肌腱损伤与修复的几个问题  

Several problem of tendon injury and rehabilitation of hand surgery

作　　者：张友乐[1] 王澍寰[1] 孙燕琨[1] 韩娟先[1] 

机构地区：[1]北京积水潭医院手外科,北京110035

出　　处：《实用手外科杂志》2010年第2期91-97,共7页Journal of Practical Hand Surgery

摘　　要：目的较全面地了解目前肌腱修复水平与现状，就肌腱修复中常遇到的几个问题进行分析、探讨，为今后肌腱修复的相关研究与临床应用提供必要的参考。方法广泛查阅近几年的国内外相关文献并结合我院500余例肌腱修复病例，就肌腱修复中发生的问题、肌腱缝合后早期功能练习、肌腱粘连与松解、肌腱缝合材料与方法、肌腱移植以及异体肌腱应用现状进行分析。结果肌腱愈合中肌腱存在内愈合与外愈合两种方式，加强肌腱的内愈合，减少外愈合，干预其愈合过程，可以减少肌腱粘连。通过选择合适的肌腱缝合材料与缝合方法，早期牵引支具的合理应用，可以降低肌腱的粘连的发生几率。肌腱粘连松解术应严格掌握适应证，以减少肌腱再粘连及断裂的发生。异体肌腱应用技术较为成熟，特别是多条肌腱移植以及分类肌腱移植滑膜与非滑膜肌腱、复合肌腱移植方面有优越性。结论通过新技术与方法的应用，加强对肌腱基础研究与临床实践，预防与避免不必要的技术失误，提高肌腱修复质量与水平。Objective To overview the current technique evolution of tendon repair and rehabilitation, and offer references for tendon surgery chnical and laboratory research. Methods Overview recent articles of tendon surgery and analysis more than 500 cases tendon repair performed by Beijing Jishuitan Hospital Hand Surgery Department. Analysis the state of clinical and laboratory evolution of tendolysis, tendon suture material and methods, tendon transplant and tendon allograft. Results There are two kinds of tendon healing model, intrinsic and extrinsic tendon healing. The intrinsic healing should be induced and enhanced to prevent tendon adhesions. Therapists try to modify suture technique and develop splint assistant early mobilization protocols to prevent adhesions formation. Tendolysis should be controlled seriously to prevent tendon rupture or re-adhesion. Tendon allograft is a mature method, and its advantage focus on the multiple and complexion tendon deficiency. Conclusion It can promote the chnical results of tendon rehabilitation by using new technique and approaches, enhancing the basic research and clinical application and prevention of mistake.

关 键 词：肌腱修复 粘连 松解术 移植 张力 

分 类 号：R658.1[医药卫生—外科学]