摘要
目的:观察异体肌腱移植重建伸肌腱止点治疗锤状指畸形的疗效。方法:选择于2003-01/2006-03在东南大学医学院附属徐州医院骨科采用改良伸肌腱止点重建术治疗的锤状指畸形患者15例,均自愿参加观察。开放损伤2例患者于急诊1期予以手术治疗,闭合损伤13例患者在1周内予以手术治疗。①手术方法:臂丛麻醉,于末节指骨基底以远4mm偏背侧的尺桡两边对向钻孔,形成骨隧道,采用修剪合适的异体肌腱穿过骨隧道,在远侧指间关节背侧交叉后分别与伸指肌腱的侧腱束吻合(吻合前选直径1.0mm克氏针将远侧指间关节固定过伸位10°￣15°),石膏托外固定,6周后拔除克氏针及拆除石膏进行末节屈伸功能锻炼。术后定期随访。②功能测评:测量手指最大伸直位掌指关节、近指间关节、远指间关节伸直受限角度的总和及手指屈曲位时指端与掌横纹之间的距离。优:伸指0°,屈指指端过掌横纹;良:伸指受限≤-15°,屈指指端达掌横纹。结果:15例患者全部进入结果分析,无脱落。术后随访2个月￣3年,平均19.5个月。所有患者伤口甲级愈合,无异物排斥反应。按Dargan功能评定标准,优12例(占80%),良2例(占13.3%),优良率达93.3%。1例因远侧指间关节僵硬而屈伸活动功能欠佳。结论:异体肌腱移植伸肌腱止点重建术是治疗锤状指畸形的有效方法。
AIM： To observe the curative effect of reconstruction of extensor tendon by transplanting heterologous tendon in the treatment of mallet finger deformity. METHODS： Fifteen cases of mallet finger deformity treated by reconstruction insertion of extensor tendon were enrolled at Department of Orthopedics, Xuzhou Hospital Affiliated to Medical College, Southeast University from January 2003 to March 2006. They all participated the observation veluntarily. Two open injury patients were treated with operation in the first emergency phase. The 13 closed injury patients were treated with operation in the first week phase. ①operation method： After brechial plexus anesthesia, an incision was conducted on the back of distal interdigital joint. A bone tunnel was made at 4 mm distance from the digital interphalangeal joint and deviation to the back of distal phalanx. A suit heterologous tendon was passed through the bone tunnel and was sutured with the lateral tendon after crossing on the back of the digital interphalangeal joint （the distal interphalangeal joint in 10°-15° extension by 1.0 mm diameter keith needle）. Fixation with plaster splint, function practice of the distal phalanx could be performed when the plaster splint and the keith needle were removed after 6 weeks. Follow-up was done regularly after operation.② function assessment： The total extension lag angle of metacarpophalangeal joint, proximal articulations interphalangeae, distal articulations interphalangeae at maximal extension position and the distance between finger tip and transverse striation at finger flexion position were measured. 0°indicated excellent flexion and finger tip was over transverse striation at finger flexion; at most -15° indicated good flexion and finger tip touched transverse striation at finger flexion. RESULTS： Totally 15 patients were involved in the result analysis, no drop-out. Postoperative follow up ranged from 2 months to 3 years, with an average of 19.5 months. The wound of all patients was good and no reject reaction, According to Dargan criteria, the overall effective rate was 93.3%. Excellent result was obtained in 12 cases （80%） and good in 2 cases （13.3%）. One case was distal interphalangeal joint stiffness and flexion function was not free, CONCLUSION： Reconstruction of extensor tendon is an effective method for mallet finger deformity.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第4期714-716,共3页
Journal of Clinical Rehabilitative Tissue Engineering Research
