微型锚钉治疗陈旧性锤状指畸形的疗效分析

Therapeutic effect of micro-anchor in chronic mallet finger deformity

[目的] 介绍一种应用微型锚钉治疗陈旧性锤状指畸形的方法，通过观察临床效果来探讨该方法治疗陈旧性锤状指畸形的可行性。[方法]对14例陈旧性锤状指患者临床应用微型锚钉治疗。于远侧指间关节（DIP）背侧做“и”形切口，显露伸指肌腱，将断端间疤痕切除，用1枚1mm克氏针将远侧指间关节（DiP）固定于伸直位，用肌腱缝合线水平褥式缝合仲指肌腱断端，于末节指骨基底背侧钻孔后安装微型锚钉，将锚钉尾部携带的肌腱缝线与伸指肌腱近断端缝合以加强缝合强度。术后前臂掌侧面石膏托固定腕关节背神30°，掌指关节及指间关节伸直位3周，6周后拔除克氏针开始功能锻炼。[结果]随访6个月-1年，按Dargan功能评定法：优10例，良2例，可1例，差1例。其中1例远侧指间关节（DIP）屈曲功能障碍，无畸形复发。优良率85．7％。[结论]应用微型锚钉治疗陈旧性锤状指畸形具有缝合强度高，畸形复发率低，操作简便，效果可靠的优点，是一种治疗陈旧性锤状指畸形简便有效的方法。

[ Objective]To introduce the method of treating chronic mallet finger using Micro Arc bone Anchor, and investigate the feasibility of this method with the clinical effects. [ Method ] Fourteen chronic mallet fingers were treated with Micro Arc bone Anchors. During the operation, a ＂и＂ skin incision over the dorsum of the DIP joint was made to expose the extensor tendon and resect the scar tissue between the disrupted ends. Then the DIP joint was made at extending position was immobilized with a 1 mm Kirschner wire and the ends of extensor tendon was sutured with horizontal mattress suture method. After that, the Micro Arc bone Anchor was sutured into the dorsal base of the distal phalanx,the suture thread attached the end of anchor was tied to the proximal end of the extensor tendon to reinforce the former suture. External fixation on the anterior face of forearm was applied to immobilize the wrist at 30° of extention and the metacarpophalangeal and interphalangeal joints and extending position for 3 w, and Kirschner wire fixation was taken out 6 w postoperatively. Functional exercises were performed after the Kirschner wires were removed. [Result]All the cases were followed up for 6 months to 1 year, and excellent results were obtained in 10 cases, good in 2, fair in 2 and poor in 1 according to Dargan$ functional assessment system, with dysfunction of flexion in DIP joint in 1 case, and recurrence of abnormity in 1 case. The total rate of excellent and good results was 85.7%. [ Conclusion] Micro Arc bone Anchor is a convenient and effective alternative for the treatment of chronic mallet finger deformity with many advantages such as the high suturing intensity,low recurrence rate of abnormity, convenient for operation and reliable effect.