吻合口无结Kessler缝合法修复指屈肌腱的疗效观察

EFFECTIVENESS OF MICROSURGICAL REPAIR OF FLEXOR TENDON RUPTURE BY NON-KNOT KESSLER SUTURE METHOD IN ANASTOMOTIC STOMA

目的通过与传统Kessler缝合法比较,分析吻合口无结Kessler缝合法修复指屈肌腱的疗效及优势。方法回顾分析2005年2月-2010年2月采用吻合口无结Kessler缝合法治疗的122例163指243根指屈肌腱断裂患者临床资料(试验组),术中一期显微缝合指屈肌腱,修复腱外膜、腱鞘及腱周组织,应用透明质酸钠充填治疗。并与2001年2月-2005年2月采用传统Kessler缝合法治疗的96例130指186根指屈肌腱断裂患者(对照组)临床资料进行比较。两组患者性别、年龄、损伤原因、损伤部位、病程等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术后3周内采用Kleinert橡皮筋牵引疗法(动态支具保护),并于24 h后开始手指功能锻炼。结果术后试验组2例、对照组5例切口发生感染,经换药后2周愈合;其余患者切口均Ⅰ期愈合。患者均获随访,随访时间6～14个月,平均9个月。术后6个月手指功能采用主动活动度(total active movement,TAM)法评定,试验组TAM为(192.0±13.1)°;其中获优54例,良58例,中8例,差2例,优良率为92%。对照组TAM为(170.0±15.2)°;其中获优23例,良30例,中22例,差21例,优良率为55%。两组TAM比较,差异有统计学意义(P<0.01)。结论吻合口无结Kessler缝合法治疗指屈肌腱断裂,辅以腱外膜、腱鞘及腱周组织修复后,手指功能恢复优于传统Kessler缝合法,但远期疗效仍需进一步观察。

Objective To analyze the effectiveness and advantages of the microsurgical repair of flexor tendon rupture with non-knot Kessler suture method in anastomotic stoma by comparing with the method of traditional Kessler suture.Methods Between February 2005 and February 2010,122 patients（163 fingers with 243 flexor digital tendons） with flexor tendon rupture,were treated with microsurgical repair by non-knot Kessler suture method（treatment group）;flexor tendon was sutured,and sodium hyaluronate was used to repair tendon membrane,tendon sheaths,and the tissue surrounding tendons.The clinical data were analysed,and were compared with ones from 96 patients（130 fingers with 186 flexor digital tendons） with flexor tendon rupture treated with traditional Kessler suture between February 2001 and February 2005（control group）.There was no significant difference in gender,age,cause of injury,injury site,duration,and other general information between 2 groups（P 〉0.05）.Kleinert elastic traction therapy（dynamic-protection） was performed at 3 weeks after surgery,and the finger function exercise was done after 24 hours.Results Infection of incision occurred in 2 cases of the treatment group and in 5 cases of the control group,and were cured after 2 weeks of dressing change;the other incisions healed by first intention.The patients were followed up 6 to 14 months（mean,9 months）.In the treatment group,the total active movement（TAM） was（192.0 ± 13.1）°;the results were excellent in 54 cases,good in 58 cases,moderate in 8 cases,and poor in 2 cases with an excellent and good rate of 92%.In the control group,TAM was（170.0 ± 15.2）°;the results were excellent in 23 cases,good in 30 cases,moderate in 22 cases,and poor in 21 cases with an excellent and good rate of 55%.Significant difference in TAM was found between 2 groups（P〈 0.01）.Conclusion The microsurgical repair of flexor tendon with non-knot Kessler suture method in anastomotic stoma with repair of tendon membrane,tendon sheaths,and the tissue surrounding tendons is more effective than the traditional Kessler suture,but long-term effectiveness still needs further observation.