超声引导下经皮松解术治疗老年桡骨远端骨折非手术治疗后腕部指屈肌腱粘连  

Ultrasound-guided percutaneous release for treatment of wrist digital flexor tendon adhesions following nonsurgical treatment of distal radius fractures in the aged

作　　者：金少枫 苏坤阳 陈毕能 林友聪 吕辉照 JIN Shaofeng;SU Kunyang;CHEN Bineng;LIN Youcong;LYU Huizhao(The 910th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army,Quanzhou 362000,Fujian,China)

机构地区：[1]中国人民解放军联勤保障部队第九一〇医院,福建泉州362000

出　　处：《中医正骨》2022年第8期12-19,24,共9页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨超声引导下经皮松解术治疗老年桡骨远端骨折非手术治疗后腕部指屈肌腱粘连的临床疗效和安全性。方法:将58例老年桡骨远端骨折非手术治疗后腕部指浅、深屈肌腱粘连患者随机分为2组,其中经皮松解组(33例)采用超声引导下经皮肌腱粘连松解术治疗,切开松解组(25例)采用切开肌腱粘连松解术治疗。分别于术前和术后1周,采用视觉模拟量表(visual analogue scale,VAS)评分评价手指疼痛程度;分别于术前和术后3个月,采用手指关节总主动活动度(total active movement,TAM)评价手指活动能力,采用手部功能独立性量表(functional independence measure,FIM)评价手指日常生活活动能力,采用明尼苏达手灵巧度测验(Minnesota manual dexterity test,MMDT)评价手指灵巧度,通过超声测量肌腱移动度和粘连带厚度以评价肌腱粘连程度;并观察并发症发生情况。结果:①手指疼痛VAS评分。术前,2组患者的手指疼痛VAS评分比较,差异无统计学意义[(1.9±1.0)分,(2.0±0.9)分,t=-0.323,P=0.748];术后1周,经皮松解组的VAS评分低于切开松解组[(1.6±0.9)分,(3.4±1.4)分,t=-6.191,P=0.001],经皮松解组的VAS评分与术前的差异无统计学意义(t=0.964,P=0.339),切开松解组的VAS评分高于术前(t=-5.309,P=0.001)。②手指关节TAM。术前和术后3个月,2组患者的手指关节TAM比较,组间差异均无统计学意义[136.2°±19.4°,140.1°±17.9°,t=-0.909,P=0.366;211.8°±18.6°,203.8°±14.3°,t=1.378,P=0.062];术后3个月,2组患者的手指关节TAM均高于术前(t=-4.597,P=0.001;t=-6.211,P=0.001)。③手部FIM评分。术前和术后3个月,2组患者的手部FIM评分比较,组间差异均无统计学意义[(17.4±3.4)分,(16.7±3.3)分,t=0.213,P=0.832;(36.7±4.2)分,(35.8±4.8)分,t=0.291,P=0.772];术后3个月,2组患者的手部FIM评分均高于术前(t=-3.000,P=0.004;t=-5.214,P=0.001)。④MMDT结果。术前和术后3个月,2组患者的放置测验所需时间比较,组间�Objective:To explore the clinical outcomes and safety of ultrasound-guided percutaneous release for treatment of wrist digital flexor tendon(DFT)adhesions in aged patients who underwent non-surgical treatment for distal radius fractures.Methods:Fifty-eight aged patients suffered from superficial and deep DFT adhesions in wrist after non-surgical treatment of distal radius fractures were randomly divided into percutaneous adhesiolysis group(33 cases)and open adhesiolysis group(25 cases).The patients in percutaneous adhesiolysis group were treated with ultrasound-guided percutaneous tendon adhesiolysis,while the ones in open adhesiolysis group with open tendon adhesiolysis.The finger pain degree was evaluated by using visual analogue scale(VAS)score before the surgery and at postsurgical week 1 respectively.The activity ability,activity of daily living(ADL)and dexterity of finger were evaluated by using finger total active movement(TAM),hand functional independence measure(FIM)and Minnesota manual dexterity test(MMDT)respectively,and the tendon adhesion degree was evaluated by measuring tendon range of motion(ROM)and adhesion band thickness using ultrasound before the surgery and at postsurgical month 3 respectively.Moreover,the complications were observed.Results:①There was no statistical difference in finger pain VAS score between the 2 groups before the surgery(1.9±1.0 vs 2.0±0.9 points,t=-0.323,P=0.748).The finger pain VAS scores were lower in percutaneous adhesiolysis group compared to open adhesiolysis group at postsurgical week 1(1.6±0.9 vs 3.4±1.4 points,t=-6.191,P=0.001),and it was not significantly different from each other between pre-surgery and postsurgical week 1 in percutaneous adhesiolysis group(t=0.964,P=0.339),while it increased in open adhesiolysis group at postsurgical week 1 compared to pre-surgery(t=-5.309,P=0.001).②There was no statistical difference in finger TAM between the 2 groups before the surgery and at postsurgical month 3(136.2±19.4 vs 140.1±17.9 degrees,t=-0.909,P=0.366;21

关 键 词：桡骨骨折 老年人 指浅屈肌腱 指深屈肌腱 肌腱粘连 肌腱粘连松解 超声引导 临床试验 

分 类 号：R687.3[医药卫生—骨科学]