摘要
目的比较保守与手术治疗闭合性腱性锤状指的临床疗效。方法回顾性分析2015年1月-2021年12月收治的66例闭合性腱性锤状指患者的临床资料,保守治疗(A组)34例,手术治疗(B组)32例。A组:夹板固定23例,铝板支具固定6例,石膏固定5例;B组:肌腱直接缝合术21例,锚钉联合克氏针重建肌腱止点术11例。对所有患者进行随访,记录患指远指间关节初始屈曲角度和治疗后欠伸角度、主动屈曲活动度、疼痛程度、并发症等情况,并按Crawford功能评定标准评定临床疗效,统计分析两组的疗效差异。结果所有病例均获得随访,A组随访时间为8~23个月,B组随访时间为9~24个月。A、B两组年龄、性别、受伤指别、随访时间差异均无统计学意义(P>0.05)。两组治疗后远指间关节的欠伸角度、主动屈曲角度、VAS评分比较差异均无统计学意义(P>0.05)。末次随访时,按Crawford功能评定标准:A组优12例,良15例,中4例,差3例,优良率为79.4%;B组优10例,良16例,中3例,差3例,优良率为81.3%。两组优良率的差异无统计学意义(P>0.05)。在A、B两组中,远指间关节初始屈曲角度≥30°与<30°者经治疗后的优良率比较差异无统计学意义(P>0.05)。A组出现皮肤I度压疮1例,皮肤浸渍1例,去除外固定并常规护理后恢复正常。B组出现线结反应1例,甲床畸形2例,无伤口感染及固定失效等情况。结论采用保守与手术治疗闭合性腱性锤状指的临床疗效相当,远指间关节初始屈曲角度≥30°与<30°者的临床疗效基本一致。
Objective To compare the clinical efficacy between conservative treatment and operative treatment for closed tendinous mallet fingers.Methods From January 2015 to December 2021,the clinical data of 66 patients with closed tendinous mallet fingers treated in our hospital were analyzed retrospectively.Among them,34 patients underwent conservative treatment(group A)and 32 patients underwent operative treatment(group B).The conservative treatment group was immobilized with braces(23patients)、aluminum plate(6 patients)and plaster(5 patients).The operative treatment group was treated with direct extensor tendon suture(21 patients)and extensor tendon insertion reconstruction with bone anchor(11patients).All patients of two groups were followed up,and data such as initial angulation of the distal interphalangeal joint and under-extension angle,active flexion range of motion,visual analogue scale and complications of the affected fingers were recorded mainly.The treatment effects of two groups were evaluated and statistically analyzed comprehensively by Crawford functional assessment method.Results All the patients were followed up clinically.The follow-up time was 8 to 23 months in group A,and 9 to 24 months in group B.There were no significant differences in age,gender,injury category,follow-up time between groups A and B(P>0.05),but the follow-up time of group A was more than that of group B(P<0.05).There were no significant differences in the affected fingers under-extension angle,active flexion range of motion,visual analogue scale between groups A and B(P>0.05).At the last follow-up,according to the Crawford functional assessment,the results were rated as excellent in 12 cases,good in 15 cases,fair in 4 cases,poor in 3 cases with the excellent and good rate 79.4%in group A;while the results were rated as excellent in 10 cases,good in16 cases,fair in 3 cases,poor in 3 cases with the excellent and good rate 81.2%in group B.There was no significant difference in the excellent and good rate between two groups.There was no significant difference in the excellent and good rate between the initial distal interphalangeal joint angulation more than 30°and the angulation less than 30°in the group A and B(P>0.05).There was no significant difference in the excellent and good rates of the initial distal interphalangeal joint angulation less than 30°between group A and B.The excellent and good rate of the initial distal interphalangeal joint angulation more than 30°between two groups(P>0.05)also showed no significant difference.In group A,only one case had slight pressure sore and one case had skin maceration after treatment,which returned to normal after proper nursing.In group B,one case had adverse reactions caused by wound line knots and two cases had nail deformity,but no case had wound infection,and implant failure and other complications.Conclusion The clinical efficacy of conservative treatment for closed tendinous mallet finger is not significantly different from that of operative treatment.There are no significant differences in clinical efficacy between initial distal interphalangeal joint angulation more than 30o and the angulation less than 30°.
作者
苏柱程
方旭
陆生林
郑亚东
王辉
李波香
SU Zhucheng;FANG Xu;LU Shenglin(Department of Orthopedics,Minzu Hospital of Guangxi Zhuang Autonomous Region,Nanning,Guangxi Zhuang Autonomous Region,530001,China)
出处
《实用手外科杂志》
2023年第3期341-344,共4页
Journal of Practical Hand Surgery
关键词
腱性锤状指
保守治疗
手术治疗
疗效比较
Tendinous mallet finger
Conservative treatment
Surgical treatment
Comparative effectiveness
