微型锚钉治疗陈旧性锤状指畸形的疗效分析

1、微型锚钉治疗陈旧性锤状指畸形的疗效分析 08-07-01 10:01:00 作者：姜国范存义编辑：studa20【摘要】 目的介绍一种应用微型锚钉治疗陈旧性锤状指畸形的方法，通过观察临床效果来探讨该方法治疗陈旧性锤状指畸形的可行性。方法对14例陈旧性锤状指患者临床应用微型锚钉治疗。于远侧指间关节（DIP）背侧做“”形切口，显露伸指肌腱，将断端间疤痕切除，用1枚1 mm克氏针将远侧指间关节（DIP）固定于伸直位，用肌腱缝合线水平褥式缝合伸指肌腱断端，于末节指骨基底背侧钻孔后安装微型锚钉，将锚钉尾部携带的肌腱缝线与伸指肌腱近断端缝合以加强缝合强度。术后前臂掌侧面石膏托固定腕关节背神30，掌指关节及

2、指间关节伸直位3周，6周后拔除克氏针开始功能锻炼。结果随访6个月1年，按Dargan功能评定法：优10例，良2例，可1例，差1例。其中1例远侧指间关节（DIP）屈曲功能障碍，无畸形复发。优良率85.7。结论应用微型锚钉治疗陈旧性锤状指畸形具有缝合强度高，畸形复发率低，操作简便，效果可靠的优点，是一种治疗陈旧性锤状指畸形简便有效的方法。 【关键词】 微型锚钉 锤状指 畸形矫治Therapeutic effect of microanchor in chronic mallet finger deformity Abstract：ObjectiveTo introduce the method o

3、f treating chronic mallet finger using Micro Arc bone Anchor, and investigate the feasibility of this method with the clinical effects.MethodFourteen chronic mallet fingers were treated with Micro Arc bone Anchors. During the operation, a skin incision over the dorsum of the DIP joint was made to ex

4、pose the extensor tendon and resect the scar tissue between the disrupted ends. Then the DIP joint was made at extending position was immobilized with a 1mm Kirschner wire and the ends of extensor tendon was sutured with horizontal mattress suture method. After that,the Micro Arc bone Anchor was sut

5、ured into the dorsal base of the distal phalanx,the suture thread attached the end of anchor was tied to the proximal end of the extensor tendon to reinforce the former suture. External fixation on the anterior face of forearm was applied to immobilize the wrist at 30of extention and the metacarpoph

6、alangeal and interphalangeal joints and extending position for 3 w, and Kirschner wire fixation was taken out 6 w postoperatively. Functional exercises were performed after the Kirschner wires were removed.ResultAll the cases were followed up for 6 months to 1 year, and excellent results were obtain

7、ed in 10 cases, good in 2, fair in 2 and poor in 1 according to Dargans functional assessment system, with dysfunction of flexion in DIP joint in 1 case, and recurrence of abnormity in 1 case.The total rate of excellent and good results was 85.7.ConclusionMicro Arc bone Anchor is a convenient and ef

8、fective alternative for the treatment of chronic mallet finger deformity with many advantages such as the high suturing intensity,low recurrence rate of abnormity, convenient for operation and reliable effect. Key words：micro arc bone anchor; mallet finger； abnormity orthopedics手指区伸指肌腱断裂或撕脱引起的远侧指间关节

9、屈曲畸形称为锤状指畸形1，在临床上较为常见。伸肌腱断裂后，由于屈肌腱力量强大，随着伤后时间的延长，屈指畸形逐渐加重。远侧指间关节背侧由于长期处于屈曲状，撞击时容易引起疼痛，不但影响患者手的功能，也对外观有一定的影响，晚期治疗效果不佳。从2005年8月2006年6月作者采用强生Mitek的Micro Arc Bone Anchor（微型锚钉）治疗陈旧性锤状指14例，效果满意。现报道如下。1 资料与方法1.1 一般资料 本组资料14例，其中男8例，女6例；年龄2046岁，平均32岁。右手12例，左手2例；食指5例，中指6例，环指2例，小指1例；致伤原因：戳伤10例，砸伤3例，扭伤1例；全部为闭合性

10、损伤，不合并末节指骨基底部背侧撕脱骨折。就诊时间：伤后3周2年就诊，就诊前保守治疗10例，未治疗4例，10例保守治疗均失败。伤后手指远侧指间关节（DIP）屈曲3060畸形，平均屈曲37。远侧指间关节（DIP）被动活动良好，近侧指间关节（PIP）伴有不同程度的背伸。1.2 手术方法 采用臂丛麻醉或指根部浸润阻滞麻醉。上肢常规消毒铺单，上臂扎止血带或指根部扎橡皮条止血。做远侧指间关节（DIP）背侧“”形切口。切开皮肤，皮下组织，于伸指肌腱浅面向两侧游离皮瓣，可见伸指肌腱连续性存在，但肌腱于远侧指间关节（DIP）附近断裂，断端间由薄的瘢痕相接，肌腱松弛不能带动远侧指间关节（DIP）主动背伸。将远侧指

11、间关节（DIP）伸直处于中立位，用1枚1 mm的克氏针贯穿远侧指间关节（DIP）。将断端间瘢痕组织切除，充分游离近段伸指肌腱，使其有足够的滑动性，注意不要损伤远侧指间关节背侧关节囊。于远节指骨基底背侧钻孔，将强生Mitek的Micro Arc Bone Anchor（微型锚钉）插入骨洞，注意不要损伤甲床根部，将锚钉尾部携带的肌腱线缝合到伸指肌腱近断端上，再将肌腱近远断端水平褥氏缝合。直接缝合皮肤，纱布包扎。1.3 术后处理 前臂掌侧面石膏托固定腕关节背伸30，掌指关节及指间关节伸直位3周。3周后去除石膏托，6周时拔出克氏针。开始主动屈伸远侧指间关节（DIP）功能锻炼。2 结果 疗效评价标准采用Dargan功能评定法2：测量手指最大伸指位时掌指关节（MP）、近侧指间关节（PIP）、远侧指间关节（DIP）伸直欠伸角度的总和以及手指屈曲时指尖与掌横纹之间的距离。优：伸指0，屈指指尖过掌横纹；良：伸指欠伸15，屈指指尖达掌横纹；可：伸指欠伸1645，屈指指尖离掌横纹在2 cm以内；差：伸指欠伸45，屈指指尖离掌横纹在2 cm以上。本组14例随访6个月到2年，其中优10例，良2例，可1例，差1例。所有患者术后未出现畸形复发，1例术后出现远侧指间关节背侧约1.51.0 cm2大小的皮肤坏死，经换药治疗5周愈合。 典型病例：患者男，39岁，右小指远侧指间关节外伤后锤状指畸