Length changes and their significance of scapholunate interosseous ligament at forearm rotation and wrist hyperextension / 中华创伤杂志

Objective To investigate the length changes of scapholunate interossous ligament (SLIL) at wrist full extension and forearm rotation and the related significance.Methods Eighteen healthy volunteers (12 males and 6 females) aged at 20-38 years (mean,28 years) were divided into forearm rotation group,wrist hyperextension group and wrist hyperextension-rotation group according to the random number table,with 6 cases per group.CT images of the wrist were analyzed and reconstructed in three-dimensions.Length of SLIL in dorsal,proximal and palmar segments was measured in different settings and compared.Results Conpared with the neutral position,lengths of palmar SLIL in distal,middle and proximal parts increased by (1.4 ±0.5)mm,(1.4 ±0.4)mm and (1.3 ±0.4)mm respectively in wrist hyperextension and increased by (0.3 ± 0.1) mm,(0.2 ± 0.1)mm and (0.3 ± 0.1)mm respectively in forearm maximal pronation.At the positions of wrist full extension,hyperextension with radial deviation or forearm maximal rotation,the palmar and part of proximal SLIL were elongated significantly (P ＜ 0.05).At forearm maximal pronation,palmar and part of proximal SLIL were elongated (P ＜ 0.05).Conclusions At wrist full extension,strain is greater in the palmar and proximal components of the SLIL.SLIL is inclined to injury at wrist hyperextension and forearm rotation.

Functional evaluation and influencing factor analysis after repair of zone V flexor tendon injury / 中华创伤杂志

Objective To evaluate the functional outcome after repair of zone V flexor tendon and to identify the relevant factors affecting the outcome.Methods A total of 52 patients ( 163 fingers) with wrist lacerations involving zone V flexor tendon from September 2003 to July 2009 were retrospectively studied.The average follow-up period was 32 months.The lacerated tendons were repaired by using three suture methods of different strands.Functional outcome was assessed by determining the active range of motion (AROM),and grip and pinch strength of the injured fingers,testing the independent flexor digitorum superficialis (FDS) action and employing the disability of arm,shoulder,and hand (DASH) questionnaire.Influencing factors for function of the repaired tendon including laceration section levels,repair methods,surgeons' experience,and injury severity were analyzed statistically.Results Functionally,146 out of 163 fingers (89.6％) achieved excellent or good range of motion and 103 out of 147 fingers with FDS injury (70.1％ ) obtained independent FDS action.Grip and pinch strength recovered to about two-thirds of the uninjured level.The mean DASH score was 11.9.Patients had adverse functional outcorme in tendons repaired with the 2-strand Kessler,in the tendons repaired by the surgeons with low level of expertise,or in the wrists with Spaghetti injuries,but levels of laceration section had no significant influence on the outcomes.ConclusionsFunctional recovery of zone V flexor tendon injuries is generally good,but repair methods,levels of expertise of surgeons,and injury severity have significant influences on the outcome.Thereby,advanced levels of expertise of surgeons can effectively improve the postoperative function.

Changes of ligament lengths at wrist hyperextension in vivo / 中华创伤骨科杂志

Objective To investigate changes of ligament lengths with the wrist at the neutral and hyperextended positions in vivo. Methods Six volunteers were enrolled in this study.Their wrists were held in 3 controlled positions:the neutral position of the carpus,hyperextension with radial deviation of 0° and hyperextension with radial deviation of 10°.We obtained computed tomography scans of the wrists at the 3 positions for each subject for 3-dimensional reconstruction of the carpal and distal radioulnar joint with customized softvare (Mimics 10.0).A total of 9 palmar and dorsal wrist ligaments were measured for the length changes. Results Lengths of the radioscaphocapitate (RSC),long radiolunate (LRL),radioscapholunate (RSL),ulnocapitate (UC),ulnolunate (UL),ulnotriquetral (UT) ligaments,and the dorsal intercarpal (DIC) inserting on the scaphoid ligament at the position of hyperextension with radial deviation of 0° were significantly longer than those at the neutral position ( P ＜ 0.05) while lengths of the dorsal-radiocarpal (DRC) ligament and the DIG ligament inserting on the trapezoid decreased significantly ( P ＜0.05).From 0°to 10° of wrist radial deviation in hyperextension,the UL,RSC,LRL,DIG inserting on the scaphoid and the trapezoid ligaments decreased significantly in length ( P ＜ 0.05),while UT,UC,RSL and DRC ligaments lengthened significantly (P ＜0.05). Conclusions The RSL,UC and UT ligaments are subjected to higher strain at the position of hyperextension with wrist radial deviation of 10°; the RSC,LRL,UL ligaments and dorsal DIC ligament inserting on the scaphoid are subjected to higher strains at the position of hyperextension; the DRC ligament at the neutral position and the DIC ligament inserting on the trapezoid when the wrist is extended are subjected to less tension.Thses findings will help understand the mechanism and range of the injury to the wrist ligaments.

Changes in lengths of the wrist ligaments during wrist radioulnar deviation: an in vivo study / 中华骨科杂志

Objective To investigate changes in lengths of the wrist ligaments during wrist radioulnar deviation. Methods Six volunteers were included in the study. CT scans was used to detect the changes under different positions of the wrist in the volunteers. The wrists were scanned from the position of radial deviation of 20° to the one of ulnar deviation of 40° at an interval of 20°. The 3-dimensional carpal and distal radioulnar joint structures were reconstructed with customized software and chauges in length of the palmar and dorsal wrist ligaments in radioulnar deviation were computed. Results From wrist radial deviation to neutral position, the lengths of the radioscaphocapitate ligament, the long radiolunate ligament and the dorsal intercarpal ligament increased significantly (P ＜ 0.05), they increased (2.4±0.3) mm, (2.3±0.8) mm,(1.2±0.6) mm, (1.2±1.2)mm and (2.6±1.0) mm respectively. While from wrist ulnar deviation to neutral position, ulnocapitate ligament and the dorsal radiocarpal ligament increased significantly (P ＜ 0.05), they increased (0.8 ±0.6) nm and (1.0±0.5) mm respectively. Conclusion At wrist radial deviation, the radioscaphocapitate, long radiolunate and dorsal intercarpal ligaments are slack. At wrist ulnar deviation, the ulnocapitate ligament and the dorsal radiocarpal ligament are slack. These positions may be favorable to healing of these ligaments.

Efficiency and distribution of gene delivery to the injured tendons by microinjection and tissue re-actions caused by vectors / 中华创伤杂志

Objective To investigate efficiency and distribution of gene delivery to the injured tendons by microinjeetion and tissue reactions caused by different vectors. Methods By using a mi-croinjection technique, 10μl of pCMV-EGFP, pCAGGS-EGFP, AAV2-EGFP and Ad5-EGFP harboring enhanced green fluorescence protein (EGFP) gene were respectively injected to two sites of the proximal stump of 48 transected digital flexor tendons in 18 chickens. At days 3, 7, 14 and 21, the tendons wereharvested for observing distribution and expression of EGFP under a fluorescence microscope by using fro-zen tissue sections. The tendon sections were also stained with hematoxylin and eosin to examine inflam-mation caused by these vectors. The other 24 normal flexor tendons were served as controls. ResultsCompared with normal tendon tissues, the EGFP expression was observed in tendons at days 3, 7, 14 and21 after injection. The EGFP expression was observed at day 3 and reached peak at day 7 for all vectors.The EGFP expression was decreased at day 14 but seldom seen at day 21. EGFP was distributed evenly inthe injected tendon segment adjacent to the cut level. The EGFP expression in the tendons injected withAAV2-EGFP and Ad5-EGFP was higher than that with pCMV-EGFP and pCAGGS-EGFP injection, withinsignificant statistical difference upon the EGFP expression between AAV2-EGFP and Ads-EGFP vec-tors. Tissue reactions of the tendons caused by the liposome-plasmid vector ( including pCMV-EGFP and pCAGGS-EGFP) were the most prominent among all vectors. Infiltration of inflammatory cells, chiefly lymphocytes and neutrophilic granulocytes, were found. The tendons injected with AAV2 vectors presen-ted gentle inflammatory reactions. Conclusions Mieroinjection to two sites of each tendon stump deliv-ers the transgene to the entire tendon segment adjacent to the cut. Gene delivery by the AAV2 and Ad5 vectors has the highest cfficiency among four vectors tested, when expression level peaks at day 7 after in-jection and AAV2 vector causes the slightest tissue reactions in the tendons, indicating that the AAV2 vector is a promising gene delivery vector and microinjection is practical for tendon gene therapy.

Comparison of tensile strength between 4 different epitendinous sutures / 中华创伤骨科杂志

Objective To evaluate the effects of 4 different epitendinous sutures on the tensile strength of the repaired tendons. Methods 40 plantar flexion deep tendons from pigs were divided into 4 groups randomly, with 10 in each group. After the core suture of Modifier Kessler was applied, 4 epitendinous sutures at different distances from suture sites to broken ends (4mm, 7mm, 10mm, 12mm) were used respectively in each group to repair the transected tendons. MTS Instron 4411 was used to test the repaired tendons. Tensile strengths at 2mm gap formation and at the peak were collected for statistical analyses by ANOVA. Results In this test, the tensile strength was found to increase with the distance from suture sites to broken ends. The tensile strength in the 4mm group was significantly lower than that in the others. There was little statistical difference between the other 3 groups. Conclusion Tensile strength of the repaired tendon tends to increase with the distance from suture sites to broken ends in epitendinous suture.

Current repairs of flexor tendon injuries in the hand / 中华创伤骨科杂志

This article reviews repair methods and results of flexor tendon injuries in the hand. Current problems associated with the tendon injuries include rupture of repaired tendon, adhesion formation, and stiffness of finger joints. We advocate multi-strand-repair techniques, release of part of critical pulleys, and modification of postoperative motion regimes to improve clinical outcomes. Future efforts to improve the function of the hand are outlined.

Comparison of tensile properties of palmar or dorsal placement of stitches in repairing the tendons across the joints / 中华创伤骨科杂志

Objective This study was designed to evaluate the biomechanical properties in tendons across the joints when Palmar or dorsal stitches were used. Methods Twenty porcine tendons were transected and then repaired in zone Ⅱand divided into two groups,using modified Kessler by placing the stitches in volar or dorsal part of tendons.The repaired tendons were placed on a joint model with flexion of 60?. An instron tensile testing machine was used to investigate 2 mm gap formation force and ultimate tensile strength. Results 2 mm gap formation force and ultimate tensile strength were both higher when dorsal placement of stitches was used. Conclusions Dorsal placement of stitches was recommended for repairing the tendons across the joints because it can offer greater tensile strength.

Experimental study of elbow joint stability following ulna coronoid process fractures / 中华骨科杂志

Objective To evalvate the influence of elbow joint stability following ulna coronoid process fractures. Methods Three cadaveric upper extremities were used. The height, width, thickness, diameter and opening angle of ulna coronoid process were measured in six arms, while the coronoid process fragments at the level of 2 mm, quarter, half, three quarter and whole height were resected consecutively, the changes of the range of the elbow joint movement were recorded. Another sixteen specimens were divided into two groups: the anterior bundle of the ulnar collateral ligaments (UCL) in one group was unrepaired; While the other repaired, then the angle of cubitus valgus between two groups was compared. Results If the osteotomy bone was within quarter of ulna coronoid process, the elbow joint function was good. However, in cases of osteotomy on half of coronoid process, the elbow extension function was limited and the elbow became unstable. After reduction with internal fixation, the angle of cubitus valgus was greater in the second group, and the difference of elbow joint in flexion 0?, 30?, 60?, 90? and 120? had statistical significance(P

Gene expression and tenocyte proliferation of nuclear factor-?B under the stimulation of basic fibroblast growth factor / 中华创伤杂志

Objective To investigate the effect of nuclear factor-?B (NF-?B), NF-?B-inducing kinase (NIK) and I-?B in basic fibroblast growth factor (bFGF) promoting gene expression and signal transduction of tenocyte NF-?B. Methods Tenocytes isolated from rabbits were divided into 3 groups with 8 dishes: no bFGF (Group A), 2 ng/ml bFGF (Group B) and 10 ng/ml bFGF (Group C). Cells in all dishes were cultured for 5 days. The effect of bFGF on tenocytes proliferation was examined by means of growth curve analysis. The mRNA was isolated after 5 days and the gene expressions of NIK,IKK? and IKK? induced by NF-?B investigated by reverse transcription-polymerase chain reaction (RT-PCR). Results The growth curve moved forward with the dosage increase of bFGF. Gene expressions of NF-?B,NIK, I?B kinase (IKK)? and IKK? were 0.4? 0.2 , 0.4 ? 0.1 , 0.3 ?0.1 and 0.2?0.1 respectively in the Group B and 1.8?0.5,1.0?0.3, 0.8 ? 0.2 and 1.5 ? 0.4 in the Group C. Gene expressions were all up-regulated in the Groups B and C posterior to adding of bFGF. Conclusions bFGF stimulates tenocyte proliferation and up-regulates gene expression of NF-?B,NIK,IKK? and IKK?, as indicates that the signal transduction of promoting tenocyte proliferation by bFGF may be through NF-?B pathway.