可吸收锚钉结合克氏针在陈旧性锤状指伸指功能重建中的应用

Application of absorbable anchor combined with Kirschner wire in reconstruction of extension function of old mallet finger

目的探讨应用可吸收锚钉结合克氏针固定重建陈旧性锤状指伸指功能的可行性和临床疗效。方法回顾分析2020年1月—2022年1月收治的23例陈旧性锤状指患者临床资料。男17例,女6例;年龄18~70岁,平均42岁。致伤原因:运动撞击伤12例,扭伤9例,既往切割伤2例。患指指别:示指4例、中指5例、环指9例、小指5例。腱性锤状指(DoyleⅠ型)18例,仅小块骨片撕脱(WehbeⅠA型)5例。受伤至手术时间45~120 d,平均67 d。术中关节松解后克氏针固定远侧指间关节于轻度背伸位,采用可吸收锚钉辅助重建指伸肌腱止点;6周后拔除克氏针开始关节屈伸功能训练。结果术后23例患者均获随访,随访时间4~24个月,平均9个月。术后切口均Ⅰ期愈合,无切口感染、皮肤坏死及指甲畸形等并发症发生。远节指间关节无僵硬,关节间隙良好,未出现疼痛、骨关节炎等并发症。末次随访时,根据Crawford功能评定标准,患指功能获优12例、良9例、可2例,优良率91.3%。结论可吸收锚钉结合克氏针固定重建陈旧性锤状指畸形伸指功能可获较好疗效,具有手术操作简便、并发症少的优点。

Objective To investigate the feasibility and effectiveness of absorbable anchor combined with Kirschner wire fixation in the reconstruction of extension function of old mallet finger.Methods Between January 2020 and January 2022,23 cases of old mallet fingers were treated.There were 17 males and 6 females with an average age of 42 years(range,18-70 years).The cause of injury included sports impact injury in 12 cases,sprain in 9 cases,and previous cut injury in 2 cases.The affected finger included index finger in 4 cases,middle finger in 5 cases,ringfinger in 9 cases,and little finger in 5 cases.There were 18 patients of tendinous mallet fingers(Doyle type I),5 patients were only small bone fragments avulsion(Wehbe type I A).The time from injury to operation was 45-120 days,with an average of 67 days.The patients were treated with Kirschner wire to fix the distal interphalangeal joint in a mild back extension position after joint release.The insertion of extensor tendon was reconstructed and fixed with absorbable anchors.After 6 weeks,the Kirschner wire was removed,and the patients started joint flexion and extension training.ResultsThe postoperative follow-up ranged from 4 to 24 months(mean,9 months).The wounds healed by first intention without complications such as skin necrosis,wound infection,and nail deformity.The distal interphalangeal joint was not stiff,the joint space was good,and there was no complication such as pain and osteoarthritis.At last follow-up,according to Crawford function evaluation standard,12 cases were excellent,9 cases were good,2 cases were fair,and the good and excellent rate was91.3%.Conclusion Absorbable anchor combined with Kirschner wire fixation can be used to reconstruct the extension function of old mallet finger,which has the advantages of simple operation and less complications.