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5-氟尿嘧啶预防屈肌腱粘连的临床研究
引用本文:郭明珂,张经歧,田德虎,张英泽,彭秀晴,王洲,吴军,段亚飞,窦志,王翠花. 5-氟尿嘧啶预防屈肌腱粘连的临床研究[J]. 中国修复重建外科杂志, 2008, 22(7): 794-796
作者姓名:郭明珂  张经歧  田德虎  张英泽  彭秀晴  王洲  吴军  段亚飞  窦志  王翠花
作者单位:1. 解放军第260医院骨科,石家庄,050041
2. 河北医科大学第三医院骨科
3. 河北省人民医院
摘    要:目的评价局部应用5-氟尿嘧啶对屈肌腱修复术后防止肌腱粘连和功能恢复的作用。方法选择2003年8月-2007年6月收治的48例开放性锐器伤致手部屈肌腱完全断裂患者,根据就诊时间随机分为5-氟尿嘧啶组及对照组。5-氟尿嘧啶组:26例39指,男17例,女9例;年龄(29.3±9.8)岁;I区损伤19指,II区损伤20指;单指肌腱损伤12例,2指以上14例;伤后(2.4±1.6)h手术。对照组:22例36指,男14例,女8例;年龄(26.1±8.7)岁;I区损伤16指,II区损伤20指;单指肌腱损伤10例,2指以上12例;伤后(2.1±1.8)h手术。两组患者年龄、性别、肌腱损伤分区和单指损伤比例比较差异均无统计学意义(P〉0.05)。5-氟尿嘧啶组于屈肌腱修复后局部应用浓度25mg/mL的5-氟尿嘧啶浸泡的脑棉片贴合于肌腱修复部位的腱鞘滑膜面4次,每次1min;对照组应用等量生理盐水替代5-氟尿嘧啶液。结果术后两组伤口均I期愈合,无切口感染及肌腱断裂发生。5-氟尿嘧啶组患者均获随访,随访时间3~8个月,平均4.1个月;对照组患者均获随访,随访时间3~8个月,平均3.9个月。采用手指总主动活动度评价法评定疗效:5-氟尿嘧啶组优22指,良13指,可3指,差1指,优良率89.7%;对照组优11指,良15指,可9指,差1指,优良率72.2%。5.氟尿嘧啶组明显优于对照组(P〈0.05)。两组疗效为差的1例均于术后6个月行肌腱松解术,术后功能恢复良好。结论5-氟尿嘧啶可有效减少屈肌腱修复术后的肌腱粘连。

关 键 词:指屈肌腱  肌腱损伤  粘连  5-氟尿嘧啶  氟尿嘧啶  预防  屈肌腱粘连  临床研究  REPAIR  TENDON  FORMATION  ADHESION  术后功能恢复  肌腱松解术  良率  疗效  评价法  活动度  手指  随访时间  发生  肌腱断裂  切口感染  Ⅰ期愈合

EFFECTS OF 5-FLUOROURACIL ON TENDON ADHESION FORMATION AFTER FLEXOR TENDON REPAIR
GUO Mingke,ZHANG Jingqi,TIAN Dehu,ZHANG Yingze,PENG Xiuqing,WANG Zhou,WU Jun,DUAN Yafei,DOU Zhi,WANG Cuihua. EFFECTS OF 5-FLUOROURACIL ON TENDON ADHESION FORMATION AFTER FLEXOR TENDON REPAIR[J]. Chinese journal of reparative and reconstructive surgery, 2008, 22(7): 794-796
Authors:GUO Mingke  ZHANG Jingqi  TIAN Dehu  ZHANG Yingze  PENG Xiuqing  WANG Zhou  WU Jun  DUAN Yafei  DOU Zhi  WANG Cuihua
Affiliation:Department of Orthopedics, the 260th Hospital of PLA, Shijiazhuang Hebei, 050041, PR China.
Abstract:OBJECTIVE: To evaluate the effect of 5-fluorouracil (5-FU) applied topically on preventing adhesion and promoting functional recovery after tendon repair. METHODS: From August 2003 to June 2007, 48 patients with flexor tendon rupture of the fingers by sharp instrument were treated and randomly divided into two groups. In 5-FU group, 39 fingers of 26 patients included 17 males and 9 females, aged (29.3 +/- 9.8) years; the locations were zone I in 19 fingers and zone II in 20 fingers; single finger was involved in 12 cases and more than 2 fingers were involved in 14 cases; and the time from injury to operation was (2.4 +/- 1.6) hours. In control group, 36 fingers of 22 patients included 14 males and 8 females; aged (26.1 +/- 8.7) years; the locations were zone I in 16 fingers and zone II in 20 fingers; single finger was involved in 10 cases and more than 2 fingers were involved in 12 cases; and the time from injury to operation was (2.1 +/- 1.8) hours. No statistically significant difference was found in constituent ratio of age, gender, injured fingers and their zones, between two groups (P > 0.05). The repair site in 5-FU group was given 5-FU at a concentration of 25 mg/mL with a soaked sponge, and the synovial sheath of the repaired site was wrapped with the 5-FU-soaked sponge for 1 minute for 4 times after the tendons were repaired; normal saline was used in the control group. RESULTS: Wound healed by first intention and no infection and tendon rupture occurred in two groups. The patients were followed up for 3-8 months (mean 4.1 months) and 3-8 months (mean 3.9 months) in 5-FU group and in control group respectively. The functional recovery degrees of the fingers were evaluated with total active movement (TAM) evaluation system. In 5-FU group, the results were excellent in 22 fingers, good in 13 fingers, fair in 3 fingers and poor in 1 finger; the excellent and good rate was 89.7%. In control group, the results were excellent in 11 fingers, good in 15 fingers, fair in 9 fingers and poor in 1 finger; the excellent and good rate was 72.2%. There was statistically significant difference in the functional recovery degrees of fingers between two groups (P < 0.05). The 2 fingers which had a poor result in 5-FU group and control group were served with tenolysis was performed in 2 cases having poor results after 6 months of operation and had an excellent result at last. CONCLUSION: 5-FU applied topically can reduce tendon adhesions after the ruptured tendon repair.
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