经皮八针法缝合修复闭合性Ⅰ区指伸肌腱断裂

Studies on the minimally invasive percutaneous suture technique of eight times for repairing closed injury extensor tendon zone I of finger

目的探讨经皮八针法缝合修复闭合性Ⅰ区指伸肌腱断裂的临床疗效。方法回顾性分析2017年4月至2020年11月治疗并获得随访的12例闭合性Ⅰ区指伸肌腱断裂(新鲜腱性锤状指)患者资料,男8例,女4例;年龄18~50岁,平均35岁;均为单指Ⅰ区指伸肌腱急性闭合性断裂,左侧5指,右侧7指;拇指1例,示指2例,中指3例,环指4例,小指2例。经皮采用3-0肌腱缝线深浅绞索八针法缝合Ⅰ区指伸肌腱,且固定于末节指骨基底部。术后6~8周拔除克氏针,使用支具固定患指于背伸位,逐步加强患指屈伸运动。术后及随访参照Crawford标准评估患指功能,测量患指及对侧健指各关节的主动屈伸活动范围,记录手指总主动活动度(total action movement,TAM);参照美国手外科学会伸指肌腱修复评价系统根据TAM评价手指功能。结果12例患者均顺利完成手术,手术时间(20.1±0.2)min(范围18~25 min);术中仅有少量出血。术后12例均获得随访,随访时间(10.2±1.1)个月(范围6~14个月)。术后12例患者的锤状指畸形均完全矫正,无线结外露、皮肤坏死等并发症。按照Crawford法评估:优9例,良2例,可1例,优良率91.7%(11/12)。患指与健指远侧指间关节屈曲角度分别为82.11°±2.02°和84.09°±2.01°,伸直角度分别为-2.04°±3.01°和0.02°±1.02°,两者比较差异均有统计学意义(t=2.447,3.246;P=0.019,0.004)。患指关节活动度:掌指关节为91.02°±4.01°,近侧指间关节94.04°±2.11°,远侧指间关节83.01°±2.02°,TAM为265.05°±13.04°;健指关节活动度:掌指关节为93.01°±3.21°,近侧指间关节94.03°±3.07°,远侧指间关节85.02°±2.01°,TAM为269.02°±12.10°;以上各指标比较差异均无统计学意义(均P>0.05)。12例根据TAM系统评定:优9例,良3例,优良率为100%(12/12)。结论经皮八针法缝合能有效修复闭合性Ⅰ区指伸肌腱断裂,矫正锤状指,术后早期疗效满意。

Objective To discuss the clinical curative effect of the minimally invasive percutaneous suture technique of eight times for repairing closed injury extensor tendon zone I of finger.Methods From February 2017 to January 2020,12 patients(male 8,female 4)with mallet finger deformity were retrospectively studied,with an average age of 35 years(range,18-50 years).And all the affected fingers were acute closed rupture of extensor tendon in zone I of single finger,5 cases of the left finger and 7 cases of the right finger.There were 1 case of the thumb finger,2 cases of the index finger,3 cases of the middle finger,4 cases of the ring finger and 2 cases of the little finger.12 patients with fresh sputum mallet fingers were with 3-0 thread monofilament suture on extensor tendon zone I of finger in the minimally invasive percutaneous suture technique of eight times,and the distal end of the tendon was fixed to the base of the distal phalanx through the bone hole.Removal of the Kirschner wire 6-8 weeks,the brace was used to fix the affected finger in the dorsal extension.The flexion and extension of the affected finger was gradually strengthened.The function of the affected finger was evaluated according to the Crawford standard after operation and follow-up.The active flexion and extension range of motion of each joint of the affected finger and the contralateral healthy finger were measured,and the total action movement(TAM)of the finger were recorded.Finger function was evaluated according to TAM of the American Association of Hand Surgeons.Results All operations were successfully completed,the operation time of the patients ranged from 18 to 25 min,with an average of 20.1±0.2 min.There was only a small amount of bleeding in the surgery.All 12 cases were followed up and the follow-up periods ranged from 6 to 14 months,with an average of 10.2±1.1 months.Mallet finger deformities were all corrected postoperatively;there were no knot exposure,skin necrosis and other complications.According to the Crawford standard,9 cases were excellent,2 cases were good,and 1 case was fair.The excellent and good rate was 91.7%(11/12).The mean active flexion of distal interphalangeal joints on the wounded finger and healthy finger were 82.11°±2.02°and 84.09°±2.01°,the mean active extension of distal interphalangeal joints on the wounded finger and healthy finger were-2.04°±3.01°and 0.02°±1.02°,there were significant differences between them(t=2.447,3.246;P=0.019,0.004).The degrees of active joint activity of wounded finger were:91.02°±4.01°of the metacar-pophalangeal joint,94.04°±2.11°of the proximal interphalangeal joint,83.01°±2.02°of the distal interphalangeal joint,and 265.05°±13.04°of total active activity;the degrees of active joint activity of healthy finger were:93.01°±3.21°of the metacar-pophalangeal joint,94.03°±3.07°of the proximal interphalangeal joint,85.02°±2.01°of the distal interphalangeal joint,and 269.02°±12.10°of total active activity.The TAMs of the healthy side were 269.02°±12.10°,and the TAMs of the affected side were 265.05°±13.04°,there was no significant difference between them(P>0.05).According to TAM system assessment criteria:excellent in 9 patients,good in 3 patients,and the excellent and good rate was 100%(12/12).Conclusion The minimally invasive percutaneous suture technique of eight times can well repair closed injury extensor tendon zone I of finger,can have satisfactory treatment outcome in mallet finger with a simple procedure and good outcome.It is a simple,safe,effective method with minimal invasion.