Silfverskiold缝合法结合术后早期动态伸直治疗Ⅲ、Ⅳ区指伸肌腱损伤

Silfverskiold technique combined with dynamic splinting for treatment of digital extensor tendon rupture in zones Ⅲ and Ⅳ

目的探讨Silfverskiold缝合法结合术后早期动态伸直治疗Ⅲ、Ⅳ区指伸肌腱损伤的效果。方法自2010年3月至2013年10月，我们共收治67例85指Ⅲ、Ⅳ区指伸肌腱断裂患者，使用Silfverskiold技术修复伸肌腱，术后1周内开始使用动态支具进行控制性活动，患指可主动屈曲，被动伸直，每小时练习10次屈伸。术后3周去除动态支具，患者进行主动屈伸练习，锻炼问隙和夜间使用单指伸直支具继续保护2周。结果术后随访时间为3—6个月，平均4个月。其中42例在术后9周内恢复正常活动度。末次随访时，按Miller功能评定标准进行评定：优50指，良30指，可5指，优良率为94．1％。结论Silfverskiold缝合法结合术后早期动态伸直是治疗Ⅲ、Ⅳ区指伸肌腱损伤的有效方法，安全可靠。

Objective To investigate the clinical results of Silfverski^ld suture combined with dynamic splinting in treating extensor digitomm tendon rupture in zones Ⅲ and IV. Methods Between March 2010 and October 2013, a total of 67 patients with 85 extensor digitorum tendon lacerations in zones Ⅲ and Ⅳ were included in this study. The tendons were repaired using Silfvemkiold technique which was a combination of modified Kessler core suture and running cross-stitch epitendinous suture. The patients began controlled exercise within seven days postoperatively wearing a dynamic extension splint. Active flexion and passive extension of the fingers were repeated ten times per hour. After three weeks, the dynamic splint was removed and the patients began active finger flexion and extension. Protective static splinting was continued with the interphalangeal joints in full extension between exercises and during the night for another 2 weeks. Results Postoperative follow-up period ranged from 3 to 6 months, with an average of 4 months. Forty-two of the 67 patients regained full range of motion within 9 weeks postoperatively. At the final follow-up evaluation, according to Miller＇s criteria, the results were graded as excellent in 50 fingers, good in 30 fingers and fair in 5 fingers. The overall satisfactory rate was 94.1%. There was no rupture of the repaired tendons. Conclusion Silfverskisld suture combined with dynamic splinting is an effective treatment method for extensor digitorum tendon lacerations in zones Ⅲ and Ⅳ It is safe and reliable.