骨隧道联合钢丝重建指伸肌腱中央腱止点缺损  

Bone tunnel combined with wire reconstruction of a central tendon stop defect of the extensor digitorum longus tendon

作　　者：黄祖望 钟少开 李培 王海文 凌利 余纯斌 曾德庆 梅雄军 王海博 刘卓红 HUANG Zuwang;ZHONG Shaokai;LI Pei(Department of Hand Surgery,Medical University Chashan Hospital Dongguan Chashan Hospital,Dongguan,Guangdong,523380,China)

机构地区：[1]广东医科大学茶山医院东莞市茶山医院手外科,广东东莞523380

出　　处：《实用手外科杂志》2022年第3期371-374,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨骨隧道联合钢丝U法治疗中央腱止点断裂并缺损的手术方法及疗效。方法2015年1月-2020年6月,对10例指伸肌腱中央腱束止点断裂并缺损患者,在其中节指骨基底背侧骨面做一垂直凹槽,骨槽长宽高约为3.0 mm×2.0 mm×3.0 mm,克氏针横向经凹槽向指骨两侧侧方做一骨隧道,近指间关节采用一枚1.0 mm克氏针斜行限制性固定,用0.4 mm钢丝U法缝合中央腱近断端,将钢丝两端经骨隧道向指骨两侧方穿出引至中节指骨背面,收紧钢丝后,将中央腱近断端重新行腱-骨贴附在中节指骨基底部骨槽内,4周后拔出克氏针内固定。患指保护性主动屈伸指训练,术后6周拆除钢丝内固定后行主被动功能训练。结果10例术后均获得随访,时间为6~12个月,平均8个月。无关节疼痛、关节僵硬,根据中华医学会手外科学会上肢部分功能评定试用标准TAM评定,近指间关节伸屈评分5分,优7例,良2例,可1例,优良率90%。结论采用骨隧道联合钢丝治疗伸肌腱中央腱止点断裂并缺损重建,能最大限度恢复解剖结构,保留近指间关节功能。手术操作简单,术后效果好,是修复指伸肌腱中央腱断裂并缺损简单、有效的方法之一。Objective To investigate the surgical method and efficacy of the bone tunnel combined with the wire U method for the treatment of central tendon stop rupture and defect.Methods From January 2015 to June 2020,we treated 10 patients with rupture and defect of the central tendon stop of the extensor digitorum longus tendon within 5 mm,using a vertical groove on the dorsal surface of the base of the middle phalanx,the length and width of the groove were about 3.0 mm×2.0 mm×3.0 mm,and a bone tunnel was made laterally on both sides of the phalanx through the groove with a 1.0 mm Kirschner pin.After tightening the wire,the proximal end of the central tendon was reattached to the bone groove at the base of the middle phalanx,and the wire was removed after 4 weeks.The wire internal fixation was removed after 4 weeks,and the affected finger was protected with active flexion and extension exercises.Results All 10 cases were followed up from 6 to 12 months after surgery,with an average of 8 months,with no joint pain and joint stiffness.Conclusion The use of bone tunnel combined with wire to treat the central tendon stop of extensor tendon rupture and defect reconstruction can maximize the restoration of the anatomical structure and preserve the function of the proximal interphalangeal joint,the operation is simple,the postoperative effect is good,it is one of the simple and effective methods to repair the central tendon rupture and defect of extensor tendon.

关 键 词：肌腱损伤 手指 外科手术 

分 类 号：R687.2[医药卫生—骨科学]