改良的骨腱道成形穿引肌腱段重建伸肌腱止点治疗锤状指

Treatment of mallet finger with modified osteotendonoplasty and tendon segment reconstruction

目的 探讨末节指骨基底部髓芯交汇式钻孔骨腱道成形结合肌腱移植重建伸肌腱止点的方法治疗锤状指的效果。方法 2017年3月-2020年5月,对32例32指手指末节伸肌腱止点腱性损伤,采用末节指骨基底外背侧进针,斜行钻孔朝向指骨髓芯,髓腔内汇合形成相通的腱道,利用钢丝引导移植肌腱穿过腱道,重建伸肌腱止点的方法进行修复。结果 术后所有伸肌腱止点重建均获得成功,切口全部一期愈合,术后32例均获随访,时间3~36个月,平均13个月。按照Crawfoud制定的锤状指疗效评价标椎,优27例,良3例,可2例,优良率93%。结论 采用末节指骨基底部髓芯交汇经骨隧道成形穿引移植腱段,重建止点治疗锤状指,该方法的止点更加接近原止点解剖位置,效果切实可靠,对切口愈合影响较小,操作简单,成功率高。

Objective To explore the method and effect of reconstruction of extensor tendon insertion injury by drilling bone tendon canal combined with tendon transplantation at the base of distal phalanx. Methods from March 2017 to may 2020, 32 patients with tendon injury of extensor tendon insertion of distal phalanx of 32 fingers were treated with lateral dorsal needling of distal phalanx base, oblique drilling toward the center of phalanx, intramedullary confluence to form a connected tendon channel, through the tunnel through the thin wire, using the steel wire to guide the transplanted tendon through the tendon channel to reconstruct the extensor tendon insertion. Results Thirty two cases were followed up for 3 ~36 months(Average 13 months), All the extensor tendon insertion reconstruction were successful, and all the incisions healed in the first stage. According to Crawfoud’s criteria, 29 cases were excellent, 2 cases were fair and 1 case was poor.The excellent and good rates was 93%. Conclusion Using the distal phalanx basal medullary core intersection through the bone tunnel to shape the transplanted tendon segment and reconstruct the insertion point to treat the extensor tendon insertion point, the insertion point of this method is closer to the anatomical position of the original insertion point, the effect is practical and reliable, the effect on the wound healing is minimal, the operation is simple, and the power is high.