应用微型骨锚重建指伸肌腱止点的临床研究

Application of Mitek micro anchor in reconstruction of distal extensor tendon insertion

目的评估应用微型骨锚重建指伸肌腱止点的疗效。方法2004年3月～2005年12月对21例（21指）指伸肌腱止点撕脱伤所致锤状指畸形患者进行治疗，用克氏针将远侧指间关节固定于过伸位，然后将Mitekmicro微型骨锚置入远节指骨基底背侧指伸肌腱附着处，再用锚尾部的4-0 Ethibond缝合线与撕脱的指伸肌腱缝合，重建止点。术后6周拔除克氏针开始功能锻炼。结果全部患者获得18～30个月（平均20．2个月）随访。21例患者伤口均一期愈合，无感染和皮肤坏死等。患指各关节被动活动正常。术后末节主动伸直功能（欠伸度为3．5°±1．3°）较术前（欠伸度为45．6°±5．8°）明显改善，差异有统计学意义（P〈0．05），达到或接近正常。依据Patel等锤状指疗效评价体系评估：优15例，良5例，中1例，优良率为95．2％。随访期间未发现锚钉脱出、松动、断裂等并发症。结论微型骨锚用于修复与重建指伸肌腱止点，操作简便，疗效可靠。

Objective To evaluate the clinical effects of reconstruction of distal extensor tendon insertion using a Mitek micro anchor. Methods From March 2004 to December 2005, surgical reconstruction of distal extensor tendon insertion was performed for 21 patients with 21 mallet fingers which had been caused by avulsion of extensor tendon insertion. The distal interphalangeal joints were stabilized in slight over-extension with Kirschner wires. The Mitek micro anchors were implanted into the base of the distal phalanx and the two 4-0 Ethibond sutures were woven into the terminal extensor tendon to reconstruct the insertion. The Kirschner wires were removed 6 weeks postoperatively before movement of the distal interphalangeal （DIP） joint started. Results All the cases were followed up for 18 to 30 months with an average of 20.2 months. The restriction of active extension at the DIP joint of the injured finger was significantly improved after the operation （3.5°± 1.3°） compared with that before the operation （45.6°± 5.8°） （ P 〈 0.05）. According to the evaluation criteria by Patel et al, the results were excellent in 15 cases and good in 5 cases. Conclusion Reconstruction of distal extensor tendon insertion for mallet fingers with a Mitek micro anchor is practical and the clinical effects are fine.