ABSTRACT
The trial was designed to compare the atrophies occurring after open surgical tenotomy and percutaneous tenotomy using the experimental model that we established. Fourty Ross-800 hybrid chickens were divided into two equal groups. The first and the second group underwent open surgical tenotomy and percutaneous tenotomy of the Achilles tendon, respectively. The animals were sacrificed after eight weeks, and the wet weight, volume, height, diameter, rate of biomechanical elongations and strength of muscles were measured by precision measurement instruments. H & E staining was performed for the histo-pathological assessment of the muscles. In addition, the preparations were photographed and the rate of fatty infiltration and the muscles were assessed by the pixel counting method. All the data were analyzed using the Mann-Whitney u test.The morphological evaluation showed that loss of muscle diameter in the surgical tenotomy group was statistically significantly different to that of the percutaneous tenotomy group (p <0.05). The results of the histo-pathological evaluation and the counting process showed that there were significant results supporting the morphological findings and objectively showing the increase in the fatty tissue in Group 1 (p <0.05).The decrease in the amount of elongation of the muscle at the time of the rupture and an increase in the power that was applied in Group 2 after the biomechanical study support the presence of atrophy and fibrosis and were found to be statistically significant (p <0.05). In this experimental study, atrophy was created in both groups at the end of eight weeks. The amount of atrophy in Group 1 was found to be higher than that of Group 2. The histo-pathological findings and the pure muscle tissue were assessed objectively with a new method called the pixel counting method
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Subject(s)
Humans , Tenotomy/methods , Muscular Atrophy/diagnosis , Achilles Tendon/surgery , Postoperative Complications , Biomechanical Phenomena/physiologyABSTRACT
OBJECTIVES: The morphology and functional results of the ulnar nerve were evaluated in patients treated with simple decompression and anterior subcutaneous transposition due to the diagnosis of cubital tunnel syndrome. PATIENTS AND METHODS: Thirteen elbows of 13 patients (8 males, 5 females; mean age 41 years; range 25 to 56 years) treated with simple decompression and anterior subcutaneous transposition due to the diagnosis of cubital tunnel syndrome were investigated. The involvement was on the dominant side in six patients. There was a 25° cubitus valgus deformity in one patient. No significant etiologic cause was found in the other patients. Seven patients were treated with anterior subcutaneous transposition and six with simple decompression. During the follow-ups, the atrophy magnitude, the new pressure areas and the intrinsic structure of the nerve tissue along the ulnar nerve path were evaluated by using soft tissue ultrasonography (USG). The flow rate of the artery supplying the ulnar nerve by Doppler mode USG and ulnar nerve conduction rate by electromyography (EMG) were assessed. Functional results were evaluated according to the Akahori's criteria and the modified Bishop scoring system. The average follow-up time was two years (range 12-44 months). RESULTS: In the Doppler USG examination, no arterial blood flow supplying the ulnar nerve was found in five of seven patients who underwent anterior transposition. A blood flow decrease of approximately 20 cm/s was found in two patients. A blood flow decrease of 10 cm/s on average was found in six patients who underwent simple decompression. There was a significant difference between the two groups (p<0.05). The control EMG revealed an increase of 9 m/s in the ulnar nerve conduction rate in the transposition group (p>0.05) and an increase of 17 m/s in the simple decompression group compared to the preoperative values (p<0.05). In seven patients who underwent anterior subcutaneous transposition, five excellent and two good results and an average of 8.2 points were achieved according to the Akahori's criteria and the modified Bishop scoring system, respectively. In six patients who underwent simple decompression, five excellent results, and one good result and an average of 8.1 points were achieved according to the Akahori's criteria and the modified Bishop scoring system, respectively. There was no statistically significant difference between functional results of both surgical techniques (p>0.05). CONCLUSION: Although the functional results of the cubital tunnel syndrome surgery are good, it must be noted that the blood supply to the nerve may be distorted, especially during anterior transposition. If there is no additional requirement, simple decompression may be considered as the first option.
