锚钉修复法、肌腱直接缝合法、抽出钢丝法治疗锤状指的临床疗效比较分析
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摘要
引言：手指1区伸指肌腱断裂或撕脱引起的远侧指间关节屈曲畸形称为锤状指。随着工业的发展,手部的创伤逐渐增多,其中l区指伸肌腱损伤较为常见,若早期不予有效治疗,可继发性引起近节指间关节过伸畸形等慢性并发症,即造成患指功能障碍,又影响其美观。传统对锤状指的手术治疗包括肌腱直接缝合法、抽出钢丝法、关节融合等方法。微型锚钉(Mitek Micro Bone Anchor)是强生公司生产的一种用于修复肌腱的微型植入物,系统包括一个锥形锚体,其头部带有2个倒钩,尾部连有4-OEthibond双针缝合线,同时配有与骨锚匹配的钻头和骨锚植入的手动操作器。我们对2006年至2009年于我院行手术治疗的63例锤状指患者进行术后功能恢复的随访,以比较肌腱直接缝合法、抽出钢丝法与微型锚钉修复法治疗锤状指的临床疗效是否具有差异性。
目的：在锤状指的手术治疗中,探讨微型锚钉法与抽出钢丝法、肌腱直接缝合法治疗锤状指的临床疗效差异。资料与方法：随访2006-1-1至2009-6-30在华山医院手外科曾行手术治疗的锤状指病人,共随访到病例数为63例,其中男性46例,女性17例,年龄为16岁-72岁,平均年龄42岁。病人按照手术方式的不同分为如下三组：锚钉修复法组病例数25例,抽出钢丝组病例数17例,直接缝合组病例数21例。随访表格内容主要由病人一般资料、手术资料及术后患指MP、PIP、DIP关节主动及被动活动度组成。疗效评价标准采用TAM系统评定法进行评定。
结果：术后随访时间均大于六个月。锚钉修复组优3例、良15例、可5例、差2例,优良率72%；抽出钢丝组优4例、良11例、可1例、差1例,优良率88%；肌腱直接缝合组优5例、良12例、可3例、差1例,优良率81%。行Kruskal-Wallis秩和检验,X20.05/2.2=3.84>Hc=2.17,P>0.05。故在α=0.05的水平上,根据本例资料尚不能认为三种手术方式的临床疗效有统计学意义。
结论：在锤状指的手术治疗中,锚钉修复法是一种有效的临床治疗方法。
Distal interphalangeal joint flexion deformity, which is caused by Finger I District extensor tendon rupture or avulsion, is known as the hammer finger. With industrial development, the trauma of the hand gradually increased, which I District extensor tendon injury is common. If it is not effectively treated early, the damage can cause secondary hyperextension of proximal interphalangeal joint deformities and other chronic complications, which refer to dysfunction, also affect its appearance. Traditional the methods of the hammer-shaped tendon surgery includes direct suture, taking the wire method, joint fusion and other methods. Mitek Micro Bone Anchor a micro-implant anchorage system used to repair tendon produced by Johnson & Johnson. It consists of a cone, is headed with two barbs, trailed by a 4-OEthibond needle suture line, matched with a drill and manual operator. We follow 63 cases of surgical treatment of mallet fingers from 2006 to 2009 in our hospital to compare the different clinical treatments efficacies of the direct tendon suture method, extracting wire method and the micro-anchor repair method.
In the surgical treatments of mallet fingers, the study compares different clinical effects among the mini-anchor wire method, the extracting wire method and the direct tendon suture method.
Follow-up 63 cases of surgical mallet fingers from 2006-1-1 to 2009-6-30 at the Huashan Hospital, including 46 males and 17 females, aged from 16 to 72 years old, at the average age of 42 years old. According to the different surgical method, the patients were divided into the following three groups:group anchor repair method the number of cases,25 cases of anchor nail repair method,17 cases of extracting wire method and 21 cases of direct tendon suture method. The content of the follow-up forms is mainly from the general information of patients, surgical data and postoperative finger's MP, PIP, DIP joints active and passive activity. Evaluation standard adopts TAM system evaluation method.
Postoperative follow-up time is more than six months. In anchor repair method group, there are 13 excellent cases,15 good cases,5 normal cases and 2 poor cases with the good rate of 72%. In extract wire method group, there are 4 excellent cases, 11 good cases, one normal case and one poor case with the good rate of 88%. In the direct tendon suture method group, there are 5 excellent cases,12 good cases,3 normal cases and one poor case with the good rate of 81%. Given the Kruskal-Wallis rank-sum test, X20.05/2,2=3.84> HC=2.17, P>0.05. Therefore, at the level of a= 0.05, it cannot believe that the clinical efficacies of the three surgical method have statistical significant according to the information in this case.
In the surgical treatment of mallet fingers, the anchor repair method is an effective clinical treatment.
目的：在锤状指的手术治疗中,探讨微型锚钉法与抽出钢丝法、肌腱直接缝合法治疗锤状指的临床疗效差异。资料与方法：随访2006-1-1至2009-6-30在华山医院手外科曾行手术治疗的锤状指病人,共随访到病例数为63例,其中男性46例,女性17例,年龄为16岁-72岁,平均年龄42岁。病人按照手术方式的不同分为如下三组：锚钉修复法组病例数25例,抽出钢丝组病例数17例,直接缝合组病例数21例。随访表格内容主要由病人一般资料、手术资料及术后患指MP、PIP、DIP关节主动及被动活动度组成。疗效评价标准采用TAM系统评定法进行评定。
结果：术后随访时间均大于六个月。锚钉修复组优3例、良15例、可5例、差2例,优良率72%；抽出钢丝组优4例、良11例、可1例、差1例,优良率88%；肌腱直接缝合组优5例、良12例、可3例、差1例,优良率81%。行Kruskal-Wallis秩和检验,X20.05/2.2=3.84>Hc=2.17,P>0.05。故在α=0.05的水平上,根据本例资料尚不能认为三种手术方式的临床疗效有统计学意义。
结论：在锤状指的手术治疗中,锚钉修复法是一种有效的临床治疗方法。
Distal interphalangeal joint flexion deformity, which is caused by Finger I District extensor tendon rupture or avulsion, is known as the hammer finger. With industrial development, the trauma of the hand gradually increased, which I District extensor tendon injury is common. If it is not effectively treated early, the damage can cause secondary hyperextension of proximal interphalangeal joint deformities and other chronic complications, which refer to dysfunction, also affect its appearance. Traditional the methods of the hammer-shaped tendon surgery includes direct suture, taking the wire method, joint fusion and other methods. Mitek Micro Bone Anchor a micro-implant anchorage system used to repair tendon produced by Johnson & Johnson. It consists of a cone, is headed with two barbs, trailed by a 4-OEthibond needle suture line, matched with a drill and manual operator. We follow 63 cases of surgical treatment of mallet fingers from 2006 to 2009 in our hospital to compare the different clinical treatments efficacies of the direct tendon suture method, extracting wire method and the micro-anchor repair method.
In the surgical treatments of mallet fingers, the study compares different clinical effects among the mini-anchor wire method, the extracting wire method and the direct tendon suture method.
Follow-up 63 cases of surgical mallet fingers from 2006-1-1 to 2009-6-30 at the Huashan Hospital, including 46 males and 17 females, aged from 16 to 72 years old, at the average age of 42 years old. According to the different surgical method, the patients were divided into the following three groups:group anchor repair method the number of cases,25 cases of anchor nail repair method,17 cases of extracting wire method and 21 cases of direct tendon suture method. The content of the follow-up forms is mainly from the general information of patients, surgical data and postoperative finger's MP, PIP, DIP joints active and passive activity. Evaluation standard adopts TAM system evaluation method.
Postoperative follow-up time is more than six months. In anchor repair method group, there are 13 excellent cases,15 good cases,5 normal cases and 2 poor cases with the good rate of 72%. In extract wire method group, there are 4 excellent cases, 11 good cases, one normal case and one poor case with the good rate of 88%. In the direct tendon suture method group, there are 5 excellent cases,12 good cases,3 normal cases and one poor case with the good rate of 81%. Given the Kruskal-Wallis rank-sum test, X20.05/2,2=3.84> HC=2.17, P>0.05. Therefore, at the level of a= 0.05, it cannot believe that the clinical efficacies of the three surgical method have statistical significant according to the information in this case.
In the surgical treatment of mallet fingers, the anchor repair method is an effective clinical treatment.
引文
[1]Weber P. SegmOller H. Non-surgical treatment of mallet finger fractures involving more than one third of the joint surface:10 cases. Handchir Mikrochir Plast Chir, 2008,40(3):145-148.
[2]Facca S, Nonnenmacher J, Liverneaux P. Treatment of mallet finger with dorsal nail glued splint:retrospective analysis of 270 cases. Rev Chir Orthop Reparatrice ApparMot'2007,93(7):682-689.
[3]Leibovic SI. Instructional Course Lecture. Arthrodesis of the interphalangeal joints with headless compression screws. J Hand Sure(Am),2007,32(7):1113-1119.
[4]Kronlage SC, Faust D. Open reduction and screw fixation of mallet fractures., Hand Sure(Sr),2004,29(1):135-138.
[5]Theivendran K, Mahon A, Rajaratnam V. A novel hook plate fixation technique for the treatment of mallet fractures. Ann Hast Sure,2007,58(1):112-115.
[6]Teoh LC, Lee IY. Mallet fractures:a novel approach to internal fixation using a hookplate. J Hand Surg Eur,2007,32(1):24·30.
[7]Stern PJ, Kastrup JJ. Compl ications and prognosis of treatment of mallet finger. J Hand Sure(Am),1988,13(3):329-334.
[8]Bischoff R, Buechler U, De Roche R, et al, Clinical results of tension band fixation of avulsion fractures of the hand. J Hand Surg(Am),1994,19(6):1019-1026.
[1]顾玉东,王澎寰.手外科学[M].上海：上海科技出版社,2002：492-496.
[2]刘云鹏,刘沂,主编.骨与关节损伤和疾病的诊断分类及功能评定标准.1版.北京：清华大学出版社,2002.207.
[3]刘璠,侍德.从力学角度探讨1区{申指肌腱断裂疗效不佳原因.中华手外科杂志,1994,10：31-33.
[4]刘璠,侍德.槌状指的手术治疗.中华手外科杂志,1995,11：11-13.
[5]金风华,孔令震,阚世廉,等.锤状指的保守治疗.中华手外科杂志,1995,11增刊：19-20.
[6]Ulusoy MG, Karalezli N, K09er U, et al. Pull-in suture technique for the treatment of mallet finger. Plast Reconstr Sure,2006,118(3):696-702.
[7]Kondo M, Minami M, Kato S, et al. New method in the treatment of mallet fracture. Tech Hand Up Extrem Sure,1998,2(3):206-209.
[8]Bauze A, Bain GI. Internal suture for mallet finger fracture. J Hand Sure(Br), 1999,24:688-692.
[9]Tutde HG, Olvey SP, Stern PI. Tendon avulsion injuries of the distal phalanx. Clin Orthop Relat Res,2006,445:157-168.
[10]Husain SN, Dietz IF, Kalainov DM, et al. A biomechanical study of distal interphalangeal joint subluxation after mallet fracture injury. J Hand Sure(Am),2008, 33(1):26-30.
[11]Kalainov DM, Hoepfner PE, Hartigan BI, et al. Nonsurgical treatment of dosed mallet finger fractures. J Hand Sure(Am),2005,30(3):580-586.
[12]Weber P. SegmOller H. Non-surgical treatment of mallet finger fractures involving more than one third of the joint surface:10 cases. Handchir Mikrochir Plast Chir,2008,40(3):145-148.
[13]梅锦荣,李雄峰,罗斌.锤状指手术治疗的1临床研究.中华手外科杂志,2006,22(3)：172.173.
[14]李新,朱占武,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.
[15]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.
[1]顾玉东,王澎寰.手外科学[M].上海：上海科技出版社,2002：492-496.
[2]王真,张录强.自制“T”形指托治疗锤状指[J].骨与关节损伤杂志,2004,19(12)：853.
[3]Jones, N. F., and Peterson, J. Epidemiologic study of the mallet finger deformity. J. Hand Surg. (Am.) 13:334,1988.
[4]Kaplan, E. B. Anatomy, injuries and treatment of extensor apparatus of the hand and the digits. Clin. Orthop.13:24,1959.
[5]Bendre, A. A., Hartigan, B. J., and Kalainov, D. M. Mallet finger. J. Am. Acad. Orthop. Surg.13:336,2005.
[6]McFarlane, R. M., and Hampole, M. K. Treatment of extensor tendon injuries of the hand. Can. J. Surg.16:366,1973.
[7]Jupiter, J. B., and Sheppard, J. E. Tension wire fixation of avulsion fractures in the hand. Clin. Orthop.214:113,1987.
[8]Hamas, R. S., Horrell, E. D., and Pierret, G. P. Treatment of mallet finger due to intra-articular fracture of the distal phalanx. J. Hand Surg. (Am.) 3:361,1978.
[9]Stark, H. H., Gainor, B. J., Ashworth, C. R., et al. Operative treatment of intra-articular fractures of the dorsal aspect of the distal phalanx of digits. J. Bone Joint Surg. (Am.) 69:892,1987.
[10]Ishiguro, T., Itoh, Y., Yabe, Y., et al. Extension block with Kirschner wire for fracture dislocation of the distal interphalangeal joint. Tech. Hand Upper Extrem. Surg.1:95,1997.
[11]Badia, A., and Riano, F. A simple fixation method for unstable bony mallet finger. J. Hand Surg. (Am.) 29:1051,2004.
[12]Bauze, A., and Bain, G. I. Internal suture for mallet finger fracture. J. Hand Surg. (Br.) 24:688,1999.
[13]王欣,陈宏,王晓峰,等.应用微型骨锚重建指伸肌腱终腱止点一附6例报告[J].中华手外科杂志。2005,21：360-361.
[2]Facca S, Nonnenmacher J, Liverneaux P. Treatment of mallet finger with dorsal nail glued splint:retrospective analysis of 270 cases. Rev Chir Orthop Reparatrice ApparMot'2007,93(7):682-689.
[3]Leibovic SI. Instructional Course Lecture. Arthrodesis of the interphalangeal joints with headless compression screws. J Hand Sure(Am),2007,32(7):1113-1119.
[4]Kronlage SC, Faust D. Open reduction and screw fixation of mallet fractures., Hand Sure(Sr),2004,29(1):135-138.
[5]Theivendran K, Mahon A, Rajaratnam V. A novel hook plate fixation technique for the treatment of mallet fractures. Ann Hast Sure,2007,58(1):112-115.
[6]Teoh LC, Lee IY. Mallet fractures:a novel approach to internal fixation using a hookplate. J Hand Surg Eur,2007,32(1):24·30.
[7]Stern PJ, Kastrup JJ. Compl ications and prognosis of treatment of mallet finger. J Hand Sure(Am),1988,13(3):329-334.
[8]Bischoff R, Buechler U, De Roche R, et al, Clinical results of tension band fixation of avulsion fractures of the hand. J Hand Surg(Am),1994,19(6):1019-1026.
[1]顾玉东,王澎寰.手外科学[M].上海：上海科技出版社,2002：492-496.
[2]刘云鹏,刘沂,主编.骨与关节损伤和疾病的诊断分类及功能评定标准.1版.北京：清华大学出版社,2002.207.
[3]刘璠,侍德.从力学角度探讨1区{申指肌腱断裂疗效不佳原因.中华手外科杂志,1994,10：31-33.
[4]刘璠,侍德.槌状指的手术治疗.中华手外科杂志,1995,11：11-13.
[5]金风华,孔令震,阚世廉,等.锤状指的保守治疗.中华手外科杂志,1995,11增刊：19-20.
[6]Ulusoy MG, Karalezli N, K09er U, et al. Pull-in suture technique for the treatment of mallet finger. Plast Reconstr Sure,2006,118(3):696-702.
[7]Kondo M, Minami M, Kato S, et al. New method in the treatment of mallet fracture. Tech Hand Up Extrem Sure,1998,2(3):206-209.
[8]Bauze A, Bain GI. Internal suture for mallet finger fracture. J Hand Sure(Br), 1999,24:688-692.
[9]Tutde HG, Olvey SP, Stern PI. Tendon avulsion injuries of the distal phalanx. Clin Orthop Relat Res,2006,445:157-168.
[10]Husain SN, Dietz IF, Kalainov DM, et al. A biomechanical study of distal interphalangeal joint subluxation after mallet fracture injury. J Hand Sure(Am),2008, 33(1):26-30.
[11]Kalainov DM, Hoepfner PE, Hartigan BI, et al. Nonsurgical treatment of dosed mallet finger fractures. J Hand Sure(Am),2005,30(3):580-586.
[12]Weber P. SegmOller H. Non-surgical treatment of mallet finger fractures involving more than one third of the joint surface:10 cases. Handchir Mikrochir Plast Chir,2008,40(3):145-148.
[13]梅锦荣,李雄峰,罗斌.锤状指手术治疗的1临床研究.中华手外科杂志,2006,22(3)：172.173.
[14]李新,朱占武,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.
[15]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.
[1]顾玉东,王澎寰.手外科学[M].上海：上海科技出版社,2002：492-496.
[2]王真,张录强.自制“T”形指托治疗锤状指[J].骨与关节损伤杂志,2004,19(12)：853.
[3]Jones, N. F., and Peterson, J. Epidemiologic study of the mallet finger deformity. J. Hand Surg. (Am.) 13:334,1988.
[4]Kaplan, E. B. Anatomy, injuries and treatment of extensor apparatus of the hand and the digits. Clin. Orthop.13:24,1959.
[5]Bendre, A. A., Hartigan, B. J., and Kalainov, D. M. Mallet finger. J. Am. Acad. Orthop. Surg.13:336,2005.
[6]McFarlane, R. M., and Hampole, M. K. Treatment of extensor tendon injuries of the hand. Can. J. Surg.16:366,1973.
[7]Jupiter, J. B., and Sheppard, J. E. Tension wire fixation of avulsion fractures in the hand. Clin. Orthop.214:113,1987.
[8]Hamas, R. S., Horrell, E. D., and Pierret, G. P. Treatment of mallet finger due to intra-articular fracture of the distal phalanx. J. Hand Surg. (Am.) 3:361,1978.
[9]Stark, H. H., Gainor, B. J., Ashworth, C. R., et al. Operative treatment of intra-articular fractures of the dorsal aspect of the distal phalanx of digits. J. Bone Joint Surg. (Am.) 69:892,1987.
[10]Ishiguro, T., Itoh, Y., Yabe, Y., et al. Extension block with Kirschner wire for fracture dislocation of the distal interphalangeal joint. Tech. Hand Upper Extrem. Surg.1:95,1997.
[11]Badia, A., and Riano, F. A simple fixation method for unstable bony mallet finger. J. Hand Surg. (Am.) 29:1051,2004.
[12]Bauze, A., and Bain, G. I. Internal suture for mallet finger fracture. J. Hand Surg. (Br.) 24:688,1999.
[13]王欣,陈宏,王晓峰,等.应用微型骨锚重建指伸肌腱终腱止点一附6例报告[J].中华手外科杂志。2005,21：360-361.