肌腱断端锁定缝合法修复Ⅱ区指屈肌腱的临床应用

Clinical Application of Broken End Locking Suture in Tendon Repair of Flexor Tendon in Zone Ⅱ

目的探讨肌腱断端锁定缝合法修复Ⅱ区指屈肌腱的可行性及优点。方法2008年3月至2011年3月临床病例155例，男114例，女41例，平均年龄23．6岁；随机分组，A组（实验组）：79例，断裂Ⅱ区屈肌腱95条，应用肌腱断端锁定缝合法吻合。B组（对照组）：76例，断裂Ⅱ区屈肌腱93条，应用改良kessler缝合法吻合。观察各组肌腱断端吻合口光滑及滑动情况，随防6-18月，评定术后恢复功能。结果肌腱断端吻合口A组明显比B组平整光滑，滑动性更佳，抗拉力更强。主动活动TAM法进行功能评价，A组：优61条，良22条，可11条，差1条，优良率87.36％；肌腱断裂再次修复2条，断裂发生率2．10％。B组：优36条，良35条，可16条，差6条，优良率76．34％；肌腱断裂再次修复6条，断裂发生率5．37％。两组优良率及断裂发生率有显著差异∽〈0．01）。结论肌腱断端锁定缝合法修复Ⅱ区指屈肌腱具有吻合口更光滑、抗拉力及抗疲劳更强等优点，适合术后早期功能锻炼，利于减少粘连，恢复功能。

Objective To study the advantages of the broken end locking suture in tendon repair of flexor tendon in zone Ⅱ Methods 155 cases （ 188 tendons in zone 11 ） were hospitalized from Mar 2008 to Mar 2011, including 114 males and 41 females. 155 cases were divided randomely into two groups, group A： 79cases（95 tendons） were performed tendon repair with broken end locking suture; group B： 76cases（93 tendons） were performed tendon repair with modified kessler surture. Results Group A compared with group B, the anastomosis of tendons were more smooth, leveling, compact and stronger tensile strength. The results were evaluated with the TAM, group A： 61 tendons get excellent, 22 tendons get good, Ⅱ tendons get fair and 1 tendon get poor, the rate of excellent or good result was 87.36%; 2 tendons ruptured, the rate of rupture was 2.10%. group B： 36 tendons get excellent, 35 tendons get good, 16 tendons get fair and 6 tendons get poor, the rate of excellent or good was 76.34%, 5 tendons rupture, the rate of rupture was 5.37%. The result had significance of statistics. Conclusion Tendon repair with broken end locking suture has some advantages such as more smooth, leveling and compact, stronger anti-tensile strength and anti-fatigue. It is an ideal method of tendon repair for early rehabilitation, decrease adhesion of tendon and increase ftmctional rehabilitation.