异体肌腱移植重建掌板-侧副韧带复合体治疗近指间关节陈旧性脱位

Reconstruction of volar plate-collateral ligament complex with allogeneic tendon transplantation for treatment of old dislocation of proximal interphalangeal joint

目的探讨异体肌腱经"T"形骨隧道移植重建掌板-侧副韧带复合体治疗近指间关节陈旧性脱位的临床疗效。方法自2015年4月至2022年12月,我院共收治8例手指近指间关节陈旧性脱位患者,采用异体肌腱经"T"形骨隧道移植重建掌板-侧副韧带复合体治疗,术后随访临床疗效。结果术后8例患者均获得随访,时间为12~16个月,平均12.7个月。术后无感染、异体肌腱排异反应、切口周围皮肤坏死等并发症,复查X线片提示近指间关节对应关系好。末次随访近指间关节无明显疼痛、关节稳定、无手指严重功能障碍。采用疼痛视觉模拟评分(visual analogue score,VAS)评估关节疼痛程度,指间关节均无明显疼痛,平均(1.0±1.3)分。按总主动活动度(total active movement,TAM)系统评定法行功能评定:优7例,良1例。结论应用异体肌腱经"T"形骨隧道移植重建掌板-侧副韧带复合体能有效恢复近指间关节稳定性且不影响关节活动,并发症少,疗效显著。

Objective To investigate the clinical efficacy of allogeneic tendon transplantation through T-shaped bone tunnel to reconstruct volar plate-collateral ligament complex for the treatment of old dislocation of the proximal interphalangeal joint.Methods From April 2015 to December 2022,our hospital treated a total of 8 patients with old dislocation of the proximal interphalangeal joint.They were treated with allogeneic tendon transplantation through a T-shaped bone tunnel to reconstruct volar plate-collateral ligament complex.The clinical efficacy was followed up after surgery.Results All 8 patients were follow-up for a period of 12 to 16 months,with an average of 12.7 months.There were no postoperative complications such as infection,allogeneic tendon rejection reaction,and skin necrosis around the incision.The follow-up X-ray showed a good correspondence of the proximal interphalangeal joint.The last follow-up showed no significant pain,joint stability,or severe finger dysfunction in the proximal interphalangeal joint.The visual analog score(VAS)was used to evaluate the degree of joint pain,and there was no significant pain in the interphalangeal joints,with an average score of(1.0±1.3)points.According to the total active movement(TAM)system evaluation method,there were 7 excellent cases and 1 good case.Conclusion The application of allogeneic tendon transplantation through T-shaped bone tunnel for reconstruction of volar plate-collateral ligament complex can effectively restore the stability of the proximal interphalangeal joint without affecting joint movement,with fewer complications and significant clinical efficacy.