微型錨釘治療陳舊性錘狀指畸形的療效分析

1、微型錨釘治療陳舊性錘狀指畸形的療效分析 08-07-01 10:01:00 作者：姜國范存義編輯：studa20【摘要】 目的介紹一種應(yīng)用微型錨釘治療陳舊性錘狀指畸形的方法，通過觀察臨床效果來探討該方法治療陳舊性錘狀指畸形的可行性。方法對14例陳舊性錘狀指患者臨床應(yīng)用微型錨釘治療。于遠側(cè)指間關(guān)節(jié)（DIP）背側(cè)做“”形切口，顯露伸指肌腱，將斷端間疤痕切除，用1枚1 mm克氏針將遠側(cè)指間關(guān)節(jié)（DIP）固定于伸直位，用肌腱縫合線水平褥式縫合伸指肌腱斷端，于末節(jié)指骨基底背側(cè)鉆孔后安裝微型錨釘，將錨釘尾部攜帶的肌腱縫線與伸指肌腱近斷端縫合以加強縫合強度。術(shù)后前臂掌側(cè)面石膏托固定腕關(guān)節(jié)背神30，掌指關(guān)節(jié)及

2、指間關(guān)節(jié)伸直位3周，6周后拔除克氏針開始功能鍛煉。結(jié)果隨訪6個月1年，按Dargan功能評定法：優(yōu)10例，良2例，可1例，差1例。其中1例遠側(cè)指間關(guān)節(jié)（DIP）屈曲功能障礙，無畸形復(fù)發(fā)。優(yōu)良率85.7。結(jié)論應(yīng)用微型錨釘治療陳舊性錘狀指畸形具有縫合強度高，畸形復(fù)發(fā)率低，操作簡便，效果可靠的優(yōu)點，是一種治療陳舊性錘狀指畸形簡便有效的方法。 【關(guān)鍵詞】 微型錨釘 錘狀指 畸形矯治Therapeutic effect of microanchor in chronic mallet finger deformity Abstract：ObjectiveTo introduce the method o

3、f treating chronic mallet finger using Micro Arc bone Anchor, and investigate the feasibility of this method with the clinical effects.MethodFourteen chronic mallet fingers were treated with Micro Arc bone Anchors. During the operation, a skin incision over the dorsum of the DIP joint was made to ex

4、pose the extensor tendon and resect the scar tissue between the disrupted ends. Then the DIP joint was made at extending position was immobilized with a 1mm Kirschner wire and the ends of extensor tendon was sutured with horizontal mattress suture method. After that,the Micro Arc bone Anchor was sut

5、ured into the dorsal base of the distal phalanx,the suture thread attached the end of anchor was tied to the proximal end of the extensor tendon to reinforce the former suture. External fixation on the anterior face of forearm was applied to immobilize the wrist at 30of extention and the metacarpoph

6、alangeal and interphalangeal joints and extending position for 3 w, and Kirschner wire fixation was taken out 6 w postoperatively. Functional exercises were performed after the Kirschner wires were removed.ResultAll the cases were followed up for 6 months to 1 year, and excellent results were obtain

7、ed in 10 cases, good in 2, fair in 2 and poor in 1 according to Dargans functional assessment system, with dysfunction of flexion in DIP joint in 1 case, and recurrence of abnormity in 1 case.The total rate of excellent and good results was 85.7.ConclusionMicro Arc bone Anchor is a convenient and ef

8、fective alternative for the treatment of chronic mallet finger deformity with many advantages such as the high suturing intensity,low recurrence rate of abnormity, convenient for operation and reliable effect. Key words：micro arc bone anchor; mallet finger； abnormity orthopedics手指區(qū)伸指肌腱斷裂或撕脫引起的遠側(cè)指間關(guān)節(jié)

9、屈曲畸形稱為錘狀指畸形1，在臨床上較為常見。伸肌腱斷裂后，由于屈肌腱力量強大，隨著傷后時間的延長，屈指畸形逐漸加重。遠側(cè)指間關(guān)節(jié)背側(cè)由于長期處于屈曲狀，撞擊時容易引起疼痛，不但影響患者手的功能，也對外觀有一定的影響，晚期治療效果不佳。從2005年8月2006年6月作者采用強生Mitek的Micro Arc Bone Anchor（微型錨釘）治療陳舊性錘狀指14例，效果滿意?，F(xiàn)報道如下。1 資料與方法1.1 一般資料 本組資料14例，其中男8例，女6例；年齡2046歲，平均32歲。右手12例，左手2例；食指5例，中指6例，環(huán)指2例，小指1例；致傷原因：戳傷10例，砸傷3例，扭傷1例；全部為閉合性

10、損傷，不合并末節(jié)指骨基底部背側(cè)撕脫骨折。就診時間：傷后3周2年就診，就診前保守治療10例，未治療4例，10例保守治療均失敗。傷后手指遠側(cè)指間關(guān)節(jié)（DIP）屈曲3060畸形，平均屈曲37。遠側(cè)指間關(guān)節(jié)（DIP）被動活動良好，近側(cè)指間關(guān)節(jié)（PIP）伴有不同程度的背伸。1.2 手術(shù)方法 采用臂叢麻醉或指根部浸潤阻滯麻醉。上肢常規(guī)消毒鋪單，上臂扎止血帶或指根部扎橡皮條止血。做遠側(cè)指間關(guān)節(jié)（DIP）背側(cè)“”形切口。切開皮膚，皮下組織，于伸指肌腱淺面向兩側(cè)游離皮瓣，可見伸指肌腱連續(xù)性存在，但肌腱于遠側(cè)指間關(guān)節(jié)（DIP）附近斷裂，斷端間由薄的瘢痕相接，肌腱松弛不能帶動遠側(cè)指間關(guān)節(jié)（DIP）主動背伸。將遠側(cè)指

11、間關(guān)節(jié)（DIP）伸直處于中立位，用1枚1 mm的克氏針貫穿遠側(cè)指間關(guān)節(jié)（DIP）。將斷端間瘢痕組織切除，充分游離近段伸指肌腱，使其有足夠的滑動性，注意不要損傷遠側(cè)指間關(guān)節(jié)背側(cè)關(guān)節(jié)囊。于遠節(jié)指骨基底背側(cè)鉆孔，將強生Mitek的Micro Arc Bone Anchor（微型錨釘）插入骨洞，注意不要損傷甲床根部，將錨釘尾部攜帶的肌腱線縫合到伸指肌腱近斷端上，再將肌腱近遠斷端水平褥氏縫合。直接縫合皮膚，紗布包扎。1.3 術(shù)后處理 前臂掌側(cè)面石膏托固定腕關(guān)節(jié)背伸30，掌指關(guān)節(jié)及指間關(guān)節(jié)伸直位3周。3周后去除石膏托，6周時拔出克氏針。開始主動屈伸遠側(cè)指間關(guān)節(jié)（DIP）功能鍛煉。2 結(jié)果 療效評價標(biāo)準(zhǔn)采用Dargan功能評定法2：測量手指最大伸指位時掌指關(guān)節(jié)（MP）、近側(cè)指間關(guān)節(jié)（PIP）、遠側(cè)指間關(guān)節(jié)（DIP）伸直欠伸角度的總和以及手指屈曲時指尖與掌橫紋之間的距離。優(yōu)：伸指0，屈指指尖過掌橫紋；良：伸指欠伸15，屈指指尖達掌橫紋；可：伸指欠伸1645，屈指指尖離掌橫紋在2 cm以內(nèi)；差：伸指欠伸45，屈指指尖離掌橫紋在2 cm以上。本組14例隨訪6個月到2年，其中優(yōu)10例，良2例，可1例，差1例。所有患者術(shù)后未出現(xiàn)畸形復(fù)發(fā)，1例術(shù)后出現(xiàn)遠側(cè)指間關(guān)節(jié)背側(cè)約1.51.0 cm2大小的皮膚壞死，經(jīng)換藥治療5周愈合。 典型病例：患者男，39歲，右小指遠側(cè)指間關(guān)節(jié)外傷后錘狀指畸