指骨压迫性缺损：一种Bunnell滑车重建术后的并发症

Pressure defect of phalanx:a complication of pulley reconstruction with Bunnell's technique

目的报告Bunnell滑车重建术后滑车下指骨可有凹陷形缺损。方法9例12指共重建滑车(Bunnell方法)16个:A_2滑车11个,A_3滑车1个,A_4滑车4个。术后随访4～55个月,平均25.22个月;观察重建滑车功能,记录手指关节主动屈、伸运动,拍摄X线平片观察指骨变化。结果重建滑车均顺利愈合,功效确实,指屈肌腱无"弓弦"状现象;关节主动屈、伸运动均有改善;X线平片显示指骨与重建滑车接触部均有凹陷形缺损。部分病例还有髓腔变窄、骨赘增生、皮质变薄等变化。结论Bunnell滑车重建术后其下指骨可有凹陷形缺损,可能是重建滑车收受指屈肌腱牵拉负荷产生压力所致。

Objective To report depressed defects of phalanx under the reconstructed pulleys with Bunnell＇ s technique.Methods Sixteen annular pulleys were reconstructed in 12 digits of 9 cases with Bunnell＇s technique. Of them, 11 were the second annular pulleys, 1 was the third annular pulley, and 4 were the fourth annular pulleys. The follow-up period ranged from 4 months to 55 months with an average of 25.22 months. The function of reconstructed pulleys was observed. The active flexion-extension motion of joints of the finger was measured. The phalanges were examined with x-ray. Results All of reconstructed pulleys healed successfully and functioned very well. No flexor tendon bewstringing was found postoperatively. Active motion of metacarpophalangeal, proximal and distal interphalangeal joints increased respectively. The depressed defects of phalanges were found in the area in contact with the reconstructed pulleys in all the cases. Narrowing of medullary cavities osteophyte formation, and thinning of cortex of phalanges were found in some cases. Conclusion Depressed defects of phalanges could be found following Bunnell＇ s procedure of pulley reconstruction. It could be resulted from the pressure converted from flexor tendon traction load by the reconstructed pulleys.