输液器管结合克氏针引导手指屈肌腱断裂近端回缩的临床应用  

Clinical application of infusion tube combined with Kirschner wire to guide proximal retraction of finger flexor tendon rupture

作　　者：吴信举 谢久虎 郝宝辉 朱自强 WU Xinju;XIE Jiuhu;HAO Baohui(Department of Hand Surgery,The Second Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu,221006,China)

机构地区：[1]徐州医科大学第二附属医院手外科,江苏徐州221006

出　　处：《实用手外科杂志》2022年第1期40-42,55,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨手指屈肌腱断裂致近端回缩时应用无菌输液器管结合克氏针引导方法的应用效果。方法2019年1月-2020年12月对43例50指屈肌腱断裂,且肌腱近端回缩较远距离的患者,根据回缩距离大致判断,在肌腱断裂区域以近的一个或多个区域处作横行小切口,找到近端肌腱断端并予以抽出,通过克氏针套入无菌输液器管引导方法,由原伤口逆行通过腱鞘,从近端横行小切口穿出,将肌腱断端缝合在无菌输液器尾端,轻轻牵引输液器管,将屈肌腱近端引入鞘管内,断端作改良Kessler缝合修复。结果43例中有1例伤口发生感染,再次彻底清创后伤口愈合,其余患者伤口均一期愈合,术后随访6~12个月,包括门诊复查、电话随访,根据国际手外科联合会肌腱损伤委员会制定的TAM系统评价标准,即伤指MP、PIP、DIP关节活动度总和与健侧比较,结果显示:优35指,良10指,可5指,优良率达90%。结论运用无菌输液器管套入克氏针后引导肌腱的方法来处理手指屈肌腱断裂近端明显回缩的患者,不仅方法简单省时,易于操作,且不易造成假道,不会对鞘管造成严重损伤;切口小,恢复快,适于临床广泛开展应用。Objective To investigate the application of sterile infusion tube combined with Kirschner wire guidance method in proximal retraction caused by finger flexor tendon rupture.Methods Forty-three cases of 50 digital flexor tendons'rupture,and tendon proximal retraction was distant,according to a retraction distance judgment,roughly in the tendon rupture area,one or more small transverse incision were made,found the proximal tendon end and pulled out,through the guidance of a kirschner wire embedded by the sterile infusion tube.From the original wound,retrograded through the sheath,a small transverse incision was made through the proximal end,and the broken end of the tendon was sutured to the end of the sterile infusion tube.The infusion tube was gently pulled out,and the proximal end of the flexor tendon was introduced into the sheath canal.The broken end was repaired by modified Kessler suture.Results In 43 cases,1 case of wound had infection,wound healed after thorough debridement,the rest of the patients obtained primary healing,postoperative follow-up of 6 to 12 months,including outpatient care,telephone follow-up,according to the international federation of TAM tendon injuries the committee evaluation standard system,namely the injured finger MP,PIP,DIP motion sum compared with the healthy side,the results showed that 35 fingers were excellent,10 fingers were fair,and 5 fingers were fair.The excellent and good rate reached 90%.Conclusion The method of guiding the tendon after inserting the Kirschner wire into the aseptic infusion tube to treat the patients with obvious retraction of proximal flexor tendon fracture is simple and time-saving,easy to operate,and not easy to cause false passage,and will not cause serious damage to the sheath canal.With small incision and quick recovery,it is suitable for wide application.

关 键 词：屈肌腱断裂 输液器 克氏针 

分 类 号：R687.2[医药卫生—骨科学]