再植指指屈肌腱粘连松解后的疗效分析

Treatment outcome of tenolysis for flexor tendon adhesion after digital replantation

目的探讨断指再植后指屈肌腱粘连松解术的疗效。方法手指中、近节离断再植成活后，Ⅱ区指屈肌腱粘连的发生率高达９８％。对１６例２９指再植指鞘内指屈肌腱粘连行松解手术后配合积极的主动屈指功能训练及系列的康复治疗。结果经过３～１２个月的随访，疗效按ＴＡＭ评定标准评定，１７指达优良，优良率为５８．６％。８指为中，伤因均系绞轧伤或冲压伤。２例４指无效或失败，占１．４％。该２例虽为电锯伤，但失败１例术后过早开始作抗阻力锻炼，导致肌腱断裂。无效１例因术后未进行正确的功能锻炼。结论切割伤再植指屈肌腱作松解后的疗效优于绞轧伤再植指。肌腱松解术后进行系统的正规的康复治疗，有助于功能的恢复。术后２个月内不应作抗强阻力的锻炼。

Objective To observe the effectiveness of tenolysis for flexor tendon adhesion after digital replantation and discuss the factors influencing the treatment outcome. Methods 29 digits of 16 cases which were replanted at the proximal phalangeal level and middle phalangeal level were involved. Tenolysis of the flexor tendons in Zone II was performed because of the 98% high incidence of tendon adhesion after digital replantation at this level. Active motion of finger flexion and comprehensive rehabilitation were carried out after tenolysis. The patients were followed up for 3～12 months. The treatment outcome was evaluated by total active motion of the fingers. Results Excellent or good result was achieved in 17 fingers, which accounted for 58.6% of the series. The result was fair in 8 fingers, of which the etiology was tangling or crush injuries. 1.4% of the series, that is 4 fingers, failed because of too early anti resistance exercise and inadequate postoperative rehabilitation. Conclusions Systematic and correct rehabilitation after tenolysis improves the functional restoration of replanted fingers. Strong anti resistance exercise however should not be permitted during the first two postoperative months.