一种指屈肌腱滑车重建术后早期活动的保护装置

A protective device for early exercises after flexor tendon pulley reconstruction

目的介绍一种用于Bunnell滑车重建术后早期功能活动的保护装置及其使用方法和应用结果。方法采用Bunnell方法重建手指A_2、A_4滑车7例8指。其中4例同时行指屈肌腱松解及近侧指间关节掌板松解、皮肤Z字成形术。术后即于重建滑车部位的手指套放一个椭圆形的开放式铝环做保护,以防前者承载过度。根据手指肿胀程度1日2次调整铝环口径,使其既不影响手指血液循环也不失保护重建滑车之功效。术后48 h手指开始主、被动屈伸活动。结果术后随访6～21个月,平均11个月,所有的重建滑车愈合顺利,功效确实,指屈肌腱无“弓弦”现象,手指关节总主活动度增加0°～123°,平均为69．75°,运动几近正常。结论使用开放式铝环做保护,Bunnell滑车重建术后手指可以早期活动。此举可减少肌腱粘连、改善手指运动功能；滑车重建的同时也可实施指屈肌腱、指间关节掌板及皮肤瘢痕松解。

Objective To introduce a protective device for early exercise following Bunnell＇s procedure of pulley reconstruction. Its effectiveness was evaluated. Methods The second and fourth annular pulleys were reconstructed in 8 digits of 7 patients with Bunnell＇s technique. Tenolysis, volar plate release of the PIP joint and Z-plasty of the skin were performed simultaneously in 4 patients. An elliptic open aluminum ring was wrapped around the reconstructed palley immediately tollowing the operation in order to protect the repaired pulley from over-loading. The rings were adjusted twice a day to accommodate the swollen fingers, being neither too tight to avoid compromising the blood circulation nor too loose so as not to lose its protective effects. The patients started active and passive flexion and extension exercises from the second postoperative day. Results The follow-up period ranged from 6 months to 21 months with an average of 11 months. All the reconstructed pulleys healed uneventfully and functioned very well. No flexor bowstringing was found postoperatively. Total active motion of the metacarpolphalangeal, proximal interphalangeal, and distal interphalangeal joints increased 69.75°, ranging from 0° to 123°. The flexion and extension movement was near normal. Conclusion Application of the open aluminum ring in patients with Bunnell＇ s procedure of pulley reconstruction allows early postoperative exercises which will reduce adhesion of the tendon to reconstructed pulley and surrounding tissues and improve movement of the fingers. Tenolysis, PIP joint volar plate release, and Z-plasty of the skin can be performed at the same time of pulley reconstruction.