Buttin Philippe, Goin Bastien, Cachon Thibaut, Viguier Eric
Itinerant Surgeon, 471 Chemin de Ronzier, Villaz 74370, France.
Université de Lyon, VetAgro Sup, ICE, Marcy l'Etoile 69280, France.
Vet Med Int. 2020 Jul 9;2020:4146790. doi: 10.1155/2020/4146790. eCollection 2020.
Surgical management of tendon rupture is challenging. One concern is to provide adequate tensile strength to prevent distraction during weight-bearing and gap formation following repair, associated with an increased risk of repair failure. Additional challenges may arise from the nature or the chronicity of the lesion. In the event of avulsion, when the tendon is torn off at the bone insertion, its reinsertion on the bone is generally difficult and may even be impossible in the presence of an avulsion fracture, especially when the bone fragment is too small or fragmented. Repair management is also complicated in chronic cases, as degeneration of the tendon may lead to excessive scar tissue formation, tendon retraction, and muscle atrophy, resulting in a large gap and inadequate tissue for reconstruction. The authors describe the surgical procedure for implanting a novel implant, illustrated by three characteristic clinical cases: (1) an acute Achilles tendon avulsion; (2) a chronic patellar tendon rupture; and (3) a chronic avulsion fracture of the triceps tendon. In these three cases, complete recovery of the function was observed at the last clinical evaluation (6 or 8 months), and no complication was noted. A splinted dressing (6 to 8 weeks) was used successfully in two cases. A resin cast (8 weeks) was preferred in case 1, a very active dog. In conclusion, this novel implant represents a simple procedure for the effective repair of chronic tendon rupture, as well as an effective tendon reinsertion on the bone and adequate support for bone tendon healing in the treatment of tendon avulsion, even in cases of fragmented bone fracture. The thinness of the implant facilitates its insertion into the native tendon, while the bone-screw-implant interface provides immediate and lasting mechanical support. This may facilitate the healing process and potentially shorten the period of immobilization.
肌腱断裂的手术治疗具有挑战性。一个问题是要提供足够的拉伸强度，以防止负重时出现牵张以及修复后形成间隙，这会增加修复失败的风险。病变的性质或慢性程度可能会带来其他挑战。在撕脱伤的情况下，当肌腱在骨附着处被撕裂时，其重新附着在骨上通常很困难，在存在撕脱性骨折时甚至可能无法实现，尤其是当骨碎片太小或破碎时。在慢性病例中，修复管理也很复杂，因为肌腱退变可能导致过多瘢痕组织形成、肌腱回缩和肌肉萎缩，从而导致较大的间隙和用于重建的组织不足。作者描述了植入一种新型植入物的手术过程，并通过三个典型临床病例进行说明：（1）急性跟腱撕脱伤；（2）慢性髌腱断裂；（3）肱三头肌腱慢性撕脱性骨折。在这三个病例中，最后一次临床评估（6或8个月）时观察到功能完全恢复，且未发现并发症。两例成功使用了夹板固定敷料（6至8周）。在病例1中，一只非常活跃的狗，首选树脂石膏固定（8周）。总之，这种新型植入物代表了一种有效修复慢性肌腱断裂的简单方法，也是在治疗肌腱撕脱伤时将肌腱有效重新附着在骨上并为骨腱愈合提供充分支持的方法，即使在存在碎骨骨折的情况下也是如此。植入物的薄度便于其插入天然肌腱，而骨螺钉 - 植入物界面提供即时和持久的机械支撑。这可能会促进愈合过程并 potentially缩短固定时间。
