防粘连高强度缝合技术治疗手伸指肌腱断裂的实验研究与临床应用  

Experimental study and clinical application of anti-adhesion treatment and high-strength suture technique on the treatment of extensor tendon rupture

作　　者：姜大伟[1,2] 贾全章[1] 侯明晓[1] 徐爽[1] 肖光[1] 陈阳[1] 李东军[2] 

机构地区：[1]解放军第208医院全军骨科中心,长春130062 [2]延边大学医学部

出　　处：《解放军医学杂志》2009年第6期704-706,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的通过动物实验与临床应用观察防粘连高强度缝合技术治疗手伸指肌腱断裂的效果。方法28只菜亨鸡随机均分为4组均横断趾长伸肌腱,A组行双十字缝合,B组行双十字缝合+玻璃酸钠喷涂,C组行交指样显微编织缝合,D组采用高强度防粘连缝合技术即交指样显微编织缝合+玻璃酸钠喷涂。术后6周处死动物,行形态组织学观察及生物力学测定并进行组间比较。按D组术式临床应用116例(男89例,女27例,年龄20～55岁,平均36岁;手伸指肌腱断裂73例,劳损松弛38例,火器伤肌腱缺损5例;发生在手背部56例,手伸指中央腱束部48例,手伸指侧腱束部12例;一期手术治疗者82例,二期手术治疗34例),随访2～5年,观察术后疗效。结果D组经防粘连高强度缝合技术修复的肌腱术后外形良好,腱细胞多排列规则。呈束状,最大载荷70.9±5.7N,与A组(48.4±5.7N)、B组(51.3±3.2N)、C组(68.3±2.8N)比较差异显著(P<0.001)。临床应用116例,术后保持腱扁平外形,无隆起,不影响运动。随访2～5年,102例术后功能良好,无粘连,外观基本正常,10例因粘连行二次手术松解,2例因患者不配合过早拆石膏致断裂,2例2年后复发松弛,经二次手术治愈。粘连二次手术松解率8.62%。结论防粘连高强度缝合技术用于治疗伸指肌腱损伤疗效确切,值得进一步推广。Objective To investigate the effects of anti-adhesion treatment and high-strength suture technique on the treatment of extensor tendon rupture by animal experiments and clinical application. Methods Twenty-eight leg-born chickens were randomly divided into four groups （7 each）. Double cross suture was applied in group A, while double cross suture combined with sodium hyaluronate spraying in group B, cross-finger-like micro-braided suture in group C, and cross-finger-like micro-braided suture combined with sodium hyaluronate spraying in group D. The animals were sacrificed 6 weeks after operation, morphological, histological and biomechanics were observed and compared among the groups. One hundred and sixteen patients were treated with the surgical method in group D （89 males, 27 females, aged 20-55 with an average of 36 years; 73 with extensor tendon rupture, 38 with strain/chalasis, 5 with firearm injuries; 56 on back of hand, 48 on central slip, 12 on lateral fixing chorda; 82 with one-stage operation, and 34 with second-stage operation）, and then followed-up for 2-5 years to observe the therapeutic effects. Results The repaired tendons in group D was in good contour, most tendon cells arranged regularly in bunches. The maximum load was significantly higher in group D （70. 9±5. 7N） than in group A （48. 4±5. 7N）, Group B （51. 3±3. 2N） and Group C （68. 3±2. 8N, P〈0. 001）. In the 116 patients, the tendons were fiat in shape and without eminence or hindering of motion. During the period of follow-up, 102 cases had fine function and normal appearance without adhesions, 2 cases complicated with adhesion were cured by second operation, 2 cases got tendon broken because of removing plaster bandage too earlier without authorization, 2 cases with chalasis 2 years after operation were cured by second operation. Second solution operation rate of adhesion was 8. 62%. Conclusion Anti adhesion treatment and high-strength suture techniques may give an exact therapeutic effect in the treatment of e

关 键 词：伸指肌腱损伤 缝合技术 透明质酸 

分 类 号：R686.1[医药卫生—骨科学]