双骨道皮下打结法治疗近指间关节掌板及侧副韧带损伤  

Application of subcutaneous knotting with double bone canals for treatment of volar plate and collateral ligament injury of proximal interphalangeal joint

作　　者：杨焕友[1] 王斌[1] 王乐[1] 张荐[1] Yang Huanyou;Wang Bin;Wang Le;Zhang Jian(Department of Hand Surgery,the Second Hospital of Tangshan,Tangshan 063000,China)

机构地区：[1]唐山市第二医院手外科,唐山063000

出　　处：《中华手外科杂志》2022年第1期10-13,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨双骨道皮下打结法治疗近指间关节掌板及侧副韧带损伤的手术方法及疗效。方法自2015年7月至2019年3月,我们对7例近指间关节掌板及侧副韧带损伤患者,采用指侧方入路,分别在掌板起点及侧副韧带止点或起点各打2处骨道,掌板及侧副韧带断端分别用3-0Prolene线“U”形缝合,于近指间关节伸直位行1枚直径1.0 mm克氏针固定,将缝线尾线分别通过骨道,在中节指骨背侧及对侧骨面抽出并在皮下打结,术后4周拔除克氏针,不负重活动手指关节。结果术后7例患者均获得随访,时间为7~36个月,平均25个月。术前、术后患者疼痛视觉评分(visual analogue scale,VSA)分别为7.10±1.06及0.71±0.75,两者比较差异有统计学意义(t=17.42,P<0.001)。患指近指间关节术前、术后活动度分别为(43.71±8.38)°及(96.43±2.07)°,两者比较差异有统计学意义(t=-16.64,P<0.001)。患指功能按Satta等评定标准评定:优5例,良2例。结论本术式手术操作简单,固定稳定,无需特殊器械,并发症少,是治疗近指间关节掌板及侧副韧带损伤较好的方法。Objective To explore the operation method and clinical efficacy of subcutaneous knotting with double bone canals for treatment of volar plate and collateral ligament injury of proximal interphalangeal joint.Methods From July 2015 to March 2019,7 patients with volar plate and collateral ligament injury of proximal interphalangeal joint were treated.Through the lateral approach of the finger,two bone canals were made at the starting point of the volar plate and the ending or starting point of the lateral collateral ligament respectively.The broken ends of the volar plate and the lateral collateral ligament were sutured in“U”shape with 3-0 Prolene thread respectively.One Kirschner wire with a diameter of 1.0 mm was fixed at the extension position of the proximal interphalangeal joint.The tail thread of the suture was pulled out on the dorsal and contralateral bone surfaces of the middle phalange through the bone canals and knotted subcutaneously.The Kirschner wire was removed 4 weeks after operation,and the finger joint was moved without weight-bearing.Results All the 7 patients were follow-up for 7 to 36 months,with an average of 25 months.The visual analogue scale(VSA)of the patients before and after operation were 7.10±1.06 and 0.71±0.75 respectively.There was significant difference between them(t=17.42,P<0.001).The preoperative and postoperative range of motion of the proximal interphalangeal joint of the affected finger were(43.71±8.38)0 and(96.43±2.07)0 respectively.There was significant difference between them(t=-16.64,P<0.001).According to Saetta’s evaluation criteria,the function of the affected finger was excellent in 5 cases and good in 2 cases.Conclusion This operation has the advantages of simple operation,stable fixation,no special instruments and less complications.It is a good method for the treatment of volar plate and lateral collateral ligament injury of proximal interphalangeal joint.

关 键 词：指损伤 治疗结果 掌板 侧副韧带 骨道 

分 类 号：R687.4[医药卫生—骨科学]