锤状指手术治疗方法的探讨  

Surgical treatment of mallet finger

作　　者：刘欢 李崇杰[1] 梁晓旭[1] 沙德峰[1] 于灏[1] LIU Huan;LI Chongjie;LIANG Xiaoxu(Department of Hand Surgery,Affiliated Central Hospital to Shenyang Medical College,Shenyang,Liaoning,110024,China)

机构地区：[1]沈阳医学院附属中心医院手外一科,辽宁沈阳110024

出　　处：《实用手外科杂志》2018年第3期300-301,共2页Journal of Practical Hand Surgery

摘　　要：目的探讨手外伤后锤状指患者的手术治疗方法及适应证。方法 2017年1月-8月手术治疗外伤所致锤状指25例,其中12例指伸肌腱止点处以远断端残留>3 mm,采用4/0尼龙线"8"字缝合;7例指伸肌腱止点处完全断裂合并较小的撕脱骨折块,采用骨锚固定骨折端重建指伸肌腱;6例指伸肌腱止点处完全撕脱断裂合并较大骨折块,采用0.8 mm克氏针固定骨折块重建指伸肌腱。术后均采用支具固定于近指间关节屈曲30°~45°位、远指间关节过伸位6周。结果术后25例均获得随访,随访时间3~10个月,根据TAM评定法及患者恢复情况,采用肌腱直接缝合12例,除1例肌腱再断裂外,11例恢复良好,其中7例远侧指间关节活动度0°~70°,4例0°~60°;骨锚固定患者7例全部恢复良好,且远指间关节活动度0°~70°;克氏针固定6例全部愈合良好,远指间关节活动度0°~70°5例,30°~45°1例。结论根据锤状指的不同损伤类型,可采用不同的手术方法均取得了较好的疗效。Objective To discuss the surgical procedures for 25 traumatic finger. Methods From January 2017 to July 2017, the traumatic mallet finger in 25 cases were treated. The distal tendon stump was more than 3ram with regular shape in 12 cases, that were treated with ＂8＂ suture by 4/0 nylon. 7 cases were completely ruptured at the stop of extend tendon and combined with small piece avulsion fracture, and the fracture was fixed by bone anchor for reconstruction of extend tendon. 6 cases were completely ruptured at the stop of extend tendon and combined with big piece avulsion fracture, and fixed by 0.8 mm Kirschner wire. Postoperatively the proximal interphalangeal joint was fixed in 30°-45°, and distal interphalangeal joint in flexion by a splint for 6 weeks. Results All the 25 patients were followed up for 3-6 months, according to TAM evaluation criteria, the results of 11 cases obtained good recovery except rupturing again in 1 case. And the range of motion of the DIP joint was 0°-70°in 7 cases, the range of motion of the DIP joint was 0°-60°in 4 cases. The 7 cases with bone anchor recovered well and the range of motion of the DIP joint was 0° -70°. The 6 cases with Kirschner wire recovered well and the range of motion of the DIP joint was 0° -70° in 5cases, and was 0° -55° in 1cases. Conclusion It is the key to obtain good outcomes that choosing different operation according to the different types of injury in mallet finger.

关 键 词：锤状指 肌腱断裂 指骨撕脱骨折 

分 类 号：R658.2[医药卫生—外科学]