末节指骨钻孔缝合止点法治疗指伸肌腱止点损伤

Drilling at the base of distal phalanx and suturing at the insertion site for treatment of the extensor tendon insertion injury

目的探讨末节指骨基底部钻孔缝合止点结合克氏针固定远指间关节治疗指伸肌腱止点损伤的方法和治疗效果。方法自2013年5月至2016年10月，我们对21例21指伸肌腱止点损伤患者，其中骨性止点损伤7例，腱性止点损伤14例，均采用末节指骨基底部钻孔缝合止点结合克氏针固定远指间关节的方法修复。结果术后所有患者伸肌腱止点重建均获得成功，切口均Ⅰ期愈合。术后21例均获得随访，时间为3～18个月，平均9个月，所有患者均未出现指间关节畸形及肌腱止点再次断裂，2例出现关节僵硬。骨性止点损伤患者术后6-8周摄X线片示骨折愈合。根据Crawford制定的锤状指疗效评价系统评价：优9例，良7例，可3例，差2例，优良率为76．2％。结论采用末节指骨基底部钻孔缝合撕脱止点结合克氏针固定远指间关节治疗指伸肌腱止点损伤，该方法操作简单，临床疗效较为满意。

Objective To investigate the surgical procedures and the clinical results of drilling at the base of distal phalanx and suturing at the insertion site combined with distal interphalangeal （DIP） joint fixation using Kirschner wire in repair of the extensor tendon insertion injury. Methods From May 2013 to October 2016, 21 patients （21 fingers） with extensor tendon insertion injury were treated by drilling at the base of distal phalanx and suturing at the insertion site combined with DIP joint fixation using Kirschner wire. There were bony insertion injury in 7 cases and tendon insertion injury in 14 cases. Results The reconstruction of the extensor tendon insertion was achieved in all the patients. All the wounds healed primarily without skin necrosis of incision. All the patients were follow-up for 3 to 18 months with an average of 9 months. No interphalangeal joint deformity and tendon insertion rupture again occurred in all the cases. Postoperative DIP joint ankylosis occurred in 2 cases. Fracture healing was achieved 6 to 8 weeks after the operation in the patients with bony insertion injury demonstrated by X-ray examination. According to the Crawford evaluation system for mallet finger, the results were excellent in 9 cases, good in 7 cases, fair in 3 cases and poor in 2 cases with the excellent and good rate being 76.2%. Conclusion It is a simple operation for drilling at the base of distal phalanx and suturing at the insertion site combined with DIP joint fixation using Kirschner wire to treat the extensor tendon insertion injury, which has achieved satisfactory clinical efficacy.