Penicillin, Chymotrypsin 및 Oradezon等의 건초막내 朱入이 腱癒着에 미치는 影響에 關한 實驗的 硏究

金興基,李弘鍵 고려대학교 의과대학 1985 고려대 의대 잡지 Vol.22 No.1

Functional restoration of surgically repaired tendons, particularly in the hand, have frequently been unsatisfactory because of the formation of peritendinous adhesions which impede smooth gliding motion of the tendon. Numerous materials and drugs have been used to lessen the formation of peritendinous adhesions without interfering tendon healing. Author have made an experimental study with penicillin, chymotrypsin and oradexon infiltrated along the repaired tendon of adult rabbits and observed the nature and extent of peritendinous adhesion. Forty rabbits were divided into four groups, each comprised 10 rabbits. In group I, tendon and tendon sheath were cut and closed after author's modification of Bunnell's tendon suture of divided flexor digitorum longus as control, and penicillin infiltrated in group Ⅱ, chymotrypsin in group Ⅲ, oradexon in group Ⅳ, respectively after the same method of repair. The results obtained are as follows: 1. In all the groups, the healing of the cut tendon were established in the dual mechanisms; The one is the proliferation of the fibrovascular tissue from the tendon sheath and the other is the regeneration of tenocytes of the tendon itself. 2. The evidence of the adhesion between tendon and tendon sheath was displayed from the postoperative 2 weeks in all groups and continued to display to the postoperative 6 weeks in the group of suture only and the penicillin injected group, but disappeared at the postoperative 6 weeks in the chymotrypsin injected group and at the postoperative 4 weeks in the oradexon injected group. The effect in the prevention of the adhesion was most remarkable in the oradexon injected group and was the next in the penicillin injected group. 3. The regeneration by the tenocytes of the cut tendon were noticed from the postoperative 4 weeks in the group of suture only and the penicillin injected group, while the regeneration were noticed from the postoperative 3 weeks in the oradexon injected group and the chymotrypsin injected group, so that chymotrypsin and oradexon were seemed to be favorable in the regeneration of the tenocytes.

Nanotopographic cues and stiffness control of tendon-derived stem cells from diverse conditions

Kim, Sun Jeong,Tatman, Philip D,Song, Da-Hyun,Gee, Albert O,Kim, Deok-Ho,Kim, Sang Jun Dove Medical Press 2018 International journal of nanomedicine Vol.13 No.-

<P><B>Background</B></P><P>Tendon-derived stem cells (TDSCs) are key factors associated with regeneration and healing in tendinopathy. The aim of this study was to investigate the effects of mechanical stiffness and topographic signals on the differentiation of TDSCs depending on age and pathological conditions.</P><P><B>Materials and methods</B></P><P>We compared TDSCs extracted from normal tendon tissues with TDSCs from tendinopathic Achilles tendon tissues of Sprague Dawley rats in vitro and TDSCs cultured on nanotopographic cues and substrate stiffness to determine how to control the TDSCs. The tendinopathy model was created using a chemical induction method, and the tendon injury model was created via an injury-and-overuse method. Norland Optical Adhesive 86 (NOA86) substrate with 2.48 GPa stiffness with and without 800 nm-wide nanogrooves and a polyurethane substrate with 800 nm-wide nanogrooves were used.</P><P><B>Results</B></P><P>TDSCs from 5-week-old normal tendon showed high expression of type III collagen on the flat NOA86 substrate. In the 15-week normal tendon model, expression of type III collagen was high in TDSCs cultured on the 800 nm NOA86 substrates. However, in the 15-week tendon injury model, expression of type III collagen was similar irrespective of nanotopographic cues or substrate stiffness. The expression of type I collagen was also independent of nanotopographic cues and substrate stiffness in the 15-week normal and tendon injury models. Gene expression of scleraxis was increased in TDSCs cultured on the flat NOA86 substrate in the 5-week normal tendon model (<I>P</I>=0.001). In the 15-week normal tendon model, scleraxis was highly expressed in TDSCs cultured on the 800 nm and flat NOA86 substrate (<I>P</I>=0.043). However, this gene expression was not significantly different between the substrates in the 5-week tendinopathy and 15-week tendon injury models.</P><P><B>Conclusion</B></P><P>Development and maturation of tendon are enhanced when TDSCs from normal tendons were cultured on stiff surface, but not when the TDSCs came from pathologic models. Therapeutic applications of TDSCs need to be flexible based on tendon age and tendinopathy.</P>

건 회복: 기초 과학 및 현재의 진행 사항에 대한 검토

권영우,왕배위,이준구 대한골절학회 2020 대한골절학회지 Vol.33 No.4

The tendon connects the muscles to the bones and transmits the loads generated by the muscles to the bones to move the joints, support the joints, and provide stability to the joints. Approximately 30% of patients complaining of musculoskeletal pain are associated with tendon disease, and approximately 50% of musculoskeletal injuries are caused by a tendon injury. Despite this frequent treatment of tendon damage, studies on the basic biology that provide scientific evidence for treatment, such as development, tendon injury, and healing, are still very limited. This review first summarizes the classification and composition of the tendon identified so far, the surrounding tissue, and the blood supply to the tendon. The limitations of the tendon recovery process after a tendon injury are also discussed. Finally, this review examines ways to improve tendon recovery and the biological approaches and tissue engineering that have been currently studied. In conclusion, innovative progress in promoting tendon healing has not been achieved despite the many advances in the basic structure of the tendon, and the cell and regulatory molecular factors involved in tendon recovery. Biological approaches and tissue engineering, which have become a recent issue, have shown many possibilities for the recovery of damaged cases, but further research will be needed until clinical application. 건은 근육을 골에 연결하여 근육에서 발생하는 부하를골에 전달하여 관절을 움직이게 하고 관절을 지지하며 관절에 안정성을 부여하는 역할을 한다. 근골격계 통증을 호소하는 환자 중 30% 정도가 건질환과 연관되며, 근골격계 손상의대략 50% 정도를 건의 손상이 차지한다. 이러한 빈번한 건손상의 치료에도 불구하고 치료를 위한 과학적인 근거를 제공하는 건의 발생(development), 건 손상(injury) 이해, 회복(healing) 등의 기초 생물학에 대한 연구는 현재까지도 매우제한적이다. 본 종설에서는 건의 분류와 구성, 건 주변 조직과 건의 혈액 공급에 대해 현재까지 연구된 사실들을 확인하고, 건 손상 이후 건의 회복 과정 시 발생하는 제한점에 대해고찰해 보고자 하였으며, 건회복을 증진시키기 위한 방법과최근에 연구 중인 생물학적 접근 및 조직공학에 대해 소개하고자 한다. 결론적으로 그동안의 노력으로 건의 기본적인 구조, 건 회복에 관여하는 세포 및 조절 분자 인자에 대한 많은진전이 있었음에도 현재까지 건 회복을 증진시키는 데 있어혁신적인 발전은 이루지 못하고 있다. 건의 기능과 회복에 대한 지속적인 관심과 체계적인 연구가 진행되고 있는 바 앞으로 건 치료와 재생에 대한 향상된 기술 개발이 이루어지고 구체적인 치료 전략으로 발전할 것으로 생각된다.

Smaller cross-sectional areas of the hamstring tendon measured from preoperative ultrasonography are likely to need additional gracilis harvesting for double-bundle anterior cruciate ligament reconstructions

Goto Kazumi,Hara Masahiko,Yamazaki Yoshiyuki,Urata Taihei,Shimizu Yuki,Shimizu Naofumi 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Background/Purpose: Hamstring tendon autografts are commonly used for double-bundle anterior cruciate ligament reconstruction (DB-ACLR). If the volume of the semitendinosus (ST) tendon is insufficient, the gracilis (G) tendon is also harvested. Additional harvesting of the G autograft can affect patients’ short-term postoperative outcome, such as muscle recovery; thus, preoperative information about whether an additional G autograft is needed would be useful. The purpose of this study was to investigate whether preoperative measurement of the ST tendon using ultrasonography could inform the intraoperative decision to harvest the G tendon. Methods: We enrolled 20 patients (13 men and seven women) who underwent DB-ACLR between October 2017 and March 2019. The mean patient age was 28.5 years. The ipsilateral ST tendon was measured using ultrasonography before surgery. Measurements included the diameter and breadth of the short-axis image. The cross-sectional area (CSA) was calculated from these measurements. During surgery, when two grafts with diameters of ≥ 5.0mm could not be made, the G tendon was also harvested. Patients were categorized into two groups: the ST group where only the ST tendon was harvested, and the semitendinosus gracilis tendon (STG) group where the ST and G tendons were both harvested. The CSA value was compared between the two groups, and the cutoff value was calculated. Results: In the ST group (n = 8), the mean diameter and breadth of the semitendinosus tendon were 4.21 and 2.34mm, respectively. In the STG group (n = 12), the mean diameter and breadth of the ST tendon were 3.39 and 1.78 mm, respectively. The CSAs calculated for the ST group and the STG group were 7.74mm2 and 4.79mm2, respectively. A cutoff value of 7.0mm2 was found to correspond to a specificity and sensitivity to harvest the G tendon of 87.5% and 75.0%, respectively. Conclusions: The preoperative CSA of the ST tendon determined using ultrasonography can, therefore, be informative for deciding whether to harvest the G tendon for DB-ACLR. The results of this study provide valuable information for graft selection in anterior cruciate ligament reconstruction.

The Effects of Elbow Joint Angle on the Mechanical Properties of the Common Extensor Tendon of the Humeral Epicondyle

Han, Jung-Soo The Korean Society of Mechanical Engineers 2004 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.18 No.4

The purpose of this study was to determine the effects of elbow joint angle on mechanical properties, as represented by ultimate load, failure strain and elastic modulus, of bone-tendon specimens of common extensor tendon of the humeral epicondyle. Eight pairs of specimens were equally divided into two groups of 8 each, which selected arbitrarily from left or right side of each pair, positioned at 45$^{\circ}$ and 90$^{\circ}$ of elbow flexion and subjected to tension to failure in the physiological direction of the common extensor tendon. For comparison of the differences in the failure and elastic modulus between tendon and the bone-junction, data for both were evaluated individually. Significant reduction in ultimate load of bone-tendon specimens was shown to occur at 45$^{\circ}$. The values obtained from the bone-tendon junctions with regard to the failure strain were significant higher than those from tendon in both loading directions, but the largest failure strain at the bone-tendon junction was found at 45$^{\circ}$. The elastic modulus was found to decrease significantly at the bone-tendon junction when the loading direction switched from 90$^{\circ}$ to 45$^{\circ}$. Histological observation, after mechanical tensile tests, in both loading directions showed that failure occurred at the interface between tendon and uncalcified fibrocartilage in the thinnest fibrocartilage zone of the bone-tendon junction. We concluded that differences in measured mechanical properties are a consequence of varying the loading direction of the tendon across the bone-tendon specimen.

Spontaneous rupture of flexor pollicis longus tendon by tendolipomatosis in proximal phalanx : A case report

Lee, Young-Keun,Lee, Malrey Wolters Kluwer Health 2018 Medicine Vol.97 No.37

<P><B>Abstract</B></P><P><B>Rationale:</B></P><P>Spontaneous flexor pollicis longus (FPL) tendon rupture is rarely reported. Although there are several studies investigating spontaneous FPL tendon rupture, the exact etiology of spontaneous rupture is unclear. Here, we present a case of unusual spontaneous FPL tendon rupture due to tendolipomatosis.</P><P><B>Patient concerns:</B></P><P>A 64-year-old right-handed retired male teacher was referred to our clinic with an inability to flex the interphalangeal joint of his left thumb.</P><P><B>Diagnosis:</B></P><P>Magnetic resonance imaging (MRI) revealed complete FPL tendon rupture at the level of the distal one-third of the proximal phalanx.</P><P><B>Interventions:</B></P><P>With the patient under general anesthesia, the FPL tendon was explored through a volar zig-zag incision. During the operation, the FPL tendon was found to be ruptured completely. Gross examination revealed a slightly yellowish denaturated tissue at the distal end of the ruptured tendon. We excised the denaturated tissue from the distal end of the ruptured tendon and sent it for histological examination. FPL tendon was repaired primarily via modified Becker method. Histopathological examination revealed normal vasculature in the tendon tissue and degenerative changes associated with lipid deposits in the tendon tissue.</P><P><B>Outcomes:</B></P><P>At 12-month follow-up, the patient was completely asymptomatic and had excellent IP joint range of motion (0° to 40°) in his left thumb. The wrist grip strength was 30 kg (28 kg in the Rt.) and the thumb pinch strength was 5.7 kg (4.7 kg in the Rt.). The Quick DASH score was 0.</P><P><B>Lessons:</B></P><P>Spontaneous rupture of the FPL tendon, attributed to degenerative changes caused by tendolipomatosis, is the first report of its kind, in the authors’ opinion. Hence we recommend to perform the histopathological examination of the debrided tissue from the ends of the ruptured tendon, if the physicians couldn’t know the exact cause of the spontaneous intratendinous rupture of the FPL. And early diagnosis followed by debridement and primary tendon repair provides an effective outcome.</P>

정적 및 반복하중 시의 주관절 Tendon의 파괴 물성치 측정

한정수,이관희,유재영,Han, Jeong-Su,Lee, Gwan-Hui,Yu, Jae-Yeong 대한의용생체공학회 1998 의공학회지 Vol.19 No.4

임상학적인 관찰에 따르면, 반복적인 하중에 의하여 뼈/건의 접합부분에 발생하는 부분적인 파손은 병리학적인 변화를 유발시킴으로 인하여 주관절의 상골과염(Epicondylitis)으로 발전시킬 수 있는 주요한 원인으로 간주되고 있다. 반복적인 하중이나 정적인 하중 하에서의 주관절에 위치한 신전건 및 굴곡건의 기계학적인 물성치와 파괴양상은 지금까지 잘 알려져 있지 않다. 본 연구에서는 상골과염과 직접적인 관계가 되는 신전건 및 굴곡건의 기계학적인 물성치인 파괴강도, 반복하중의 회수와 변형율(Strain)간의 연관관계 및 반복하중에 있어서의 생체조직학적 변화의 향상, 특히 파괴의 진행양상을 관찰하였다. 적용하중의 속도에 따르는 신전건 및 굴곡건의 파괴강도의 통계학적인 차이는 보이지 않고 있으나, 파괴강도에 있어서 신전건은 1199.0 N/$cm^2{\pm}$388.8, 굴곡건 1922.0 N/$cm^2{\pm}$764.4로, 굴곡건이 신전건에 비하여 1.6배 정도 크게 나타났으며, 상호간의 파괴강도에 있어서 통계학적인 차이가 있음을 보여주고 있다.(p<0.05). 조직학적 관찰에 의하면, 반복하중 하에서 뼈/건의 접합부분 특히 Uncalcified Fibrocartilage 부분에서 분리가 시작되었으며, 이는 상골과염을 발생시키는 주요생체조직부분이라는 것을 시사하고 있다. Based on clinical observations, it is suspected that the bone-tendon origin is the site where piratical failure, leading to pathophysiological changes in the humeral epicondyle after repetitive loading, is initiated Mechanical properties and failure patterns of the common extensor and flexor tendons of the humeral epicondyle under static and repetitive loading have not been well documented. Our goal was to determine mechanical properties of failure strength and strain changes, to correlate strain changes and the number of cyclic repetitions, and to identify the failure pattern of bone-tendon specimens of common extensor and flexor tendons of the humeral epicondyle. Mechnaical properties of human cadaver bone-tendon specimens of the common extensor and flexor tendons of the humeral epicondyle were tested under two different loading rates. No statistically significant difference in ultimate tensile strength was found between male and female specimens or between slow (10 mm/sec) and fast elongation (100 mm/sec) rates. However, a statistically significant difference in ultimate tensile strength between the common extensor (1190.0 N/$cm^2{\pm}$388.8) and flexor 1922.0 N/$cm^2{\pm}$764.4)tendons was found (p<0.05). When loads of 25%, 33%, and 41% of the ultimate tensile strength of their contralateral sides were applied, the number of cycles required to reach 24% strain change for the common extersor and flexor tendons were approximately 8,893, 1,907, and 410, respectively. The relationship between cycles and loads was correlated ($R^2$=0.46) Histological observation showed that complete or partial failure after tensile or cyclic loadings occurred at the transitional zone, which is the uncalcified fibrocartilage zone between tendon and bone of the humeral epicondyle. Sequential histological sections revealed that failure initiated at the upper, medial aspect of the extensor carpi radialis brevis tendon origin. Biomechanical and hstological data obtained in this study indicated that the uncalcified fibrocartilage zone at the bone-tendon origin of the common extensor and flexor tendons is the weak anatomical structure of the humeral epicondyle.

외부 PSC 보에서 외부강선의 극한 응력 예측식 제안

유성원,하헌재 한국안전학회 2010 한국안전학회지 Vol.25 No.5

Recently, the external prestressed concrete structures are increasingly being built. The mechanical behavior of prestressed concrete beams with unbonded tendon is different from that of normal bonded PSC beams in that the increment of tendon stress was derived by whole member behavior. By this reason, the ultimate stress of external tendon is smaller than that of bonded tendon or internal unbonded tendon. However, in the domestic and abroad code, the equation of ultimate stress of external tendon is not suggested yet, and the equation of ultimate stress of internal unbonded tendon is used instead of that of external tendon. Therefore, in this paper, after effective variables of ultimate stress of external tendon were analyzed, the analytical equation of ultimate stress of external tendon was proposed. And the reasonable coefficients were proposed by statistical work of test results of 25 beam with external tendon. Finally, the practical proposed equation of ultimate stress of external tendon was proposed with analytical and statistical model. The equation of ACI-318 and AASHTO 1994 were not matched with test results and had no correlations, and the proposed equation was well matched with test results. So the proposed equation in this paper will be a effective basis for the evaluation of external tendons in analysis and design.

외부 부분 부착 PSC 보의 휨거동 실험

유성원 ( Sung Won Yoo ),이상준 ( Sang Jun Lee ) 한국안전학회(구 한국산업안전학회) 2012 한국안전학회지 Vol.27 No.5

Recently, the external prestressed concrete structures are increasingly being built. The mechanical behavior of prestressed concrete beams with external tendon is different from that of normal bonded PSC beams in that the increment of tendon stress was derived by whole member behavior. By this reason, the ultimate stress of external tendon is smaller than that of bonded tendon or internal unbonded tendon. The purposes of the present paper are therefore to improve the mechanical behavior of external unbonded tendon by using partially bonded external tendon and to evaluate the flexural behavior of partially bonded external tendon by the flexural member experiment. From the experimental results, before flexural cracking, there was no difference between external unbonded, partially bonded and bonded tendons. However, after cracking, yielding load of reinforcement, ultimate load, and tendon stress were increased in the sequence of external unbonded, partially bonded and bonded tendon members. The equation of ACI-318 and AASHTO 1994 were not matched with test results and had no correlations. So the newly proposed equation will be needed including the consideration of tendon profile, tendon bonded type, and so on. The proposed partially bonded external tendon in this paper will be a effective basis for the evaluation of external tendons in construction and design.

자가 골-슬개건-골과 동종 아킬레스 건을 이용한 전방십자인대 재건술의 임상결과 비교

최호림(Ho-Rim Choi),최상욱(Sang-Wook Choi),권세원(Sai-Won Kwon),박종석(Jong-Seok Park),이병일(Byung-Ill Lee) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.5

목적: 전방 십자 인대 손상에 대한 자가 골-슬개건-골과 신선 동결 동종 아킬레스 건을 이용한 관절경적 재건술의 임상 결과를 비교하고자 한다. 대상 및 방법: 2002년 3월부터 2006년 12월까지 동종 아킬레스 건과 자가 골-슬개건-골을 이용하여 전방 십자 인대 재건술을 시행 받은 61명의 환자를 대상으로 하였다. 자가 골-슬개건-골 군은 29예, 동종 아킬레스 건군은 32예였다. 수술 시 환자의 평균 나이는 자가 골-슬개건 골 군 30.4세, 동종 아킬레스 건 군 32.5세였으며, 평균 추시 기간은 자가 골-슬개건-골 군 18.2개월, 동종 아킬레스 건 군 25.7개월이었다. 수술 전과 최종 추시 시점에서 이학적 검사와, KT-2000 관절측정기, 전방 전위 스트레스 방사선 사진을 이용하여 양 군을 비교하였고, IKDC 평가와 Lysholm 점수를 시행하였다. 결과: 수술 전과 최종 추시에서 KT-2000 관절측정기로 평가한 환측과 건측의 전방 전위 정도 차이는 자가골-슬개건-골 군은 평균 6.4 ㎜±3.0에서 3.2 ㎜±1.9로, 동종 아킬레스 건 군은 7.6 ㎜±3.1에서 2.9㎜±2.0로, 두 군 모두 통계학적으로 유의하게 향상되었으며(p<0.001), 향상 정도는 동종 아킬레스 건에서 유의하게 높았다(p=0.045). 전방 전위 스트레스 방사선 사진에서는 자가 골-슬개건-골 군이 평균 5.3㎜±2.5에서 2.0 ㎜±2.1로, 동종 아킬레스 건 군은 평균 6.0㎜±3.4에서 2.2 ㎜±2.1로, 두 군에서 통계학적으로 유의하게 호전되었으며(p<0.001), 두 군 간 차이는 없었다. 최종 추시 IKDC 평가에서 자가 골-슬개건-골 군은 26예(89.7%)가 정상 또는 거의 정상이었으며, 동종 아킬레스 건 군은 28예(87.5%)가 정상 또는 거의 정상을 보였다. Lysholm 슬관절 점수는 자가 골-슬개건-골 군은 69.9점에서 90.2점으로, 동종 아킬레스 건 군은 64.4점 에서 91.4점으로 향상되었다(p<0.001). 결론: 전방십자인대 재건수술에서 자가 골-슬개건-골과 동종아킬레스건 모두 이식물에 따른 양군간 임상적 차이 없이 양호한 결과를 얻어, 자가 골 슬개건-골과 동종 아킬레스 건 모두 전방십자인대 재건을 위한 적절한 이식물로 고려될 수 있을 것으로 생각된다. Purpose: To compare clinical outcomes after arthroscopic ACL reconstruction using bone-patellar tendon-bone autograft and using fresh-frozen Achilles tendon allograft. Materials and Methods: We enrolled 61 patients who underwent anterior cruciate ligament reconstruction by means of bone-patellar tendon-bone autograft or Achilles tendon allograft between March, 2002 and December, 2006. The bone-patellar tendon-bone group included 29 patients (mean age 30.4 years), and the Achilles tendon allograft group included 32 patients (mean age 32.5 years). The mean follow-up was 18.2 months and 25.7 months in each group, respectively. Preoperative and last follow-up clinical results were evaluated through physical examination, KT-2000 arthrometer, stress roentgenogram, IKDC knee rating system, and Lysholm knee score. Results: The mean side-to-side difference in anterior translation, as measured by KT-2000 arthrometer, was significantly improved from 6.4 ㎜±3.0 to 3.2 ㎜±1.9 in the bone-patellar tendon-bone group, and from 7.6 ㎜±3.1 to 2.9 ㎜±2.0 in the Achilles tendon allograft group (p < 0.001). The Achilles tendon allograft group improved more significantly than did the bone-patellar tendon-bone group (p=0.045). The mean side-to-side difference on stress roentgenogram was significantly improved from 5.3 ㎜±2.5 to 2.0 ㎜±2.1 in the bone-patellar tendon-bone group, and from 6.0 ㎜±3.4 to 2.2 ㎜±2.1 in the Achilles tendon allograft group (p < 0.001). There was no significant difference between the two groups. According to the IKDC knee rating system at last follow-up, 26 (89.7%) patients in the bone-patellar tendon-bone group and 28 (87.5%) patients in the Achilles allograft group were normal or nearly normal. The mean Lysholm knee score significantly improved from 69.9 to 90.2 in the bone-patellar tendon-bone group, and from 64.4 to 91.4 in the Achilles tendon allograft group (p < 0.001). Conclusion: Both bone-patellar tendon-bone and Achilles tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. We suggest that both bone-patellar tendon-bone autograft and Achilles tendon allograft be considered as graft substitutes for anterior cruciate ligament reconstruction.