钢丝张力带与带线锚钉重建近指间关节掌板止点的临床疗效对比

A comparison of the clinical efficacy of reconstruction of the volar plate insertion of the interphalangeal joint with steel wire tension band and anchor

目的对比观察钢丝张力带与带线锚钉重建近指间关节掌板止点的临床疗效。方法自2016年7月至2019年4月,我们共收治36例手指近指间关节掌板止点撕脱患者,其中18例采用钢丝张力带重建掌板止点(钢丝组),18例采用带线锚钉重建掌板止点(锚钉组)。随访比较两组患者的手术相关指标、术后并发症、关节活动度,采用手指总主动屈曲度量表(total active flexion scale,TAFS)评价患者的手功能恢复情况。结果钢丝组的手术时间及手功能锻炼开始时间明显短于锚钉组,差异有统计学意义(P<0.05),而两组手术切口长度差异无统计学意义(P>0.05);两组在感染、内固定松动、肌腱粘连、关节僵硬等独立并发症方面差异无统计学意义(P>0.05),但锚钉组的总并发症比例明显高于钢丝组,差异有统计学意义(P<0.05);两组的术后近指间关节活动度均较术前明显改善,并且钢丝组的改善程度优于锚钉组,差异均有统计学意义(P<0.05);钢丝组术后TAFS优良率明显高于锚钉组,差异有统计学意义(P<0.05)。结论钢丝张力带重建掌板止点在手术时间、功能锻炼开始时间、术后总体并发症、关节活动度改善及手功能恢复方面均优于带线锚钉,可获得更好的治疗效果。

Objective To compare the clinical efficacy of reconstruction of the volar plate insertion of the interphalangeal joint with steel wire tension band and anchor.Methods From July 2016 to April 2019,36 cases of avulsion of the volar plate insertion of the interphalangeal joint were treated.Among them,18 cases were treated with steel wire tension band to reconstruct the volar plate insertion(steel wire group)and 18 cases were treated with anchor(anchor group).The operation related indexes,postoperative complications and joint mobility of the two groups were follow-up and compared.The total active flexion scale(TAFS)was used to evaluate the recovery of hand function.Results The operation time and the beginning time of hand function exercise in the steel wire group were significantly shorter than that in the anchor group,and the difference was statistically significant(P<0.05),but there was no statistical significance in the length of incision between the two groups(P>0.05);there was no statistical significance in the infection,internal fixation loosening,tendon adhesion,joint stiffness and other independent complications between the two groups(P>0.05),but the total complication ratio in the anchor group was significantly higher than that in the steel wire group,and the difference between the two groups was statistically significant(P<0.05);the activity of proximal interphalangeal joint in the two groups was significantly improved after operation,and the improvement of the steel wire group was better than that of the anchor group with the difference being statistically significant(P<0.05);the excellent and good rate of TAFS in the steel wire group was significantly higher than that in the anchor group with the difference being statistically significant(P<0.05).Conclusion The reconstruction of the volar plate insertion with steel wire tension band is better than that with anchor in the operation time,the beginning time of functional exercise,overall postoperative complications,the improvement of joint activity and hand function recovery,which can obtain better clinical efficacy.