摘要
目的探讨应用可抽出缝线牵引联合克氏针固定治疗手指末节屈伸肌腱止点断裂的临床疗效。方法回顾性研究保定市第六人民医院2018年3月—2023年12月收治的手指创伤性末节屈伸肌腱止点断裂30例患者资料,其中男性21例,女性9例;年龄3~60岁,平均31.6岁;运动撞击伤11例,碰撞伤4例,机器挤压伤3例,扭伤7例,切割伤5例。均采用切开手术治疗,应用克氏针从指端经皮固定远指间关节呈过伸位或屈曲位,针尾远端弯钩,肌腱缝线修复缝合肌腱断端,再用缝合线牵引肌腱断端经皮穿出,打结固定在克氏针弯钩上。术后6周拆除克氏针和缝线,开始循序渐进锻炼。术后观察指甲有无畸形、伤口瘢痕受线结刺激程度,远指间关节活动范围采用国际手外科学会推荐的主动运动活动度(TAM)系统评定。结果本组病例术后随访3~60个月,平均8.6个月,伤口均无感染,皮缘无坏死。1例出现指甲生长轻度凹槽畸形,1例术后出现明显血肿,清除后加压包扎,换药愈合;2例指背伤口受肌腱缝合线结刺激出现破溃,拆除线结,换药愈合。TAM系统评分:优15例,良11例,可3例,差1例,优良率86.6%。结论应用可抽出缝线牵引联合克氏针固定治疗手指末节屈伸肌腱止点断裂,克氏针和缝线对肌腱断端形成持续弹性牵引,使肌腱断端无张力愈合,操作简单,并发症少,临床疗效满意。
Objective To explore the clinical efficacy of extractable suture traction combined with K-wire fixation in the treatment of rupture of the insertion point of the flexor and extensor tendons of the distal phalanx of the finger.Methods A retrospective analysis was conducted on the data of 30 cases with traumatic rupture of the insertion point of the flexor and extensor tendons of the distal phalanx admitted to Baoding Sixth People’s Hospital from Mar.2018 to Dec.2023,including 21 males and 9 females.The age ranged from 3 to 60 years,with an average of 31.6 years.There were 11 cases of sports impact injuries,4 collision injuries,3 machine crush injuries,7 sprain injuries,and 5 cutting injuries.All patients were treated with open surgery.A K-wire was used to fix the distal interphalangeal joint in hyperextension or flexion position percutaneously from the fingertip.A hook was made at the distal end of the wire tail.The tendon suture was used to repair and suture the tendon stump,and then to tract the tendon stump to penetrate the skin and finally be knotted and fixed on the hook of the K-wire.The K-wire and suture were removed 6 weeks after surgery,and progressive exercise was started.After surgery,the presence of nail deformity was observed,and the degree of wound scar irritation by the suture knot was evaluated.The range of motion of the distal interphalangeal joint was evaluated using the total active motion(TAM)recommended by the Inter national Society of Hand Surgery.Results All the cases were followed up for 3 to 60 months,with an average of 8.6 months.There was no wound infection or skin edge necrosis.Mild groove-shaped nail deformity occurred in 1 case;another case presented obvious hematoma after surgery,which was removed with compression bandage and healed after dressing change.The dorsal finger wounds of 2 cases were ulcerated due to irritation by the tendon suture knots,which also healed after removal of the suture knots and dressing change.Based on the TAM,there were 15 excellent cases,11 good,3 fair,and 1 poor,with an excellent-good rate of 86.6%.Conclusion Using extractable suture traction combined with K-wire fixation in the treatment of rupture of the insertion point of the flexor and extensor tendons of the distal phalanx of the finger can provide continuous elastic traction on the tendon stumps to enable the tendon stumps to heal without tension.This method is simple,with few complications but satisfactory clinical outcomes.
作者
王松
陶忠生
耿丽
陈金强
赵宁
汪强
朱月新
李长云
Wang Song;Tao Zhongsheng;Geng Li;Chen Jinqiang;Zhao Ning;Wang Qiang;Zhu Yuexin;Li Changyun(Department of Orthopedics,Baoding Sixth People’s Hospital,Baoding,Hebei Province 071100,China;Department of Hand Surgery,the 82nd Group Army Hospital of PLA,Baoding,Hebei Province 071000,China;Department of Orthopedics,Xushui Traditional Chinese Medicine Hospital,Baoding,Hebei Province 072550,China)
出处
《创伤外科杂志》
2025年第3期211-215,共5页
Journal of Traumatic Surgery
基金
保定市医学科研课题(2341ZF413)。
关键词
肌腱断裂
手指
可抽出缝线
牵引
Rupture of the tendons
Fingers
Extractable suture
Traction
