手部陈旧性屈指肌腱断裂的重建修复治疗分析

Analysis of the effect of reconstruction scheme in old hand flexor tendon fracture

目的研究手部陈旧性屈指肌腱断裂的重建修复方案的治疗效果。方法选择2014年1月—2016年1月青海大学附属医院创伤骨科收治的手部陈旧性屈指肌腱断裂患者63例,根据损伤肌腱部位按照解剖区域分为Ⅰ~Ⅴ五区。随机分为治疗组32例和对照组31例。其中,治疗组采取分期改良手术即一期植入硅胶管、二期植入掌长肌(由可吸收生物膜即脑磷脂和卵磷脂材料包裹)重建其屈指肌腱结构并恢复其功能;对照组患者给予延迟活动治疗。两组患者术后通过总主动活动度(total active movement,TAM)测定以及功能独立性评定(functional independence measure,FIM)综合评估患者屈指肌腱功能重建情况,分析治疗效果。结果随访第12周,TAM评级治疗组为优者26例,对照组7例,治疗组明显优于对照组(χ~2=15.00,P<0.05);FIM评分治疗组(36.1±6.2),对照组(24.8±8.3),治疗组活动度范围显著优于对照组(t=5.97,P<0.05),治疗组其术后功能重建效果满意。结论改良手术能够明显提高手部陈旧性屈指肌腱断裂患者的重建修复效果,手术效果的提升得益于肌腱粘连的避免,值得临床深入研究和推广。

Objective To analyze the effect of reconstruction scheme in old hand flexor tendon fracture.Methods Totally 63 cases（ Traumatic Department of Orthopedics,Hospital of Qinghai University,Jan. 2014 to Jan. 2016） with old hand flexor tendon fracture were selected into our study,who were randomly divided into 2groups（ 32 cases in the treatment group and 31 cases in the control group）. According to the anatomical region,patients with injury of tendon lesions were divided into area Ⅰ-Ⅴ. The treatment group was treated by staged operation. The first stage was implantation of silicone rubber tube and the second was implantation in the palm long muscle,which was wrapped by biofilm（ lecithin and cephalin） for reconstruction. The control group was treated by delayed activity therapy. Total active movement（ TAM） and functional independence measure（ FIM） were taken to estimate the effect of reconstruction scheme in old hand flexor tendon fracture treatment. Results After 12-week follow-up,TAM of excellent in the treatment group was 26 and was 7 in the control group,which could be seen as a significant promotion（ χ~2= 15. 00,P〈0. 05）. FIM in the treatment group was（ 36. 1 ± 6. 2） and was（ 24. 8 ± 8. 3）in the control group,indicating that the treatment group had a wider range of finger movement（ t = 5. 97,P〈0. 05）and better curative effect. Conclusion The improved operation in reconstructing old hand flexor tendon fracture can significantly promote the curative effect,which is worth further studying and promoting during the clinical work.