自体腱鞘移植在修复肌腱及腱周组织严重损伤中的应用

Application of tendon sheath graft for tendon repair with severe peritendinous injuries

目的 探索自体腱鞘移植在屈肌腱伴腱周组织严重损伤时 ,重建指屈肌腱背侧或环周腱鞘缺损的方法和效果。方法 对 2 1例 2 5指 区指屈肌腱伴腱周组织严重损伤者 ,取自体腕伸肌腱腱鞘作游离移植 ,修复缺损的指屈肌腱背侧或环周腱鞘 ;并按肌腱损伤时间的早晚 ,同时作肌腱修复术、肌腱移植术或肌腱粘连松解术。术后共随访到 2 4指 ,平均随访 10个月。结果 根据 Strickland评价标准 ,优 7指 ,良 11指 ,中 5指 ,差 1指 ;优良率为 75 %。结论 用游离自体腱鞘移植重建指屈肌腱背侧腱鞘或环周腱鞘 ,可提高肌腱修复术在治疗肌腱伴腱周组织严重损伤中的疗效。

Objective To study methods and results of tendon sheath graft for dorsal digital sheath or circumferential sheath reconstruction in flexor tendon repair with severe peritendinous injuries. Methods 25 fingers with zone Ⅱ flexor tendon and peritendinous structure injury were involved in this study. The sheath defects were reconstructed with autogenous sheath taken from the first dorsal compartment of the wrist. The tendons were repaired or replaced by a tendon graft or only underwent tenolysis according to intervals from the injuries to the repair. 24 fingers were followed for an average 10 months and evaluated by Strickland criteria. Results The functional return was excellent in 7 fingers, good in 11, fair in 5 and poor in 1. The good and excellent rate was 75 %. Conclusions Reconstruction of dorsal or circumferential sheath defects using autogenous sheath graft provides an effective way to improve results of tendon repair with severe peritendinous injuries.