指伸肌腱创伤后并发肌腱粘连的危险因素分析

Risk factors of tendon adhesion after extensor digitorum tendon trauma

目的分析指伸肌腱创伤后并发肌腱粘连的危险因素。方法我院自2010年6月至2020年12月手术治疗指伸肌腱损伤患者531例,根据术后是否发生指伸肌腱粘连分为肌腱粘连组(54例)和非肌腱粘连组(477例)。通过单因素x检验或Fisher确切概率法分析性别、年龄、BMI、地区、文化程度、吸烟、饮酒、损伤类型、损伤原因、单/多根指伸肌腱损伤、指伸肌腱损伤分区、受伤手指、受伤发生季节、手别、骨折、神经损伤、血管损伤、关节囊损伤、受伤至手术时间、术后功能锻炼等因素对指伸肌腱粘连发生率的影响,筛选出指伸肌腱粘连的相关因素,采用二元Logistic回归分析探讨指伸肌腱创伤术后并发肌腱粘连的独立危险因素。结果531例指伸肌腱损伤患者中,54例(10.2%)发生指伸肌腱粘连。单因素分析结果显示肌腱粘连组和非肌腱粘连组的损伤原因、指伸肌腱损伤分区、是否合并骨折、受伤手指、是否合并关节囊损伤比较差异均有统计学意义(P<0.05);二元Logistic回归分析结果显示绞伤(P=0.003,OR=8.411,95%CI:2.044~34.606)、指伸肌Ⅲ区损伤(P=0.044,OR=10.605,95%CI:1.065~105.567)、合并骨折(P=0.04,OR=2.405,95%CI:1.041~5.556)、受伤发生至手术时间>12h(P=0.035,OR=2.168,95%CI:1.055~4.456)、合并关节囊损伤(P=0.000,OR=5.105,95%CI:2.194~11.878)、术后未进行功能锻炼(P=0.000,OR=8.675,95%CI:3.329~22.607)是发生创伤后指伸肌腱粘连的危险因素。结论绞伤、指伸肌腱Ⅲ区损伤、合并骨折、受伤发生至手术时间>12h、合并关节囊损伤、术后未进行功能锻炼是发生指伸肌腱粘连的危险因素,此类患者应高度警惕指伸肌腱粘连的发生,外科医生应早期临床干预,降低其发生率。

ObjectiveTo analyze the risk factors of tendon adhesion after extensor digitorum tendon trauma.Methods From June 2010 to December 2020,531 patients with extensor digitorum tendon injury were treated surgically in our hospital.They were divided into tendon adhesion group(54 cases)and non tendon adhesion group(477 cases)according to whether adhesion of extensor digitorum tendon occurred after operation.The effects of gender,age,BMl,region,educationlevel,smoking,alcohol consumption,injury type,injury cause,single/multiple extensor digitorum tendon injury,extensor digitorum tendon injury partition,injured finger,season of injury,hand side,fracture,nerve injury,vascular injury,joint capsule injury,time from injury to surgery,and postoperative functional exercise on the incidencerate of extensordigitorum tendon adhesions were analyzed by one-way X test or Fisher's exact probability method.The related factors of extensor digitorum tendon adhesion were screened,and the independent risk factors of tendon adhesion after extensor digitorum tendon trauma were investigated by binary Logistic regression analysis.ResultsAmong 531 cases of extensor digitorum tendon injury,54 cases(10.2%)developed adhesion of extensor digitorum tendon.Univariate analysis showed that there were statistically significant diferences between the tendon adhesion group and the non tendon adhesion group in the causes of injury,the division of extensor tendon injury,whether there was fracture,injured finger,and whether there was joint capsule injury(P<0.05).The results of binary Logistic regression analysis showed that strangulation(P=0.003,or=8.411,95%CI:2.044 to 34.606),extensor digitorum tendon zoneⅢinjury(P=0.044,or=10.605,95%CI:1.065 to 105.567),combined with fractures(P=0.04,or=2.405,95%CI:1.041 to 5.556),time from injury to operation>12 hours(P=0.035,or=2.168,95%CI:1.055 to 4.456),combine withjoint capsule injury(P=0.000,or=5.105,95%CI:2.194 to 11.878)and no functional exercise after operation(P=0.000,or=8.675,95%CI:3.329 to 22.607)were the risk factors for extensor digitorum tendon adhesion after trauma.Conclusion The risk factors of extensor digitorum tendon adhesion are strangulation,extensor digitorum tendon zone Il injury,combined with fractures,injury occurring more than 12 hours after operation,combined with joint capsule injury,and failure to perform functional exercise after operation.Such patients should be highly vigilant against the occurrence of extensor digitorum tendon adhesion,and surgeons should make early clinical intervention to reduce its incidence.