| BackgroundSpontaneous rupture of tendon in rheumatoid arthritis is not very common in clinic,and the rate of misdiagnosis and mistreatment is high.Rheumatoid arthritis(RA)is one of the most severe pain symptoms in chronic rheumatic diseases,characterized by hyperplastic synovitis.Dorsal wrist pain is usually the first occurrence of a swollen part,generally,hyperplasia and synovial invasion of wrist extensor tendon;due to the lack of protection of the affected tendon between the ulnar head and dorsal carpal ligament tension sliding friction,gradually break,causing the loss of finger deformity and function.Because this process is slow,and the deformation degree of the back of wrist and finger joint inflammatory hyperplasia degree is not related,therefore,in clinical practice,patients with rheumatoid arthritis of spontaneous tendon rupture is easily misdiagnosed.In the treatment of spontaneous rupture of tendon in rheumatoid arthritis,there are few reports and reports of fewer cases,and there is no standardized surgical repair method.In contrast,there are quite a few patients,spontaneous tendon rupture as the first symptom of rheumatoid arthritis,and were found in some patients in the dorsum of the wrist and no obvious hyperplasia of synovial tissue;then,in the whole process ofpathological fracture,rheumatoid inflammatory factors direct erosion resulting in decrease in their quality of tendon tendon fracture,physical friction and rheumatoid synovitis local hyperplasia caused by tendon rupture,the two factors which is the main reason? Whether rheumatoid tendon ruptures are similar to those of normal inflammatory tendon rupture requires that animal models be constructed and studied in depth.The construction of animal model of rheumatoid arthritis literature more,but there is no animal model of spontaneous rupture of the tendon of rheumatoid arthritis;rheumatoid tendinitis and common contrast tendinitis of the literature did not.In this study,the statistical analysis of 17 cases of rheumatoid arthritis with spontaneous tendon rupture in the past 7 years were cases,comparative analysis of characteristics of tendon rupture in each case stated in detail,hoping to summarize the correlation between tendon rupture regularity and rheumatoid arthritis and disease severity.At the same time,through the follow-up of the treatment effect,we explored an effective treatment method.In order to solve the clinical problems of this study was to investigate the possibility of establishing the animal model of spontaneous rupture of the tendon of rheumatoid arthritis,and by comparing the difference in rheumatoid arthritis and tendinitis of tendon rupture tendon rupture animal model.Therefore,this study is divided into two parts: clinical research and animal experimental study.Part One(clinical research)Analysis and treatment of spontaneous rupture of wrist tendon in rheumatoid arthritisObjective:To retrospectively analyze the causes and treatment of wrist tendon rupture in rheumatoid arthritis.Methods:The clinical data of 17 cases of wrist tendon rupture in rheumatoid arthritis patients,to observe the location and extent of records of the tendon rupture,statistics of all cases of age,fracture,fracture of wrist side time,there is no history of rheumatoid arthritis and no joint deformity,comparative analysis of the regularity of tendon rupture,to summarize the clinical features of spontaneous rupture tendon of wrist in rheumatoid arthritis.Surgical treatment according to physical examination and ultrasound examination clear location and rupture of tendon blood supply,while understanding the local adhesions,labeled according to preoperative examination,a minimally invasive incision incision,fascia layer under the channel operation.In surgical repair,all cases of simple transposition of a tendon to repair tendon rupture in all of the preferred index finger extensor tendon,if the index finger extensor tendon rupture or partial fracture also,from the transfer of EPB tendon suture,Pulvertaft method was used to realize a tendon weave suture with multiple tendon.In the exploration of loose ends,pruning local excision,and rheumatoid synovial tissue inflammatory hyperplasia,ensure smooth soft tissue around the tendon;clean the inflammatory tissue range according to the need of self base of the wrist to metacarpal,when cleaning need to carefully identify and retain as much as possible ligament tissue.After the operation,the wrist and metacarpophalangeal joints were fixed by the plaster for 4 weeks,and the interphalangeal joints were not fixed.For the first 2 weeks,the doctor advised regular and proper mobilization of the interphalangeal joints and mobilization of the interphalangeal joints 2 weeks after the operation.The stitches were removed 12 days after operation and left 2 weeks after operation.All cases were followed up for 12 months or more.The follow-up time was1 months,2 months,3 months,6 months and 12 months,respectively.The function of the tendon was evaluated and analyzed at each follow-up.Results:There was no correlation between trace spontaneous rupture of tendon and fracture history whether in this group of cases(P=0.000),and whether there is ahistory of spontaneous rupture of tendon in rheumatoid arthritis(P=0.000),there was no correlation between spontaneous rupture of tendon and joint deformity showed there was no correlation(P=0.000).The patients were followed up for more than 1years,there were no tendon rupture,no tendon adhesion;using Pulvertaft suture to achieve a tendon weave suture and a tendon is an effective method for spontaneous rupture of the tendon.Conclusion:There were many reason caused the spontaneous rupture of tendon of wrist of rheumatoid arthritis,often without a clear history of fracture,tendon rupture and rheumatoid arthritis and rheumatoid arthritis malformation had no direct relationship.Satisfactory results can be achieved by the use of a single tendon transposition.Part two(Animal experiment)Construction of a rabbit model of spontaneous rupture of tendon in rheumatoid arthritisObjective:To investigate the feasibility of constructing a rabbit model of spontaneous rupture of tendon in rheumatoid arthritis.Methods:The experimental animal model of exercise to construct rheumatoid tendon spontaneous,pure 20 New Zealand rabbits were randomized single blind method divided into three groups,group A as control group,in the construction of the animal model of rheumatoid arthritis when injected with saline;group B animal model group,induced using antigen(AIA)method to construct animal model C;group for animal model by tendinitis in tendon,collagen injection around the construction of animal model of tendonitis.The egg albumin was dissolved in normal saline and mixed with an equal amount of Freund's adjuvant to prepare the emulsion at a concentration of 20mg/ml.Group B experimental animals were injected with 1ml(10mg)emulsion subcutaneously at 5 different parts of the shoulder area,1 times a week,and 3consecutive rheumatoid arthritis models were prepared by Zhou Zhimin.A group was injected with saline at the same site.In fourth weeks,4 B animal group(B1)hind right knee intra-articular injection of 0.5ml ovalbumin(5mg),4 B(B2)group of animal hind right knee intra-articular injection of 0.3ml ovalbumin(3mg)and right ankle joint injection of 0.2ml(2mg)of chicken egg protein,4 B(group of animal B3)hind right ankle joint injection of ovalbumin(5mg)0.5ml.Compared with the A group B group animal in general and joint inflammatory changes before and after the measurement of serum interleukin 1(IL-1)and tumor necrosis factor alpha(TNFalpha)content,determine the animal model of rheumatoid arthritis is constructed successfully.An animal model of spontaneous rupture of the tendon was constructed by using a neuromuscular electrical stimulator and an experimental animal ankle joint.The anatomical model and the pathological section were used to determine whether the animal model was successfully constructed.Results:With the increase of the number of animal immune,loss of appetite,slow increase of body weight,hair color yellow,sparse activity decreased;in the intra-articular injection of ovalbumin after severe joint swelling,B ankle diameter(1.7 + 0.3)cm,temperature(38.1 + 0.4)and A group C ankle diameter and temperature significantly different(P=0.003),the content of IL-1 in serum of B group(168.4 + 21.5)ng/L,TNF-(408.4 + 47.5)was significantly higher than that of group A(P=0.000 ng/L).The establishment of rheumatoid arthritis model was successfully confirmed by anatomical observation,pathological section and histological observation.After muscle electrical stimulation,B group animals gradually appeared toe to toe dysfunction at 5 to 17 d.Anatomical observation of flexor digitorum tendon confirmed the spontaneous exercise of tendon,and the animal model was successfully constructed.Conclusion:The rabbit model of spontaneous rupture of rheumatoid arthritis tendon can be constructed by stimulating the flexor muscle of rheumatoid arthritis with muscle electrical stimulation. |
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