关节松解联合肌腱松解术治疗断指再植术后近指间关节僵硬的效果研究

Study on effect of arthrolysis combined with tenolysis in the treatment of proximal interphalangeal joint stiffness after replantation of severed finger

目的 探讨关节松解联合肌腱松解术治疗断指再植术后近指间关节僵硬的效果。方法 76例断指再植术后近指间关节僵硬患者,随机分为对照组与观察组,每组38例。对照组使用常规功能锻炼+中药熏洗治疗,观察组使用关节松解联合肌腱松解术治疗。对比两组的临床疗效、并发症发生情况、密歇根手功能问卷(MHQ)评分、日常生活能力[日常生活能力评定量表(ADL)评分]及相关指标[手指总主动活动度(TAM)、手指握力]。结果 观察组再植指关节功能恢复优良率为86.84%,明显高于对照组的63.16%,差异有统计学意义(P<0.05)。观察组并发症发生率为7.89%,明显低于对照组的28.95%,差异有统计学意义(P<0.05)。治疗后,观察组整体功能、日常活动、外观、疼痛、工作情况及满意度评分分别为(83.31±10.69)、(85.23±9.80)、(77.02±8.25)、(56.91±6.23)、(75.36±9.53)、(76.31±8.67)分,均高于对照组的(71.82±9.87)、(75.38±8.64)、(59.13±6.46)、(45.86±7.01)、(60.27±10.06)、(64.44±8.28)分,差异有统计学意义(P<0.05)。治疗后,观察组ADL评分、手指TAM、手指握力分别为(76.84±13.25)分、(164.87±26.57)°、(8.73±1.92)kg,均高于对照组的(67.06±12.43)分、(132.45±25.62)°、(6.45±1.57)kg,差异有统计学意义(P<0.05)。结论 关节松解联合肌腱松解术治疗断指再植术后近指间关节僵硬的效果显著,并发症发生率低,手指功能恢复好。

Objective To discuss the effect of arthrolysis combined with tenolysis in the treatment of proximal interphalangeal joint stiffness after replantation of severed finger.Methods 76 patients with proximal interphalangeal joint stiffness after replantation of severed finger were randomly divided into a control group and an observation group,with 38 cases in each group.The control group was treated with conventional functional exercise and fumigation with traditional Chinese medicine,and the observation group was treated with arthrolysis and tenolysis.Comparison was made on clinical efficacy,complications,Michigan Hand Outcomes Questionnaire(MHQ)score,activities of daily living(ADL)score and related indicators[total active range of motion(TAM),finger-grip strength]between the two groups.Results The excellent rate of functional recovery of replanted finger in the observation group was 86.84%,which was significantly higher than 63.16%in the control group,and the difference was statistically significant(P<0.05).The incidence of complications in the observation group was 7.89%,which was significantly lower than that of 28.95%in the control group,and the difference was statistically significant(P<0.05).After treatment,the scores of overall function,daily activities,appearance,pain,work status and satisfaction in the observation group were(83.31±10.69),(85.23±9.80),(77.02±8.25),(56.91±6.23),(75.36±9.53)and(76.31±8.67)points,which were higher than those of(71.82±9.87),(75.38±8.64),(59.13±6.46),(45.86±7.01),(60.27±10.06)and(64.44±8.28)points in the control group,and the difference was statistically significant(P<0.05).After treatment,ADL score,finger TAM and finger-grip strength of the observation group were(76.84±13.25)points,(164.87±26.57)°and(8.73±1.92)kg,which were higher than those of(67.06±12.43)points,(132.45±25.62)°and(6.45±1.57)kg of the control group.The difference was statistically significant(P<0.05).Conclusion Arthrolysis combined with tenolysis is effective in the treatment of proximal interphalangeal joint stiffness after replantation of severed finger,and has low complication rate and good recovery of finger function.