不同方法防治屈肌腱粘连的临床研究

Study on the effects of different methods for treatment and prevention of flexor tendon adhesion in the tendon sheath

目的比较4种不同方法防治肌腱粘连的作用。方法一期修复鞘管区屈肌腱损伤4887条肌腱,术中用套圈缝合法缝接肌腱后,在肌腱鞘管内分别置入透明质酸钠1.0ml、bFGF加维生素复合膜、自体脂肪颗粒和空白对照,缝合皮肤。术后24h开始功能锻炼。结果4组经过平均18个月随访,按TAM法评定疗效,透明质酸钠组随访的23条肌腱,疗效优良者21条,优良率为91.30%。bFG加维生素C复合膜组22条肌腱,疗效优良者19条,优良率为86.36%。脂肪颗粒组22条肌腱,疗效优者15条,优良率为68.20%。空白对照组20条肌腱,疗效优良者11条,优良率为55.00%。各组之间有著差异(P<0.01)。结论透明质酸钠和bFGF加维生素C复合膜具有较好促进肌腱愈合,防止或减术后粘连,改善肌腱滑动的作用。

Objective To observe the effect of different methods for prevention and treatment of flexor tendon adhesion in the tendon sheath.Methods SHA,bFGF,autogenous fat particle and control groups were random injected into the tendon sheath during the primary tendon repair operation of87flexor tendon in48patients.Functional training was performed as early as24hours postoperatively.Results According to TAM standard,23tendons in SHA injection group,91.30%(21/23)had an ex-cellent or good result in an average of18months'follow-up;22tendons in bFGF group,86.36%(10/22);68.20%(15/22),in autogenous fat particle group and55.00%(11/20)in control group.The excellent and good rate of SHA and bFGF groups were significantly higher than of the control group (P<0.01).Conclusion SHA and bFGF could effectively promote tendon healing,prevent or reduce tendon adhe-sion,and improve tendon excursion.