游离掌长肌腱移植重建术治疗腕手部屈肌腱痛风石侵蚀病变疗效观察  

Clinical observation of free palmaris longus tendon graft reconstruction in treatment of gouty tophus erosion lesions in flexor tendon of wrist and hand

作　　者：王国忠 路超 屈志刚 张月娟 毕本军 高飞[1] 张钊[1] 潘月海 祝恩霞 黄恒[1] WANG Guozhong;LU Chao;QU Zhigang;ZHANG Yuejuan;BI Benjun;GAO Fei;ZHANG Zhao;PAN Yuehai;ZHU Enxia;HUANG Heng(Department of Hand and Foot Surgery,the Affiliated Hospital of Qingdao University,Qingdao Shandong,266000,P.R.China;Department of Pathology,the Affiliated Hospital of Qingdao University,Qingdao Shandong,266000,P.R.China;Department of Thoracic Surgery,the Affiliated Hospital of Qingdao University,Qingdao Shandong,266000,P.R.China)

机构地区：[1]青岛大学附属医院手足外科,山东青岛266000 [2]青岛大学附属医院病理科,山东青岛266000 [3]青岛大学附属医院胸外科,山东青岛266000

出　　处：《中国修复重建外科杂志》2025年第3期278-283,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨游离掌长肌腱移植重建术治疗腕手部屈肌腱痛风石侵蚀病变的临床效果。方法回顾分析2017年6月—2023年12月应用游离掌长肌腱移植重建术治疗的8例腕手部屈肌腱痛风石侵蚀病变患者。患者均为男性,年龄22~65岁,平均45.9岁。痛风病史2~18年,平均8.8年。发现痛风石至手术时间12~26个月,平均17.6个月。痛风石侵蚀拇长屈肌腱4例,Verdan屈肌腱分区为Ⅰ-Ⅱ区1例、Ⅳ-Ⅴ区3例;示指屈指深肌腱2例、中指屈指深肌腱1例、环指屈指深肌腱1例,均为Ⅳ-Ⅴ区。痛风石长轴2.3~4.5 cm,平均3.4 cm。8例患者均表现为手指屈伸活动受限,其中4例合并正中神经卡压症状;1例伴有手部骨、关节破坏。根据中华医学会手外科学会手部肌腱修复后评定标准,患者术前患指总主动活动度(total active motion,TAM)为(81.3±30.2)°,功能评价均为差。术中切取掌长肌腱长度为7~9 cm。结果8例患者手术切口均Ⅰ期愈合,无感染、移植肌腱不愈合及粘连等并发症发生。患者均获随访,随访时间8~25个月,平均14.8个月。4例合并正中神经卡压症状者麻木症状均消失。患者均未出现腕部疼痛等不适症状,未影响功能。末次随访时,根据中华医学会手外科学会手部肌腱修复后评定标准,8例患者TAM为(197.5±55.8)°,较术前显著改善,差异有统计学意义(t=11.638,P<0.001);1例Ⅰ-Ⅱ区拇长屈肌腱痛风石患者手部功能评分为良,余7例均为优。结论游离掌长肌腱移植重建术治疗腕手部屈肌腱痛风石侵蚀病变效果良好。Objective To investigate the effectiveness of free palmaris longus tendon graft reconstruction in the treatment of gouty tophus erosion lesions in flexor tendon of wrist and hand.Methods A retrospective analysis was conducted on 8 patients with gouty tophus erosion lesions in flexor tendon of wrist and hand who underwent free palmaris longus tendon graft reconstruction between June 2017 and December 2023.All patients were male,aged 22-65 years,with an average of 45.9 years.The duration of gout history ranged from 2 to 18 years,with an average of 8.8 years.The duration from the discovery of gouty tophus to operation ranged from 12 to 26 months,with an average of 17.6 months.The gouty tophus eroded the flexor pollicis longus tendon in 4 cases,with Verdan flexor tendon zones beingⅠ-Ⅱin 1 case andⅣ-Ⅴin 3 cases.The flexor digitorum profundus tendons were affected in 2 cases for the index finger,1 for the middle finger,and 1 for the ring finger,all located in zoneⅣ-Ⅴ.The long axis of the gouty tophus ranged from 2.3 to 4.5 cm,with an average of 3.4 cm.All 8 patients presented with limited finger flexion and extension.Among them,4 cases were accompanied by median nerve compression symptoms,and 1 case had associated bone and joint destruction in the hand.The total active motion(TAM)of the affected finger was(81.3±30.2)°before operation according to the hand function evaluation criteria for tendon repair by the Chinese Society of Hand Surgery of the Chinese Medical Association,and the functional evaluation was poor.The harvested palmaris longus tendon intraoperatively was 7-9 cm in length.Results Surgical incisions in all 8 patients healed by first intention,with no infections,graft non-union,or significant adhesion complications.All patients were followed up 8-25 months,with an average of 14.8 months.Numbness symptoms resolved in all 4 patients who presented with median nerve compression symptoms.Patients did not experience wrist pain or other discomfort,and function was not compromised.At last follow-up,ac

关 键 词：掌长肌腱 游离移植 肌腱痛风石 神经卡压 

分 类 号：R687.2[医药卫生—骨科学]