微型骨锚修复手指伸肌腱止点撕脱伤并发症12例原因分析

Analysis of 12 cases of complications after repair of avulsion injury of extensor tendon insertion with micro bone anchor

目的通过对12例锚钉缝线修复手指伸肌腱止点撕脱伤的并发症病例进行分析,查找原因,探讨减少并发症的方法。方法自2014年4月至2019年5月对127例手指伸肌腱Ⅰ区损伤的患者进行锚钉缝线止点功能重建,其中12例患者出现术后并发症。其中男9例,女3例;年龄14~37岁,平均19岁。示指4例,中指6例,小指2例。12例患者于受伤后4~12周行手术治疗,应用强生1.3 mm Micro锚钉进行伸肌腱止点功能重建,患者术后随访4~18周发现手术失效。结果7例患者出现锚钉缝线异物反应,伤口愈合不良,3例出现指甲畸形,2例出现关节炎。除3例指甲畸形患者,余9例患者均接受二次手术。结论应用微型锚钉进行指伸肌腱止点功能重建,术中需精细操作,注意锚钉钉入角度,与关节面及甲根的距离,同时缝线打结的位置等都会影响术后的效果。

Objective To analyze the 12 cases of complications after repair of avulsion injury of extensor tendon insertion with micro bone anchor suture,find the cause of the failure,and explore the methods to reduce the complications.Methods From April 2014 to May 2019,127 patients with digital extensor tendon injuries in zoneⅠwere treated by tendon insertion reconstruction with anchor suture,of which 12 patients had postoperative complications.There were 9 males and 3 females.The age ranged from 14 to 37 years,with an average of 19 years.There were 4 cases of index finger,6 cases of middle finger and 2 cases of little finger.12 patients underwent surgery from 4 to 12 weeks after injury.Johnson&Johnson 1.3-mm micro anchor was used to reconstruct the extensor tendon insertion function.The patients were follow-up for 4 to 18 weeks and the surgical failure was found.Results The foreign body reaction of anchor suture occurred in 7 cases with poor wound healing.The nail deformity occurred in 3 cases and the arthritis occurred in 2 cases.Except for 3 patients with nail deformity,the other 9 patients underwent secondary surgery.Conclusion The application of micro anchor in the reconstruction of extensor tendon insertion needs fine operation,attention to the insertion angle of anchor and the distance from articular surface to nail root.And the position of suture knot will also affect the postoperative effect.