微型锚钉在锤状指治疗中的应用
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摘要
目的
分析应用微型骨锚治疗锤状指的临床疗效。
方法
自2005年6月至2008年12月共对152例锤状指患者采用微型骨锚钉加克氏针固定手术治疗,本组152例患者中男性130例,女性22例,年龄15岁—59岁,平均32.2岁；新鲜损伤137例,陈旧性损伤15例；食指15例,中指39例,环指65例,小指33例,我们按照肌腱损伤的部位、特点以及是否合并撕脱骨折块分为三型：Ⅰ型为肌腱腱性部分完全离断,Ⅱ型为肌腱于附着点处完全撕脱,Ⅲ型为肌腱合并微小撕脱骨折块,其中本组病例Ⅰ型为12例,Ⅱ型为113例,Ⅲ型为27例。
结果
本组152例患者均得到随访,术后随访3—18个月,平均6.3个月。主动活动范围采用Dargan功能评定法(评定标准优：伸指0°,屈指指端过掌横纹；良：伸指欠伸≤15°,屈指指端达掌横纹；可：伸指欠伸160—45°,屈指指端距掌横纹≤2厘米；差：伸指欠伸>45°,屈指指端距掌横纹>2厘米)评定,优103例,良30例,可13例,差6例；优良率为87.5%。
结论
微型锚钉加克氏针固定治疗锤状指疗效可靠,简便易行,但操作应规范,尽量避免并发症的发生。
Objective
The purpose of the study was to analyse the clinical observations on the mallet finger treated by micro anchor.
Methods
From June 2005 to December 2008,152 patients with the mallet finger were treated by fixing the DIP with Kirschner wire and reconstruct insertion of extensor tendon with the micro anchor. Of them there are 130 males and 22 females cases. The average age was 32.2 (15 to 59) years. There are 137 cases with fresh injury,and 15 chronic injury. The cases included 15 index fingers,39 middle fingers,65 ring fingers,33 pinky fingers. We describe the mallet finger with 3 types, TypeⅠ:the total injury of the tender part, TypeⅡ:the injury of the attachment part, TypeⅢ: the avulsion fracture of the dorsal base phalanx finger. There are 12 cases with typeⅠ, 113 typeⅡ, and 27 typeⅢ.
Results
All the 152 patients were followed for at least 3 months postoperatively (3-18 months; average 6.3months). All the cases were evaluated by the Dargan criteria There are 103 fingers were excellent,30 fingers good,13 finger fair, and 6 finger poor. The good to excellent rate was 87.5%.
Conlusions
The treatment of mallet finger by micro anchor and Kirschner wire is reliable, simply and we should avoid complications.
分析应用微型骨锚治疗锤状指的临床疗效。
方法
自2005年6月至2008年12月共对152例锤状指患者采用微型骨锚钉加克氏针固定手术治疗,本组152例患者中男性130例,女性22例,年龄15岁—59岁,平均32.2岁；新鲜损伤137例,陈旧性损伤15例；食指15例,中指39例,环指65例,小指33例,我们按照肌腱损伤的部位、特点以及是否合并撕脱骨折块分为三型：Ⅰ型为肌腱腱性部分完全离断,Ⅱ型为肌腱于附着点处完全撕脱,Ⅲ型为肌腱合并微小撕脱骨折块,其中本组病例Ⅰ型为12例,Ⅱ型为113例,Ⅲ型为27例。
结果
本组152例患者均得到随访,术后随访3—18个月,平均6.3个月。主动活动范围采用Dargan功能评定法(评定标准优：伸指0°,屈指指端过掌横纹；良：伸指欠伸≤15°,屈指指端达掌横纹；可：伸指欠伸160—45°,屈指指端距掌横纹≤2厘米；差：伸指欠伸>45°,屈指指端距掌横纹>2厘米)评定,优103例,良30例,可13例,差6例；优良率为87.5%。
结论
微型锚钉加克氏针固定治疗锤状指疗效可靠,简便易行,但操作应规范,尽量避免并发症的发生。
Objective
The purpose of the study was to analyse the clinical observations on the mallet finger treated by micro anchor.
Methods
From June 2005 to December 2008,152 patients with the mallet finger were treated by fixing the DIP with Kirschner wire and reconstruct insertion of extensor tendon with the micro anchor. Of them there are 130 males and 22 females cases. The average age was 32.2 (15 to 59) years. There are 137 cases with fresh injury,and 15 chronic injury. The cases included 15 index fingers,39 middle fingers,65 ring fingers,33 pinky fingers. We describe the mallet finger with 3 types, TypeⅠ:the total injury of the tender part, TypeⅡ:the injury of the attachment part, TypeⅢ: the avulsion fracture of the dorsal base phalanx finger. There are 12 cases with typeⅠ, 113 typeⅡ, and 27 typeⅢ.
Results
All the 152 patients were followed for at least 3 months postoperatively (3-18 months; average 6.3months). All the cases were evaluated by the Dargan criteria There are 103 fingers were excellent,30 fingers good,13 finger fair, and 6 finger poor. The good to excellent rate was 87.5%.
Conlusions
The treatment of mallet finger by micro anchor and Kirschner wire is reliable, simply and we should avoid complications.
引文
[1]A.H克伦肖主编,过邦辅主编译。坎贝尔骨科手术大全[M],七版,上册,1991：103
[2]王亦璁主编,骨与关节损伤[M],第三版,2001：704-705
[3]杨大平,徐学武,鲁艺荣,等.微型骨锚重建指伸肌腱中央束止点的生物力学研究和临床应用.中华手外科杂志[J],2001,17(3)：142-144
[4]Muzaffar AR, Orenstein HH.Use of the Mitek Mini G2 anchor forcrossed intrinsic transfer[J].Plast Reconstr Surg,2000,105(1):469-470.
[5]熊革,中村蓼吾.骨锚在腕关节韧带修复与重建中的应用[J].中华手外科杂志,2002,18(2)：88-90.
[6]BrusteinM, Pellegrini J, Choueka J,et al. Bone suture anchors versus the pullout button for repair of distal p rofundus tendon injuries:a com2parison of strength in human cadaveric hands[J].J Hand Surg (Am),2001,26(3):489-496
[7]Bonin N, Obert L, Jeunet L, et al.Reinsertion of the flexor tendon u2sing a suture anchor:p rospective study using early active motion [J].ChirMain,2003,22(6): 305-311
[8]陆大明,陆振良,徐雪平,等。Anchor钉重建伸肌腱止点治疗锤状指。临床和实验医学杂志[J],2006,5(12)：1939-1940
[9]梅锦荣,李雄峰,罗斌.锤状指手术治疗的临床研究.中华手外科杂志,2006,22(3)：172-173.
[10]李新,朱吉武,付宝驰,等.锤状指治疗方法的选择.实用医技杂志,2007,14(14)：1919-1920.
[11]周风金,申彬,周建兴,等.闭合穿针加石膏夹板固定治疗锤状指的体会.中华手外科杂志,2007,23(3)：190.
[12]潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志,2000,16(3)：130-135.
[13]Ulusoy MG, Karalezli N, Kocer U, et al.Pull-in suture techniquefor the treatment of mallet finger. Plast Reconstr Surg,2006,118(3):696-702.
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[17]曾展鹏,苏博源,黄学员,等。应用微型骨锚钉重建指伸肌腱止点恢复关节功能28例。中国组织工程研究与临床康复杂志[J],2007,11(47)
[18]Matsuzaki H, Zaegel MA, Gelberman RH,Silva MJ.Effect of suture material and bone quality on the mechanical properties of zone I flexor tendon-bone reattachment with bone anchors. J Hand Surg [Am].2008 May-Jun;33(5):709-17
[19]Ulkur E, Acikel C, Ergun O, Celikoz B.Repair of chronic mallet finger deformity using Mitek micro arc bone anchor. Ann Plast Surg.2005 Apr;54(4):393-6
[20]李伟,郑军,张杰.微型锚钉加克氏针固定治疗锤状指疗效观察.医药论坛杂志[J],2008,29(21)：112.
[21]黄学员,苏博源,曾展鹏.微型A ncho r钉重建术配合中药熏洗治疗指伸肌腱止点断裂的临床观察[J].新中医,2007,39(9)：55256.
[22]姜国,范存义.微型锚钉治疗陈旧性锤状指畸形的疗效分析[J].中国矫形外科杂志,2007,15(4)：2512253.
[23]田敏,李坤.微型锚钉在治疗锤状指中的应用[J].中国矫形外科杂志,2006,14(26)：190621907
[24]McCallister WV, Ambrose HC, Katolik LI. Comparison ofpullout button versus suture anchor for zone I flexortendon repair[J].J Hand Surg (Am),2006, 31(2):246-251
[25]Stern PJ, Kastrup JJ.Complications and prognosis of treatment ofmallet finger. J Hand Surg (Am),1988,13(3):329-334.
[26]Bischoff R, Buechler U, De Roche R, et al.Clinical results of tensionband fixation of avulsion fractures of the hand. J Hand Surg (Am),1994,19(6): 1019-1026.
[27]李瑞华,许效坤.锤状指治疗的国内进展.中国误诊学杂志[J],2008,8(18)：9924-9925
[28]陈履平,张诗兴,孙贤敏,等.陈旧性锤状指的显微解剖与治疗研究.中华手外科杂志[J],1994,10(1)：34—35
[29]宫福良,姜长明,李杰,等.微型骨锚和抽出钢丝法治疗伸肌腱止点断裂的对比研究.实用手外科杂志[J],2008,22(3)：96
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[2]王亦璁主编,骨与关节损伤[M],第三版,2001：704-705.
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[6]Brus tein M, Pellegrini J,Choueka J,et al.Bone suture anchors versus the pullout button for repair of dis tal profundus tendon injuries:acomparison of s trength in human cadaveric hands. J Hand Surg [Am] 2001;26(3):489-496.
[7]Bonin N, Obert L, Jeunet L, et al.Reinsertion of the flexor tendon us ing a suture anchor:prospective s tudy us ing early active motion. Chir Main 2003;22(6): 305-311.
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[12]Muzaffar AR, Orenstein HH.Use of the Mitek Mini G2 anchor forcrossed intrinsic transfer[J].Plast Reconstr Surg,2000,105(1):469-470.
[13]熊革,中村蓼吾.骨锚在腕关节韧带修复与重建中的应用[J].中华手外科杂志,2002,18(2)：88-90.
[14]陆大明,陆振良,徐雪平,等。Anchor钉重建伸肌腱止点治疗锤状指。临床
和实验医学杂志[J],2006,5(12)：1939-1940.
[15]梅锦荣,李雄峰,罗斌.锤状指手术治疗的临床研究.中华手外科杂志,2006,22(3)：172-173.
[16]李新,朱吉武,付宝驰,等.锤状指治疗方法的选择.实用医技杂志,2007,14(14)：1919-1920.
[17]周风金,申彬,周建兴,等.闭合穿针加石膏夹板固定治疗锤状指的体会.中华手外科杂志,2007,23(3)：190.
[18]潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志,2000,16(3)：130-135.
[19]Ulusoy MG, Karalezli N, Kocer U, et al.Pull-in suture techniquefor the treatment of mallet fi nger.Plast Reconstr Surg,2006,118(3):696-702.
[20]Kondo M, Minami M, Kato S, et al.New method in the treatment ofmallet fracture. Tech Hand Up Extrem Surg,1998,2(3):206-209.
[21]Bauze A, Bain GI. Internal suture for mallet fi nger fracture. J HandSurg (Br), 1999,24:688-692.
[22]Tuttle HG, Olvey SP, Stern PJ.Tendon avulsion injuries of the distalphalanx. Clin Orthop Relat Res,2006,445:157-168.
[23]陆涛,宋知非,任杰.Ⅰ区伸肌腱断裂锤状指保守疗法疗效不佳的探讨[J].中华创伤骨科杂志,2005,7(9)：891.
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[27]Kalainov DM, Hoepfner PE, Hartigan BJ,et al. Nonsurgical treatmentof closed mallet finger fractures. J Hand Surg (Am),2005,30(3):580-586.
[28]Weber P, Segmuller H. Non-surgical treatment of mallet fi nger fracturesinvolving more than one third of the joint surface:10 cases.Handchir Mikrochir Plast Chir,2008,40(3):145-148.
[29]Facca S, Nonnenmacher J, Liverneaux P.Treatment of mallet fi ngerwith dorsal nail glued splint:retrospective analysis of 270 cases. RevChir Orthop Reparatrice Appar Mot,2007,93(7):682-689.
[30]田敏,李坤.微型锚钉在治疗锤状指中的应用.中国矫形外科杂志,2006,14(24)：1906-1907.
[31]宋传祥,西中海,孙立枫,等.克氏针固定指间关节治疗新鲜锤状指[J].实用手外科杂志,2007,21(2)：95.
[32]朱伍,陈丽娜,马少云,等.23例锤状指治疗分析[J].现代中西医结合杂志,2005,14(3)：343.
[33]杨大平,徐学武,鲁艺荣,等.微型骨锚重建指伸肌腱中央束止点的生物力学研究和临床应用.中华手外科杂志[J],2001,17(3)：142-144.
[34]黄学员,苏博源,曾展鹏.微型A ncho r钉重建术配合中药熏洗治疗指伸肌腱止点断裂的临床观察[J].新中医,2007,39(9)：55-56.
[35]姜国,范存义.微型锚钉治疗陈旧性锤状指畸形的疗效分析[J].中国矫形外科杂志,2007,15(4)：251-253.
[36]McCallister WV, Ambrose HC, Katolik LI.Comparison ofpullout button versus suture anchor for zone I flexortendon repair[J].J Hand Surg (Am),2006, 31(2):246-251.
[37]Matsuzaki H, Zaegel MA, Gelberman RH, Silva MJ. Effect of suture material and bone quality on the mechanical properties of zone I flexor tendon-bone reattachment with bone anchors. J Hand Surg [Am].2008 May-Jun;33(5):709-17.
[38]Ulkur E, Acikel C, Ergun O, Celikoz B.Repair of chronic mallet finger deformity using Mitek micro arc bone anchor. Ann Plast Surg.2005 Apr;54(4):393-6.
[39]李伟,郑军,张杰.微型锚钉加克氏针固定治疗锤状指疗效观察.医药论坛杂志[J],2008,29(21)：112.
[40]曾展鹏,苏博源,黄学员,等。应用微型骨锚钉重建指伸肌腱止点恢复关节功能28例。中国组织工程研究与临床康复杂志[J],2007,11(47)
[41]Stern PJ, Kastrup JJ.Complications and prognosis of treatment ofmallet finger. J Hand Surg (Am),1988,13(3):329-334.
[42]Bischoff R, Buechler U, De Roche R, et al.Clinical results of tensionband fixation of avulsion fractures of the hand. J Hand Surg (Am),1994,19(6): 1019-1026.
[43]李瑞华,许效坤.锤状指治疗的国内进展.中国误诊学杂志[J],2008,8(18)：9924-9925.
[44]陈履平,张诗兴,孙贤敏,等.陈旧性锤状指的显微解剖与治疗研究.中华手外科杂志[J],1994,10(1)：34-35.
[45]宫福良,姜长明,李杰,等.微型骨锚和抽出钢丝法治疗伸肌腱止点断裂的对比研究.实用手外科杂志[J],2008,22(3)：96.
[2]王亦璁主编,骨与关节损伤[M],第三版,2001：704-705
[3]杨大平,徐学武,鲁艺荣,等.微型骨锚重建指伸肌腱中央束止点的生物力学研究和临床应用.中华手外科杂志[J],2001,17(3)：142-144
[4]Muzaffar AR, Orenstein HH.Use of the Mitek Mini G2 anchor forcrossed intrinsic transfer[J].Plast Reconstr Surg,2000,105(1):469-470.
[5]熊革,中村蓼吾.骨锚在腕关节韧带修复与重建中的应用[J].中华手外科杂志,2002,18(2)：88-90.
[6]BrusteinM, Pellegrini J, Choueka J,et al. Bone suture anchors versus the pullout button for repair of distal p rofundus tendon injuries:a com2parison of strength in human cadaveric hands[J].J Hand Surg (Am),2001,26(3):489-496
[7]Bonin N, Obert L, Jeunet L, et al.Reinsertion of the flexor tendon u2sing a suture anchor:p rospective study using early active motion [J].ChirMain,2003,22(6): 305-311
[8]陆大明,陆振良,徐雪平,等。Anchor钉重建伸肌腱止点治疗锤状指。临床和实验医学杂志[J],2006,5(12)：1939-1940
[9]梅锦荣,李雄峰,罗斌.锤状指手术治疗的临床研究.中华手外科杂志,2006,22(3)：172-173.
[10]李新,朱吉武,付宝驰,等.锤状指治疗方法的选择.实用医技杂志,2007,14(14)：1919-1920.
[11]周风金,申彬,周建兴,等.闭合穿针加石膏夹板固定治疗锤状指的体会.中华手外科杂志,2007,23(3)：190.
[12]潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志,2000,16(3)：130-135.
[13]Ulusoy MG, Karalezli N, Kocer U, et al.Pull-in suture techniquefor the treatment of mallet finger. Plast Reconstr Surg,2006,118(3):696-702.
[14]Kondo M, Minami M, Kato S, et al. New method in the treatment ofinallet fracture. Tech Hand Up Extrem Surg,1998,2(3):206-209.
[15]Bauze A, Bain GI. Internal suture for mallet fi nger fracture. J HandSurg (Br), 1999,24:688-692.
[16]Tuttle HG, Olvey SP, Stern PJ. Tendon avulsion injuries of the distalphalanx. Clin Orthop Relat Res,2006,445:157-168
[17]曾展鹏,苏博源,黄学员,等。应用微型骨锚钉重建指伸肌腱止点恢复关节功能28例。中国组织工程研究与临床康复杂志[J],2007,11(47)
[18]Matsuzaki H, Zaegel MA, Gelberman RH,Silva MJ.Effect of suture material and bone quality on the mechanical properties of zone I flexor tendon-bone reattachment with bone anchors. J Hand Surg [Am].2008 May-Jun;33(5):709-17
[19]Ulkur E, Acikel C, Ergun O, Celikoz B.Repair of chronic mallet finger deformity using Mitek micro arc bone anchor. Ann Plast Surg.2005 Apr;54(4):393-6
[20]李伟,郑军,张杰.微型锚钉加克氏针固定治疗锤状指疗效观察.医药论坛杂志[J],2008,29(21)：112.
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