单排三点式张力带治疗急性末节锤状指畸形的解剖与临床研究  

Anatomical and clinical study of single row three-point tension band treatment for acute distal mallet fingerdeformity

作　　者：李友 唐林峰 杜伟伟 刘海亮 程贺云 巨积辉 Li You;Tang Linfeng;Du Weiwei;Liu Hailiang;Chen Heyun;Ju Jihui(Department of Hand Surgery,Suzhou Ruihua Orthopedic Hospital,Suzhou 215104,China)

机构地区：[1]苏州瑞华骨科医院手外科,苏州215104

出　　处：《中华手外科杂志》2024年第5期440-443,共4页Chinese Journal of Hand Surgery

基　　金：苏州市重点学科(SZXK202127);苏州市吴中区科技计划项目(WZYW2022015)。

摘　　要：目的 探讨单排三点式张力带治疗急性末节锤状指畸形的基础与临床研究,并观察该术式可行性及临床治疗效果.方法 解剖3例成人尸体手部标本,测量手指末节基底部至甲基质的距离及末节基底部指骨宽度.并在手指尸体标本上模拟手术,验证单排三点式张力带治疗锤状指的可行性.自2018年4月至2023年9月我们应用单排三点式张力带治疗急性末节锤状指畸形患者17例17指,均为急诊手术,13例为腱性锤状指,4例为Ⅰ a型骨性锤状指.术中均于患指末节基底部背侧钻3个骨孔,然后经此孔用无损伤肌腱缝线与伸肌腱止点近端腱性组织断端"8"字缝合,骨性锤状指患者在缝合时将骨折块原位纳回.其中10例钻入克氏针牵引远指间关节、7例未钻入克氏针.术后2周去除支具,术后4周去除牵引克氏针,指导患者开展功能训练,并定期随访.结果 解剖学研究结果显示,手指末节基底部至甲基质的距离为(4.79±1.16)mm,末节指骨基底部指骨宽度为(7.68±1.62)mm.尸体标本模拟手术提示单排三点式张力带治疗锤状指可行.本组患者术后伤口均Ⅰ期愈合,术后随访时间为3~24个月,平均8个月,末节锤状指畸形均得到矫正,各关节活动时无疼痛.根据Crawford锤状指疗效评价体系评价手指功能:优12例、良4例、可1例.结论 解剖学研究及模拟手术显示单排三点式张力带治疗锤状指可行,临床应用效果满意,具有操作简便、把持力强等优势.Objective To investigate the basic and clinical research of single row three-point tension band treatment for acute distal mallet finger deformity,and observe the feasibility and clinical efficacy of this surgical method.Methods Three adult cadaveric hand specimens were dissected,and the distance from the base of the distal phalanx to the methyl substance and the width of the distal phalanx were measured.And simulate surgery on finger specimens to verify the feasibility of single row three-point tension band treatment for mallet fingers.From April 2018 to September 2023,a single row three-point tension band was used to treat 17 patients with acute distal mallet finger deformity,all of whom underwent emergency surgery.Among them,13 were tendinous mallet fingers and 4 were typeⅠa bony mallet fingers.During the surgery,three bone holes were drilled on the dorsal side of the base of the distal segment of the affected finger,and then sutured with non-invasive tendon suture to the proximal end of the extensor tendon insertion point in the shape of an"8".The fracture block was retrieved in situ during suturing for the patients with bony mallet fingers.Among them,10 cases were inserted with Kirschner wires to traction the distal interphalangeal joint,and 7 cases were not inserted with Kirschner wires.The brace was removed 2 weeks after surgery,and the traction Kirschner wire was removed 4 weeks after surgery.The patients were guided to carry out functional training,and performed regularly follow-up.Results The anatomical research results showed that the distance from the base of the distal phalanx to the methyl substance was(4.79±1.16)mm,and the width of the distal phalanx base was(7.68±1.62)mm.The simulated surgery of cadaver specimens suggested that a single row three-point tension band was feasible for the treatment of mallet fingers.The wound of all patients in this group achieved primary healing after surgery,and the follow-up time was 3 to 24 months,with an average of 8 months.The distal mallet finger deformity

关 键 词：指损伤 治疗结果 解剖学 外科手术 锤状指 

分 类 号：R658.2[医药卫生—外科学]