超声评估手腕部肌腱断裂修复术后患指功能的价值  

Value of ultrasound in evaluating the finger function after tendon repair in hand and twist

作　　者：蒲大容[1] 王冬[1] 张勇[1] PU Darong;WANG Dong;ZHANG Yong(Department of Ultrasound,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院超声科,重庆市400016

出　　处：《临床超声医学杂志》2022年第2期123-126,共4页Journal of Clinical Ultrasound in Medicine

基　　金：重庆市卫生适宜技术推广项目(2021jstg011)。

摘　　要：目的探讨高频超声在手腕部肌腱断裂修复术后患指功能评估中的价值。方法选取我院因手腕部肌腱断裂修复术后仍有不同程度患指活动障碍患者52例(包括手指屈肌腱障碍45根,伸肌腱障碍38根),应用高频超声对损伤部位进行检查,根据肌腱超声表现将肌腱修复术后两断端连接分为腱性连接、瘢痕连接和再离断;分析其活动受限的原因,根据超声评估结果并结合患者意愿采取相应康复治疗或手术,于治疗后行手指总主动活动度(TAM)系统评估患指功能疗效。结果腱性连接9根,其中8根TAM评估良,1根TAM评估可;瘢痕连接65根,其中TAM评估良2根,可28根,差35根;再离断9根,TAM评估均为差。8根单纯腱性连接肌腱由于患指功能得到大部分恢复未采取进一步治疗措施;1根腱性连接肌腱因合并骨折采取包括磁疗在内的综合康复治疗,治疗3个月后患指疼痛明显减轻,TAM评估良。63根瘢痕连接并粘连肌腱首先采取康复治疗,治疗后3根单纯与软组织粘连和11根合并指骨粘连肌腱主动活动无明显改善但被动运动接近正常,进一步行粘连松解术;治疗后复查TAM,评估优1根,良27根,可25根,差10根。2根瘢痕连接但TAM评估良的肌腱未行进一步治疗。9根再离断肌腱行二次手术修复后,在超声指导下采取综合康复治疗,复查TAM评估优1根,良5根,可1根,差2根。结论高频超声能明确手腕部肌腱断裂修复术后患指功能障碍的原因,指导进一步康复或手术治疗。Objective tendon repair in hand and twist.MethodsA total of 52 patients(including 45 fingers with flexor tendon disorders and 38 fingers with extensor tendon disorders)with different degrees of finger movement disorders after tendon repair in our hospital were selected,and the injured places were scanned by high-frequency ultrasound. According to the ultrasonic manifestations of tendon,the connection types after tendon repair were divided into tendon connection,scar connection,and re-rupture. The causes of the activity limitation were analyzed,and corresponding rehabilitation treatment or surgery was carried out according to the results of ultrasound evaluation and the patient’s wishes.Total active movement(TAM)system was used to evaluate the functional efficacy of the affected finger.Results TAM assessment.There were 65 scar connections,among which 2 were good,28 were fair and 35 were poor by TAM assessment.9 tendons were re-rupture,and all were poor by TAM assessment. 8 tendons with simple tendon connection were mostly recovered without further treatment. 1 tendon with tendon connection combined with fracture received comprehensive rehabilitation therapy including magnetic therapy.After 3 months of treatment, the pain of the affected finger was significantly relieved,and TAM assessment was good.63 tendons with scar connection and adhesion were accepted rehabilitation treatment firstly.The patients with no significant improvement in active activity after treatment but close to normal passive movement were treated with adhesiolysis,including 3 tendons with adhesion with soft tissue alone and 11 tendons with adhesion with finger bone.After treatment,1 was excellent,27 were good,25 were fair and 10 were poor by TAM assessment.No further treatment was taken in 2 tendons with scar connection and TAM assessment of good.The 9 re-ruptured tendons underwent secondary surgery,and comprehensive rehabilitation therapy were adopted under the ultrasound guidance. TAM assessment showed 1 was excellent,5 were good,1 was fair,

关 键 词：超声检查 高频 肌腱修复 功能障碍 

分 类 号：R445.1[医药卫生—影像医学与核医学] R687.2[医药卫生—诊断学]