经双骨隧道“8”字捆绑骨块治疗陈旧性骨性锤状指

The treatment of bundling bone fragment with figure-of-eight suture through double bone tunnels in the chronic bony mallet finger

目的探讨经双骨隧道"8"字捆绑骨块治疗陈旧性骨性锤状指的临床效果。方法回顾性分析2021年5月至2023年2月南京江北医院手足显微外科收治的陈旧性骨性锤状指患者临床资料。术中采用0.8 mm克氏针于末节指骨基底部缺损远端及近端各制作1条横向骨隧道,先采用肌腱缝线沿远、近端骨隧道"8"字捆绑骨块于末节指骨基底部缺损处,再用克氏针弹性加压固定。术后3周拔除克氏针后逐步加强患指伸屈运动。末次随访时测量患指与对应健指各关节的主动屈伸活动范围,记录手指(患指与健指)远指间关节(DIPJ)活动度及总主动活动度(TAM);参照美国手外科协会TAM系统评定手指功能,分为优、良、可、差4个等级。采用SPSS 13.0软件对数据进行统计分析,符合正态分布的计量资料以±s表示,术后6个月患指DIPJ活动度、TAM与对侧健指比较采用配对样本t检验,P<0.05表示差异有统计学意义。结果共纳入30例患者(30指),男19例,女11例;年龄18~62岁,平均31岁;受伤至手术时间24~65 d,平均35 d。根据Wehbe和Schneider分型:Ⅰa型8指,Ⅰb型6指,Ⅱa型7指,Ⅱb型5指,Ⅲa型2指,Ⅲb型2指。术后切口出血极少,无感染,均一期愈合。30例患指术后均获随访,时间为6~7个月,骨折处均对位可、愈合佳,锤状指畸形均完全矫正,无针道感染及断针现象。术后末次随访时测量显示,患指DIPJ活动度与对侧健指比较,差异无统计学意义[(30.2±3.5)°vs.(30.4±3.3)°,t=2.57,P=0.463];患指TAM与对侧健指比较,差异亦无统计学意义[(235.3±3.6)°vs.(237.7±4.2)°,t=1.78,P=0.247]。患指功能评价:优27指,良3指,优良率为100%。结论经双骨隧道"8"字捆绑骨块,可多维度立体独立地固定骨块,稳定牢固,治疗陈旧性骨性锤状指效果好,且利于早期功能锻炼。

Objective To discuss the clinical curative effect of the treatment of bundling bone fragment with figure-of-eight suture through double bone tunnels in the chronic bony mallet finger.Methods A retrospective analysis was performed on patients with chronic bony mallet fingers who underwent surgery in the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital from May 2021 to February 2023.During the procedure,made into transverse double bone tunnels on the base of the distal phalanx with 0.8 mm Kirschner wire,bundling bone fragment with figure-of-eight suture through double bone tunnels,then fixed with Kirschner wire elastic compression.Removal of the Kirschner wire 3 weeks after the procedure,the active flexion and extension range of the joints of the affected finger and the corresponding finger were measured at the last follow-up,then the range of motion(ROM)of the distal interphalangeal joint(DIPJ)and total action movement(TAM)of the fingers(affected and healthy finger)were recorded.The curative effects were evaluated according to the TAM system of the American Association of Hand Surgeons,including 4 grades:excellent,good,fair,and poor.SPSS 13.0 software was used for statistical analysis of the data,and the measurement data conforming to normal distribution were expressed as Mean±SD.The ROM of DIPJ and TAM of the affected finger were compared with the corresponding healthy finger 6 months after surgery by a paired sample t-test.P<0.05 indicated that the difference was statistically significant.Results A total of 30 patients(30 digits)were enrolled,including 19 males and 11 females,and the age ranged from 18 to 62 years old,with an average age of 31 years old.The time from injury to operation was 24 to 65 days(mean of 35 days).According to Wehbe and Schneider classification,there were 8 cases of typeⅠa,6 cases of typeⅠb,7 cases of typeⅡa,5 cases of typeⅡb,2 cases of typeⅢa and 2 cases of typeⅢb.All incisions healed well,the intraoperative blood loss was minimal,with no infection.All 30 cases were followed up for 6 to 7 months.All fractures were well aligned and healed,malformed fingers were completely corrected,and no needle tunnel infection or needle breakage were observed.At the last follow-up,the differences of the ROM of the DIPJ[(30.2±3.5)°vs.(30.4±3.3)°,t=2.57,P=0.463]and the TAM[(235.3±3.6)°vs.(237.7±4.2)°,t=1.78,P=0.247]between the affected and healthy fingers were not statistically significant.Finger function assessment:27 cases were excellent,and 3 cases were good,and the excellent and good rate was 100%.Conclusion Satisfactory therapeutic outcome for the treatment of chronic bony mallet finger deformity can be achieved by bundling bone fragment with figure-of-eight suture through double bone tunnels.It is an effective and practical method.