不同手术方式治疗糖尿病患者手指屈肌腱止点断裂的临床研究

Clinical study on different surgical methods to treat the attachment rupture of the flexor tendon of finger in diabetic patient

目的分析传统术式(皮下隧道细钢丝加压缝合术)及微型带线锚钉修复术治疗外伤性手指屈肌腱止点断裂糖尿病患者的疗效,以评估微型带线锚钉修复糖尿病患者屈肌腱止点断裂的临床疗效及可行性。方法前瞻性收集石家庄市第二医院和唐山市第二医院的外伤性手指屈肌腱止点断裂的糖尿病患者60例,随机分为试验组(微型带线锚钉修复)及对照组(皮下隧道细钢丝加压缝合术)。两组患者术后2、3、4个月行患指功能、伤口愈合评定,比较行两种术式后手指屈伸功能。结果 60例患者均获得随访,末次随访时试验组与对照组相比MP和PIP屈伸活动度,差异无统计学意义;试验组与对照组相比DIP屈伸活动度和TAM值差异有统计学意义,且试验组DIP屈伸活动度和TAM值大于对照组;手运动功能TAM分级:试验组优23例,良6例,可1例;对照组优22例,良6例,可2例。结论微型带线锚钉修复糖尿病患者屈肌腱止点断裂能够有效地防止和减少肌腱粘连,显著提高患指术后的屈伸功能,是一种有效的、可行的术式,较传统术式具有较大优势。

Objective To analyze the effect of traditional surgical method(steel wire suture through subcutaneous tunnel)and the method of mini-anchor repair to treat the attachment rupture of finger flexor tendon after hand injury in diabetic patient and confirm the advantage of miniature anchor in the treatment of tendon rupture in patient with diabetes.Methods Prospective collection of sixty diabetic patients with rupture of finger flexor tendon in The Second Hospital of Shijiazhuang and The Second Hospital of Tangshan.Two groups were randomly divided,the experimental group(mini-anchor repair)and the control group(steel wire suture through subcutaneous tunnel).The function of the affected finger and wound healing were evaluated 2,3,4 months after surgery in two groups and the flexion and extension functions of the finger were compared between the two groups.Results Sixty patients were all followed up.At the last follow-up,there was no significant difference in flexion and extension ROM of MP and PIP between the experimental group and the control group.Compared with the control group,the flexion and extension ROM of DIP and TAM values in the experimental group were significantly different and the flexion and extension ROM of DIP and TAM values in the experimental group were significantly higher than those in the control group.TAM classification of hand motor function:23 cases in experimental group were excellent,6 cases were good,1 case was fair.22 cases in control group were excellent,6 cases were good,2 cases were good.Conclusion Repairing the rupture of flexor tendon attachment with mini-anchor can effectively prevent and reduce tendon adhesion,significantly improve the function of finger flexion and extension after surgery.It is an effective and feasible method and has relatively large advantages over traditional surgery.