and assessed with Arner Lindholm standards. RESULTS AND CONCLUSION:The folow-up interval was 6-45 months (average 24.5 months). Two cases were lost to folow-up. According to the Arner Lindholm standards, the effects were excelent in seven cases (78%) and good in two cases (22%). Local appearance and function recovered wel postoperatively, and no complications occurred such as wound infection, secondary rupture and so on. A “wrap” method with hernia repair materials is suggested to strengthen the anastomosis repair of ruptured Achiles tendon after the conventional repair surgery is completed, it can significantly promote the healing of Achiles tendon ruptured end anastomosis, prevent Achiles tendon recurrent ruptures, local adhesion and infection.
Résumé
Objective To analyze the magnetic resonance imaging(MRI) appearance and pathological changes of pig thigh of soft tissues after been shot by rifle,so as to offer a theoretical foundation for wound management in early stage of gunshot injuries.Methods Seventeen adult pigs were intravenously anesthetized and suspended in supine position,the pigs were shot in 10 meters away by domestic-made rifle of 95 type.The wound limb were undergone 1.5T MRI scans and histological observation at 2h,6h,12h,24h,48h,9day,and 18day after shot injury.Results The wounded tissues included four areas of different pathological changes:primary ballistic cavity,coagulative necrosis area,tissue disruption area and tissue distortion area.The thickness of coagulative necrosis area was about 1 to 3 millimeters,which showed double-hypointense signal phenomenon in both T2 weighted image and enhanced T1 weighted image.The tissue disruption area and part of tissue distortion area showed double-hyperintense signal phenomenon in both T2 weight image and enhanced T1 weighted image.Conclusion Penetrating gunshot wound in soft tissues of hind limb can be divided into four areas:primary ballistic cavity,coagulative necrosis area,tissue disruption area and tissue distortion area.MRI can clearly show primary ballistic cavity and coagulative necrosis area.Tissue disruption area and tissue distortion area are hyperintense signal areas on the outside of the primary ballistic cavity,which can be distinguished clearly by pathalogical observation,but tissue disruption area and part of tissue distortion area are undistinguishable by MRI.