肌腱止点经骨减张缝合联合克氏针固定治疗指深屈肌腱止点Al-Qattan Ⅴb型损伤

Treatment of Al-Qattan Ⅴb type avulsion injury of flexor digitorum profundus tendon insertion with bone tension-reducing suture and Kirschner wire fixation

目的探讨肌腱止点经骨减张缝合联合克氏针固定治疗Al-Qattan Ⅴb型指深屈肌腱撕脱性损伤的临床疗效.方法自2015年5月至2022年12月,我们对8例Al-Qattan Ⅴb型指深屈肌腱撕脱性损伤患者采用肌腱止点经骨减张缝合联合克氏针固定治疗,术后随访临床疗效.结果术后8例患者均获得随访,时间为12~14个月,平均12.8个月.术后无减张缝线断裂失效、克氏针断裂松动、针道感染、切口皮缘及甲床压迫坏死、甲板畸形、手指严重功能障碍等并发症.术后根据X线片提示骨折全部愈合,关节间隙正常.骨折愈合时间为8~10周,平均8.6周.末次随访患指远指间关节无明显疼痛,疼痛视觉模拟评分(visual analogue score,VAS)为(1.0±1.3)分.采用总主动活动度(total active movement,TAM)系统评定法进行功能评定:优7例,良1例.结论应用肌腱止点经骨减张缝合联合克氏针固定治疗Al-Qattan Ⅴb型指深屈肌腱撕脱性损伤固定有效、牢靠,并发症少,疗效显著.

Objective To explore the clinical efficacy of bone tension-reducing suture of tendon insertion and Kirschner wire fixation in the treatment of Al-Qattan Ⅴb type avulsion injury of flexor digitorum profundus tendon insertion.Methods From May 2015 to December 2022,8 patients with a Al-Qattan Ⅴb type avulsion injury of flexor digitorum profundus tendon insertion were treated by bone tension-reducing suture of tendon insertion and Kirschner wire fixation.The clinical efficacy was followed up after surgery.Results All 8 patients were follow-up for 12 to 14 months with an average of 12.8 months.There were no postoperative complications such as reduced tension suture breakage and failure,Kirschner wire breakage and loosening,needle infection,incision skin margin and nail bed compression necrosis,deck deformity,and severe finger dysfunction.After surgery,according to the X-ray findings,all fractures healed and the joint space was normal.The fracture healing time was 8 to 10 weeks,with an average of 8.6 weeks.At the last follow-up,there was no significant pain in the distal interphalangeal joint of the affected finger,and the visual analog score(VAS)for pain was(1.0±1.3)points.The total active movement(TAM)system evaluation method was used for functional assessment.The result was excellent in 7 cases and good in 1 case.Conclusion The application of bone tension-reducing suture of tendon insertion and Kirschner wire fixation in the treatment of Al-Qattan Ⅴb type avulsion injury of flexor digitorum profundus tendon insertion is effective,reliable,with fewer complications and significant therapeutic effect.