| Objective To explore the biomechanical properties of TSOL knot and surgical knot in pig toe flexor tendon with Mclarney and Adelaide techniques respectively.Methods Forty fresh frozen flexor digitorum profundus tendons were randomly divided into 4 groups.MS group: Mc Larney method was used to suture tendon to tie surgical knot;MT group: Mc Larney method was used to suture tendon and TSOL knot;AS group: Adelaide method was used to suture tendon and surgical knot;AT group: Adelaide method was used to suture tendon and TSOL knot.The tendon was stretched on the biomechanical machine,the tension of the 2mm gap of the tendon was recorded,the maximum tensile load of the sutured tendon was recorded,and the failure mode of the sutured tendon was observed.Results The 2mm clearance loads of MS,MT,AS and AT groups are 31.26±2.67 N,31.17±2.21 N,50.06±4.47 N and 52.23±5.00 N respectively,and the maximum loads of the four groups are 45.86±4.41 N,44.78±4.20 N,respectively.There is no statistical difference between MS group and MT group in 2mm clearance load and maximum load(p=0.958,p=0.628,p > 0.05),but there is no statistical difference between AS group and AT group in 2mm clearance load(p=0.207,p>0.05)and maximum load(p=0.001,p<0.05).There were statistical differences in 2mm gap load and maximum load between MS group and AS group,MT group and AT group(p=0.001,p< 0.05).Failure mode: 1 case of suture rupture in MS group,9 cases of tendon avulsion,10 cases of tendon avulsion in MT group,5 cases of knot opening,3 cases of suture rupture and 2 cases of tendon avulsion in AS group;In AT group,there were 1 case of knot opening,7 cases of suture breakage and 2 cases of tendon avulsion,and the failure modes of the four groups were statistically different(p < 0.05).Conclusion 1.The 2mm gap load and maximum load of Adelaide suture is better than that of Mclarney suture.2.TSOL knot can be used in flexor tendon suture,and the strength of TSOL knot is higher than that of surgical knot commonly used in clinic.Objective After Adelaide repair of flexor tendon,the rehabilitation effects of short wrist splint early active rehabilitation scheme and modified Duran early passive rehabilitation scheme in II area of flexor tendon were compared.Methods Forty patients(52 fingers)with acute second flexor tendon rupture in the hand surgery and emergency department of our hospital from December 2020 to October 2022 were selected.40 patients with flexor tendon area Ⅱ injury were randomly divided into short wrist splint early active rehabilitation group(n=21)and modified Duran early passive rehabilitation group(n=19).Functional exercise was performed according to their respective schemes on the 3rd day after operation.The improvement points of the short wrist splint group were as follows :unstable wrist joint,40°flexion of metacarpophalangeal joint,straight position of interphalangeal joint,light clench fist in wrist extension position in early postoperative exercise,metacarpophalangeal joint and interphalangeal joint during wrist flexion.The patients began their daily life 4 weeks after operation,only limited the pinching and pulling activities of the injured fingers,and did not restrict the movement of the affected limbs after 6 weeks.The modified Duran passive rehabilitation program only performed passive activities within 3 weeks,began active flexion after 3 weeks,and did not restrict the movement of the affected limbs after 8 weeks.The total active range of motion(total active motion,TAM)of finger joints,Strickland score,grip strength(ratio)and forearm circumference difference were measured in the two groups at the 12 th week,and the DASH scores were collected at 4,8 and 12 weeks.Results The results of follow-up 12 weeks after operation showed that there was no secondary rupture of tendon in both groups,and the TAM value at the end of 12th week was 211.24°±17.8°in the short wrist splint early active rehabilitation group and176.73°±19.33° in the modified Duran early passive rehabilitation group(p <0.05).The excellent and good rate of Strickland score was 95.2% in the short wrist splint early active rehabilitation group and 73.7% in the modified Duran early passive rehabilitation plan group at 12 weeks.The grip strength,grip strength ratio and forearm circumference difference at 12 weeks in the short wrist splint early active rehabilitation scheme group were 29.15±6.16 kg,73.82%±9.05%,0.54±0.19 cm respectively,while those in the modified Duran early passive rehabilitation scheme group were 19.07±8.14 kg,48.16%±13.60%,0.95±0.26 cm at 12 weeks.The DASH scores were 27.89 ±2.34,12.37±1.44,4.21±0.77 in the short wrist splint early active rehabilitation group at 4,8,12 weeks,respectively,and the DASH scores in the improved Duran early passive rehabilitation program group were 39.32±3.31,20.22±1.27,5.26±0.78 at 4,8,12 weeks.Conclusion 1.The early active rehabilitation scheme of short wrist splint has better rehabilitation effect than the early passive rehabilitation scheme of modified Duran in the postoperative rehabilitation of flexor tendon injury in area Ⅱ.2.The early active exercise program of short wrist splint has obvious advantages in reducing the degree of forearm muscle atrophy and restoring grip strength compared with the improved Duran early passive exercise rehabilitation program.3.In the subjective score of DASH upper limb function,the early active rehabilitation program with short wrist splint has less influence on daily life than the early passive rehabilitation program with improved Duran. |
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