8针微创法联合克氏针弹性固定治疗锤状指畸形  

Combination therapy of the minimally invasive percutaneous quantitative suture technique eight times and Kirschner wire elastic fixation in the treatment of mallet finger

作　　者：江起庭 姚翔 邱福平 何兵 张磊 王斌 卞健 Jiang Qiting;Yao Xiang;Qiu Fuping;He Bing;Zhang Lei;Wang Bin;Bian Jian(Department of Hand and Foot Microsurgery,Nanjing Jiangbei Hospital,Nanjing 210048,China)

机构地区：[1]南京江北医院手足显微外科,南京210048

出　　处：《中华整形外科杂志》2024年第10期1086-1092,共7页Chinese Journal of Plastic Surgery

摘　　要：目的探讨8针微创法联合克氏针弹性固定治疗锤状指畸形的临床效果及可行性。方法回顾性分析2021年7月至2023年6月南京江北医院手足显微外科收治的闭合性指伸肌腱Ⅰ区断裂的腱性锤状指患者资料。采用8针微创法联合克氏针弹性固定治疗:先标记数字1到8为进针点,采用3-0肌腱缝线按照数字1到8的顺序经皮缝合指伸肌腱Ⅰ区,并通过骨隧道固定于末节指骨基底部。再用2枚克氏针不穿过远指间关节(DIPJ)、不损伤关节面,实施弹性固定DIPJ。术后4~5周去除克氏针,逐步加强患指伸屈运动。末次随访测量患指及对应健指各关节的主动屈伸活动范围,记录手指总主动活动度(TAM)及DIPJ活动度。参照美国手外科协会TAM系统评定手指功能,分为优、良、可、差4级。采用SPSS 15.0软件进行统计学分析,符合正态分布的计量资料以±s表示,患指与对应健指比较采用配对t检验。结果共纳入30例患者,男19例,女11例;年龄(38.5±4.3)岁(14~71岁);均为单指闭合性损伤;受伤至手术时间为(1.1±0.4)d(3 h~7 d);伸肌腱Ⅰ区断端间距(8.4±0.5)mm(4~12 mm)。所有患者均顺利完成手术,术后锤状指畸形均完全矫正,患指背侧皮肤无瘢痕、缝线外露等并发症。所有患者均获随访,时间为(7.5±1.3)个月(6~13个月)。末次随访时患指及对应健指的DIPJ活动度分别为43.28°±2.03°和44.15°±1.12°,差异无统计学意义(t=1.32,P=0.084);患指及对应健指的TAM分别为240.15°±5.13°和242.13°±3.11°,差异无统计学意义(t=2.12,P=0.135)。参照TAM系统评定标准:优27例,良3例,优良率为100%(30/30)。结论8针微创法联合克氏针弹性固定能有效治疗锤状指畸形,DIPJ关节面无损伤,是一种较好的微创治疗方法。ObjectiveTo discuss the clinical curative effect and feasibility of the combination therapy of the minimally invasive percutaneous quantitative suture technique eight times and Kirschner wire elastic fixation in the treatment of mallet finger.MethodsA retrospective analysis was performed on patients with tendon zoneⅠrupture of tendinous mallet fingers who underwent surgery in the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital from July 2021 to June 2023.During the procedure,firstly,the extensor digitalis tendon in the zoneⅠwas sutured percutaneous with 3-0 thread monofilament sutures in the"quantitative 8-stitch method"according to the pre-marked number sequence of 1 to 8,and fixed at the base of the distal phalanx via a constructed bone tunnel.Secondly,the distal interphalangeal joint(DIPJ)was fixed elastically with Kirschner wire,without damage to the articular surface.Four to five weeks after the operation,the Kirschner wire was removed,and flexion and extension of the affected finger were gradually increased.At the last follow-up,the range of motion(ROM)and the total action motion(TAM)of the finger were recorded,and the healthy side of the ROM and TAM slightly differed.Finger function was evaluated following the American Association of Hand Surgeons TAM system.It was divided into four grades:excellent,good,fair and poor.SPSS 15.0 software was used for statistical analysis.Measurement data conforming to normal distribution were expressed as Mean±SD,and a paired sample t-test was used for comparison between the affected finger and the corresponding healthy finger.ResultsA total of 30 patients(30 digits)were enrolled,including 19 males and 11 females with the age of(38.5±4.3)years(14 to 71 years).All were single closed injuries.Time from injury to operation was(1.1±0.4)d(3 h to 7 d).The distance of tendon break was(8.4±0.5)mm(4 to 12 mm).Mallet finger deformities were all corrected postoperatively.There were no complications such as scar,exposed suture,nail tract infection,or nail

关 键 词：指损伤 锤状指 8针法 微创技术 弹性固定 

分 类 号：R658[医药卫生—外科学]