摘要
目的:探讨应用双侧等长指浅屈肌腱外侧腱束转至指背侧治疗纽扣指畸形的临床效果。方法:回顾性分析2021年2月至2022年5月,南京江北医院手足显微外科收治的纽扣指畸形患者的临床资料。将指浅屈肌腱外侧近止点处向近端各劈出1束,形成双侧等长外侧腱束,于中节指骨基底部钻孔,再将双侧等长外侧腱束经骨孔转至背侧,与伸肌腱中央腱近断端编织缝合。术后用支具将患指伸直位固定4周,逐步加强患指近指间关节伸屈运动。术后随访观察近指间关节主、被动伸屈活动,参照美国手外科协会总主动活动度(TAM)系统评定手指功能。结果:共纳入7例(7指)患者,男5例5指,女2例2指;年龄22~64岁,平均42岁。受伤指别:示指1例,中指2例,环指2例,小指2例。所有病例均获随访6~8个月,平均7个月,术后7例(7指)切口均无感染,一期愈合,纽扣指畸形均完全矫正。末次随访时患指近指间关节均能主动屈曲、伸直,近指间关节、远指间关节伸直均达至正常范围,患指近指间关节主动活动度平均为92.4°,患指TAM平均为271.3°。参照TAM功能评定法进行评价:优6指,良1指。结论:应用双侧等长指浅屈肌腱外侧腱束转至背侧编织缝合能有效治疗纽扣指畸形,临床效果满意,是一种安全、行之有效的新方法。
Objective To evaluate the clinical efficacy of the treatment of boutonniere deformity by tenodesis of the bilateral slips of the flexor digitorum superficialis(FDS)tendon.Methods From February 2021 to May 2022,the boutonniere deformity was retrospectively analyzed,by tenodesis of the bilateral slips of the FDS in the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital.During the operation,the lateral side of the bilateral FDS was split at the distal end separately.Then the two bundles were tunneled through the bone of the middle phalanx and weaved with the central band of the extensor tendon.The involved finger was stabilized in extension with splinting for 4 weeks after surgery.Extension and flexion of the proximal interphalangeal joint(PIPJ)of the finger should be gradually strengthened.Finger function was evaluated according to the total action movement(TAM)system of the American Association of Hand Surgeons.Results A total of 7 patients(7 digits)were enrolled,including 5 males and 2 females,and the age ranged from 22 to 64 years old,with an average age of 42 years old.The injured included 1 index finger,2 middle fingers,2 ring fingers,and 2 little fingers.These patients were follow-up for 6 to 8 months with an average of 7 months.All wounds healed by primary intention.This operation can obtain the complete correction of the boutonniere deformity.The PIPJ was stable and capable of active flexion and straightness.The straightness of PIPJ and distal interphalangeal joint was improved.The mean active motion of the PIPJ of the affected finger was 92.4°,and the mean TAM of the affected finger was 271.3°.According to TAM system assessment criteria:excellent in 6 patients,good in 1 patient.Conclusion It is a safe and effective new method for the correction of boutonniere deformity,which can be effectively treated with tenodesis of the bilateral slips of the FDS.
作者
江起庭
李智
余红
王志钢
方威
李涛
Jiang Qiting;Li Zhi;Yu Hong;Wang Zhigang;Fang Wei;Li Tao(Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital,Nanjing 210048,China)
出处
《中华整形外科杂志》
CSCD
2023年第3期278-284,共7页
Chinese Journal of Plastic Surgery
关键词
指
纽扣畸形
肌腱修复
外科手术
Finger
Boutonniere deformity
Tendon repair
Surgery
