Safety and efficacy of ultrasonography of tension after zone II flexor tendon repair: A randomized controlled trial.

BACKGROUND: Primary flexor tendon repairs of lacerations in zone II of the hand are fraught with problems. Traditionally, exercise (active and passive), orthoses, and physical agents are common interventions for the rehabilitation of patients experiencing these issues. One area of focus in this field is how to safely utilize tension to lengthen gliding distance following zone II injury. Finding effective solutions in this area is a key priority for improving patient outcomes and quality of life. PURPOSE: To identify the optimal immobilization position that meets safety standards for tension and is the most efficient, and consequently, to validate our clinical effectiveness. STUDY DESIGN: A cross-sectional study was adopted for the first part of the research (Research 1). A prospective, parallel, 2-group, randomized trial was conducted with concealed allocation and single blinding in the second part of the research (Research 2). METHODS: A total of 60 healthy adults were recruited to select the best-fit protective immobilization position in Research 1, which was confirmed by tendon tension (via Young's modulus) and excursion (via gliding distance). We then randomly assigned 45 patients after zone II flexor tendon repair into two groups in Research 2 to compare functional outcomes. The control group underwent the conventional modified Duran protocol with early passive motion, while the experimental group received the protocol (optimized by Research 1) with early active motion. Ultrasonography was used to measure the tension and excursion of the flexor tendons. The outcomes measured at 16 weeks post-repair included total active motion, strength, the Disabilities of the Arm, Shoulder and Hand, and Strickland scores. RESULTS: Three participants were unable to participate in Research 2 due to medical issues and poor attendance. The investigation found that the safe tendon threshold was 345.09 ± 87.74 kPa for partial active digital motion among the 60 participants. The optimal immobilization position requires the wrist to be neutral with a flexion angle of 30° at the metacarpophalangeal joint. The grip strengths (p = 0.012), ratio of grip strength (p = 0.015), the Disabilities of the Arm, Shoulder and Hand (p = 0.036), and total active motion (p = 0.023) differed significantly between the two groups. CONCLUSIONS: Protective immobilization of the wrist in a neutral flexion position and with the metacarpophalangeal joint flexed at 30° can secure the repaired flexor tendon safely and efficiently. The effects of an early active motion protocol may improve the grip strength and upper limb mobility of individuals after zone II flexor tendon repair. CLINICAL TRIAL REGISTRATION: ChiCTR2000030592.

[Effect of different molarity cathepsins specific inhibitor E-64 on dentin-resin bonding durability].

OBJECTIVE: To investigate, in vitro, the effect of cathepsins specific inhibitor N-(trans-epoxysuccinyl)-L-leucine 4-guanidinobutylamide(E-64) on dental endogenous cathepsins and to find its most effective molarity to elevate dentin-resin bonding durability. METHODS: Fifty recently extracted human third molars were divided into five groups according to random number table, and treated with different molarity of E-64 as follow: 0, 2.5, 5.0, 10.0 and 20.0 µmol/L. The group 0 µmol/L was control group. Then 20 specimens of dentin-resin composite were fabricated in each group. Half of the specimens were tested after 24 h water storage(37 °C) and the other half were tested after 90 days water storage(37 °C) followed by 3000 cycles'thermocyling(5-55 °C) as aging treatment. Fractured specimens were analyzed using scanning electron microscopy(SEM). RESULTS: After 24 h water storage, no significant differences were found in micro-tensile bond strength(µTBS) of samples between different groups (P > 0.05). However, after ageing treatment, µTBS of the samples in group 2.5, 5.0, 10.0 and 20.0 µmol/L [(18.7 ± 2.7), (20.8 ± 3.4), (18.3 ± 2.8) and (19.1 ± 2.7) MPa] were significantly higher than that in group 0 µmol/L [(15.1 ± 3.0) MPa] (P < 0.05). Only in the group 5.0 µmol/L no significant difference was found between the original and the decreased value of µTBS(P > 0.05), while the µTBS in other groups decreased significantly after aging treatment(P < 0.05). Failure types were almost adhesive and mixed types. Collagens in hybrid layer were less degraded in the groups using E-64 after aging treatment than control group. CONCLUSIONS: E-64 was effective on inhibiting cathepsins activity in dentin, and induced less collagens degradation in smear layer for better dentin-resin bond durability.