Microsurgical Technique And Herbal Fumigation In Prevention Of Flexor Tendon Adhesion In Clinical Research

Objective: Tendon injuries are very common in clinical practice.Tendon injuries in hand and wrist are in the majority .Tendon adhesion have become the serious one of postoperative complications in Hand Surgery.It restricts the operictive effect.Therefore,it has become an important subject to prevent hand tendon adhesion in Hand Surgery,especially the flexor tendon adhesion in hand. At present,it's well-known that there are two healing mechanisms of tendon injury,i.e. endogenous and exogenous healing ways.And exogenous healing mechanism plays a leading role in the tendon adhesion.So it has become the key to prevent tendon adhesion that we hadve to promote the endogenous healing process meanwhlie resist the exogenous healing process to decrease the degree of adhesion. Tendon adhesion belongs to Bi syndrome or injury of tendon and muscle in Traditional Chinese Medicine(TCM).Its pathogeny coprises mightiness of pathogenic factor,deficiency of healthy ability, the stagnation of qi and blood, main and collateral channels obstructions.The locations of disease comprise muscle, the grain of skin and the texture of the subcutaneous flesh, main and collateral channels,muscle and bone,knuckle. Compared with the application of the poly DL-lactic acid absorbable anti-adhesion membrane,the effect of prevention of postsurgical flexor tendon adhesion in the clinical application of microsurgical technique and herbal fumigation is studid in this paper.Methods:According to the principle of randomized control,the 20 cases of acute flexor tendon of hand or wrist injuried patients were divided into two groups:the Test Group and the Control Group,10 patients in each group.There were 40 tendons in Test Group and 38 tendons in Control Group.There were 3 cases with neurotrosis or artery injuries in Test Group and 2 cases in Control Group.They were in the same operation conditions.In the Control Group, the poly DL-lactic acid absorbable anti-adhesion membrane was used to wrap the stump,the operations were all accomplished in eyes,the tendons were sutured with improved method of Kessler, postsurgical conventional anti-inflammator- y and symptomatic treatment were implemented by 3 to 7 days,the limb was fixed by plaster on the tendon relaxation position ,i.e. wrist palmar flexion 30°,the metacarpophalangeal jiont flexion 45°, fixed for 4 weeks.The plaster was removed by 4 weeks after the surgery and the fingers began to practise active or passive flexion and extenxion exercises;In the Test Group, the operations were all accomplished by microsurgical technique,the tendons were sutured with improved method of Kessler, postsurgical convetional anti-inflammatory and symptomatic treatment were implemented by 3 to 7 days,the limb was fixed by plaster on the tendon relaxation position ,i.e. wrist palmar flexion 30°,the metacarpophalangeal jiont flexion 45°.After 3 days, the fingers began to practise protective and passive flexion and extension exercises.The plaster was removed in day from the second week to the third week after surgery and the fingers began to practise active or passive flexion and extension exercises with herbal fumigation. The plaster was removed from the third week to the 4th week after surgery and the fingers began to practise active or passive flexion and extenxion exercises with herbal fumigation. From the 4th week after surgery,the fingers began to practise more and more .All wounds were took out stitches on the 12th day after surgery.Results: Postoperative wound healed.Postoprative follow-up time:12 weeks after surgery.100% of the patients were followed up.The status of the functional recovery of tendon were evaluated by TAM system.In 6th week after surgery,by Independent-sample T Test between the test group and the controll,t for the 6.604, P value(P=0.00) was less than 0.05,there was significant difference between them. In twelfth week, by Independent-sample T Test between the test group and the controll,t for the 0.943, P value(P=0.349) was greater than 0.05,there was no significant difference between them. The Test Group 10 patients with 40 flexor tendons in an integrated rate of 92.50% fine. The Control Group 10 patients with 38 flexor tendons in an integrated rate of 89.47% fine.By chi-square test,χ~2 for the 0.276,P value(P=0.965) was greater than 0.05,there was no significant difference.Conclusion: Tendon adhesion is one of the postoperatinal complications in Hand Suegery.It has maken an effective result that microsurgical technique and herbal fumigation was applied to prevent flexor tendon adhesion.After tendon injuries,its blood circulation decreases,its integrated structures are damaged, the tendon is short of blood and nutrition,so the endogenous healing reduces but the exogenous healing increases,and then the tendon adhesion becomes inevitable.Tendon affiliated tissue carefully repaired is the first condition to improve the endogenous healing because the main source of tendon nutrition roots in tendon affiliated tissue.It may effectively prevent tendon adhesion that microsurgical technique is applied on opretion,because it can help surgeon to improve the level of the operation in detail.The operational injuries decrease and it decreases scar.Postoperational herbal fumigation promoting blood circulation , removing blood stasis,diminishing swelling, relieving pain, relaxing the tendons, unblocking collaterals,improving blood circulation and metabolism,decreasing scars,can prevent tendon adhesion. The experimental results show that such method of preventing tendon adhesion is effective,operable, has fewer side -effects,higher safety factor and has good clinical perspective and practicability on the prevention of tendon adhesion.