双套圈经隧道交叉加压缝合法用于指伸肌腱止点重建

Reconstruction of extensor apparatus insertion using crisscross tunneling and double loop suture

目的介绍一种末节指伸肌腱止点重建的方法。方法克氏针固定远侧指间关节，肌腱两侧套圈缝合，经末节指骨基底的横行隧道交叉至对侧，两侧套线各分出1股向近侧返折后会合，于肌腱背侧中线做套圈缝合。两侧剩余的套线于肌腱背侧直接打结。结果术后随访时间为5个月至2年，无一例发生肌腱断裂和肌腱粘连。远侧指问关节活动度：0°～70°18例，0°～60°17例，0°～50°4例。按TAM系统评定方法评定：优25例，良14例；优良率为100％。结论采用双套圈经隧道交叉加压缝合法重建指伸肌腱止点，操作简单，疗效可靠。

Objective To introduce a method of extensor apparatus insertion reconstruction. Methods The distal interphalangeal joint was fixed by a Kirschner wire. Two loop sutures were placed on both sides of the distal end of the extensor tendon and passed through a transverse tunnel at the base of the distal phalanx in a crissoross fashion. One end of the loop suture was reflected proximally to weave through the extensor tendon and tied on the axis of the tendon. Another end of the loop suture was directly tied against the dorsum of the tendon. This technique was applied in 39 cases of mallet fingers due to extensor tendon insertion rupture. Results All the cases were followed for 5 months to 2 years. There was no tendon rupture and tendon adhesion. Range of motion of the distal interphalangeal joint was 0°-70° in 18 cases, 0°-60° in 17 cases, and 0°-50° in 4 cases. According to TAM evaluation criteria, the results were rated as excellent in 25 cases and good in 14 cases. The overall satisfactory rate was 100%. Conclusion Crisscross tunneling and double loop suture is an easy and effective way to reconstruct extensor apparatus insertion.