骨性锤状指的手术治疗进展

骨性锤状指是伸肌腱终腱自末节指骨基底部背侧止点撕脱,且伴有撕脱骨折,伸肌腱终腱与撕脱骨块的连接是完整的.当末节指骨伸直且有纵向轴性应力的情况下,远侧指间关节过度背伸就会造成骨性锤状指,反之远侧指间关节过度掌屈则会造成腱性锤状指.此外,临床上比较罕见的同时伴有末节指骨背侧的撕脱骨折块、骨折块与伸肌腱终腱连接断裂的腱性、骨...     

微型骨锚在外伤性锤状指畸形中的应用

手指损伤形成的锤状指，是指伸终腱在末节指骨止点处或近止点处断裂，断端肌腱纤维往往呈抽麻样状态。如从止点处连同—小骨片撕脱，则外伤应力造成指伸肌腱或末节指骨基底背侧的连续性中断，由于指深屈肌腱的张力及掌板作用，远指间关节（DIP）往往掌屈移位，不能伸直呈锤状指畸形。锤状指的治疗主要分为保守与外科手术两类，其效果各家报道不一，特别是陈旧性锤状指的治疗，目前仍存在争论。     

双微型骨锚重建伸指肌腱终腱止点的临床应用

锤状指是由于末节指骨基底背侧至中央腱束止点间伸肌健断裂或撕脱部分指骨所致。若处理不当锤状指畸形长期存在,影响手部功能及外观。针对当前骨锚在手部肌腱损伤重建的应用逐渐广泛的现状,及我科在临床应用中的经验,分别采用单、双骨锚进行止点重建。2007年7月-2009年1月随访患者8例,笔者发现采用双微型骨锚重建修复指伸肌腱终腱止点撕脱伤者疗效优于采用单微型骨锚重建修复指伸肌腱终腱止点撕脱伤者。     

远节指骨靠近基底部背侧钻孔修复指伸肌腱Ⅰ区止点处撕脱伤

手的指伸肌腱Ⅰ区为中央束在中节指骨基底背侧抵止处至两侧束，中央束延续的终腱止点之间的部分，末节指骨基底背侧，接近止点的一段肌腱菲薄呈膜状，部分与远侧指间关节背侧关节囊融合。手指伸指肌腱Ⅰ区损伤多见于锐器切割伤或闭合性戳伤。手指末节下垂不能伸直，又称为“棒球指”或“锤状指”，常合并末节指骨背侧的撕脱骨折。此区由于其独特的解剖结构和功能特点，愈合能力较差，     

手指侧方肌腱加压缝合法联合克氏针固定治疗腱性锤状指

目的:探讨手指侧方肌腱加压缝合法联合克氏针固定治疗腱性锤状指的方法和临床效果。方法:自2015年6月至2019年6月,我们对13例腱性锤状指患者,采用1枚克氏针固定DIP于过伸位置,再将两条缝线分别用改良Kleinert法穿过终腱远断端两侧部,将肌腱拉向末节指骨止点处,缝针从指侧方穿出皮肤后拉紧加压打结固定,最后再将终...     

新鲜锤状指伸指肌腱止点重建改良固定20例分析

目的 介绍一种锤状指伸指肌腱止点重建的改良固定方法. 方法 术中用直径1.2mm克氏针固定远指间关节,将伸肌腱近断端用不可吸收线套圈缝合法固定后经末节指骨骨道穿出后打结固定于末节指骨指腹侧. 结果 术后患者伤口均Ⅰ期愈合,皮肤均未出现坏死.锤状指畸形矫正,伤指活动无疼痛. 结论 采用线缝合肌腱于末节指骨指腹侧打结固定改良伸肌腱止点重建,是一种简便、有效、经济的方法.     

伸肌腱止点重建治疗锤状指畸形

目的介绍应用重建伸肌腱止点治疗锤状指畸形的方法和疗效。方法对13例锤状指患者,于末节指骨终腱止点处作粗糙面熏取掌长肌腱游离移植。肌腱近端用3/0缝合线重叠缝合,远端用4/0丝线作“8”字缝合后绕行至指端皮肤外打结。远侧指间关节用直径1.0mm克氏针固定过伸位10°～15°,近侧指间关节石膏托固定屈曲位30°～40°。4周后拆除牵引线及外固定进行近侧指间关节及掌指关节功能锻炼,6周后拔除克氏针进行末节屈伸功能锻炼。结果随访2个月～2年,按Dargan功能评定法:优11例,良1例,可1例,优良率92.3%。结论伸肌腱止点重建术是治疗锤状指畸形的有效方法。     

克氏针钢丝悬吊法治疗骨性锤状指

锤状指是由于末节指骨基底背侧至中央腱束止点间伸肌腱断裂(即腱性锤状指)或撕脱部分指骨所致(即骨性锤状指).对于末节指骨基底背侧撕脱骨块大于关节面1/3的骨性锤状指,以往采用抽出钢丝法重建伸肌腱止点,但指腹掌侧固定的钮扣常导致皮肤压迫性损伤.2006年8月-2008年6月,我科采用克氏针钢丝悬吊法治疗骨性锤状指46例,疗效满意.     

克氏针钢丝悬吊法治疗骨性锤状指

锤状指是由于末节指骨基底背侧至中央腱束止点间伸肌腱断裂(即腱性锤状指)或撕脱部分指骨所致(即骨性锤状指).对于末节指骨基底背侧撕脱骨块大于关节面1/3的骨性锤状指,以往采用抽出钢丝法重建伸肌腱止点,但指腹掌侧固定的钮扣常导致皮肤压迫性损伤.2006年8月-2008年6月,我科采用克氏针钢丝悬吊法治疗骨性锤状指46例,疗效满意.     

克氏针钢丝悬吊法治疗骨性锤状指

锤状指是由于末节指骨基底背侧至中央腱束止点间伸肌腱断裂(即腱性锤状指)或撕脱部分指骨所致(即骨性锤状指).对于末节指骨基底背侧撕脱骨块大于关节面1/3的骨性锤状指,以往采用抽出钢丝法重建伸肌腱止点,但指腹掌侧固定的钮扣常导致皮肤压迫性损伤.2006年8月-2008年6月,我科采用克氏针钢丝悬吊法治疗骨性锤状指46例,疗效满意.     

Current concepts: mallet finger

Loss of the extensor mechanism at the distal interphalangeal (DIP) joint leads to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of a rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between the proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger leads to a swan neck deformity from PIP joint hyper extension and DIP joint flexion. Most mallet finger injuries can be managed non-surgically, but occasionally surgery is recommended for either an acute or a chronic mallet finger or for salvage of failed prior treatment.     

Central slip tenotomy for the treatment of chronic mallet finger: an anatomic study

PURPOSE: Tenotomy of the central slip, described by Fowler, can clinically improve chronic distal interphalangeal joint (DIP) extensor lag secondary to mallet finger (terminal tendon disruption). The goal of this study is to evaluate the potential of central slip tenotomy to restore DIP joint extension. METHODS: A mallet deformity was reproduced in 15 fresh-frozen cadaver fingers after the extensor tendon insertion was sectioned over the DIP joint. A suture anchor inserted at the terminal insertion was then secured to the extensor tendon over the middle phalanx to reconstruct the extensor mechanism. A 500-g weight attached to the proximal extensor tendon applied extensor tension. Central slip tenotomy was then performed. DIP extensor lags before and after tenotomy were recorded. RESULTS: After sectioning of the terminal tendon over the DIP joint the average amount of extensor tendon lag produced was 45 degrees. After central slip tenotomy was performed the average amount of extensor lag correction was 36 degrees (range, 30 degrees-46 degrees). CONCLUSIONS: Several clinical studies have shown that central slip tenotomy is an effective treatment for chronic mallet finger but may not fully restore DIP joint extension. Our data suggest that patients with a pre-existing extensor lag of greater than 36 degrees may not achieve full extension from central slip tenotomy, although extensor lags of up to 46 degrees may be corrected.     

经骨隧道加压缝合治疗手指伸肌腱止点断裂

目的探讨应用经骨隧道加压缝合治疗手指伸肌腱止点断裂的手术方法。方法对20例手指伸肌腱止点损伤所致锤状指畸形患者．用5ml注射器针头在末节指骨基底部横行钻一骨隧道,先用2／0两头带针肌腱吻合线将伸肌腱近断端按Kessler法缝合,然后将一针夹直后穿过骨隧道,如有撕脱骨折块,则将骨折块复位,对平关节面,拉紧肌腱吻合线打结,压紧骨折块,再将伸肌腱止点与指骨末节背侧软组织加强缝合1针。,术后用石膏耗外固定手指近侧指间关节屈曲45°、远侧指骨间关节轻微背伸位4~6周。结果20例木后切口愈合良好。15例患者随访6~24个月,无锤状指畸形发生。伸指0°、屈指指端过掌横纹8例;伸指受限-5°—-10°,屈指指端达掌横纹6例;伸指受限-20°,屈指指端离掌横纹1cm1例。根据Dargan功能评定法,优良率93．3％。结论本法操作简单,取材方便、便宜,能持续有效地内固定伸肌腱止点,值得临床推广应用。     

肌腱线经隧道双缝合法治疗特殊类型锤状指

目的介绍一种治疗特殊类型锤状指的方法。方法对32例手指伸肌腱止点离断的患者给予肌腱线经隧道双缝合法治疗,即在远节指骨基底部钻孔,远侧指间关节用直径1．0mm克氏针固定过伸位10°～15°,两根肌腱线反向穿过骨隧道后分别在肌腱断端止点近端做“8”字缝合及经止点背侧单圈缝合。术后6周拔除克氏针内固定开始末节指间关节功能锻炼。结果术后随访4-12个月（平均6．8个月）,32例均一期愈合,无1例发生切口感染、肌腱再断裂、皮肤坏死。按TAM系统评定方法评定：优19例,良13例．优良率为100％。结论肌腱线经隧道双缝合法是临床上治疗特殊类型锤状指的一种简单、疗效确切、经济实用的治疗方法。     

Mallet Finger Fracture through Enchondroma of the Distal Phalanx

A 46-year-old man injured his ring finger and developed a mallet deformity. Radiographs showed a mallet finger fracture through an osteolytic lesion of the distal phalanx. Magnetic resonance imaging showed low intensity on T1-weighted imaging and high intensity on T2-weighted imaging, which suggested the clinical diagnosis of enchondroma. The bone tumor was excised, and osteosynthesis was performed using Ishiguro''s extension block pinning, and a flexion block pin was added to prevent flexor tendon avulsion fracture through the enchondroma, followed by an autologous iliac cancellous bone graft. One year after surgery, the patient had no pain or extension lag of the affected ring finger, and his quickDASH score was 0 points. Radiographs showed no recurrence and minimal arthritic change of the distal interphalangeal joint. One-stage treatment of a mallet finger fracture through an enchondroma using Ishiguro''s method was effective.     

Treatment of chronic mallet finger with tendon flap graft. Report of 16 cases]

A series of 16 cases of chronic mallet finger deformity repaired with tendon flap from palmaris longus tendon or lateral band of extensor tendons is reported. Follow-up ranged from 1 to 4 years, the deformity has been corrected and pain disappeared in all cases. The active extention of DIP joints are 0 degrees in 12 cases and 5 degrees-15 degrees hyperextention in 4 cases. The active flexion of DIP joints are normal (65 degrees-80 degrees) in 11 cases, has 5 degrees-15 degrees flexion lag in 5 cases. The PIP and MP are normal in all cases. The anatomic basis of this procedure is narrated. The restoration of the anatomic continuity of the terminal extensor tendon reestablishes the coordinative effect between the long extensor tendon, intrinsic lateral band and oblique retinacular ligament and thus brings good long term result.     

Repair of chronic mallet finger deformity using Mitek micro arc bone anchor

Surgical correction of chronic mallet finger caused by terminal tendon disruption was carried out in 22 patients. The distal stump of the tendon was fixed to the base of the distal phalanx with a Mitek micro arc bone anchor. In all patients the mallet finger deformity was corrected. There were 15 patients with excellent results, 5 with good results, and 2 with fair results. None of the patients had a poor result. No further treatment was needed. The Mitek micro arc bone anchor system is a reliable alternative for the treatment of chronic mallet finger deformity without proximal interphalangeal hyperextension.     

Conservative treatment of mallet thumb

Four cases of mallet thumb were treated conservatively by splinting the interphalangeal joint of the thumb in extension using the Stack splint. Two patients had sharply cut the extensor tendon on the dorsum of the proximal phalanx and two had avulsion of the extensor tendon from the base of the distal phalanx. Eight weeks of continuous splinting was followed by 2 weeks of night splinting. Six months of follow-up revealed excellent range of motion in all four cases.     

Modification of the extension block Kirschner wire technique for mallet fractures

A modification of the extension block Kirschner wire technique that is used for closed reduction of mallet fractures is described. Eighteen mallet avulsion fractures of the distal phalanx treated with this modification were included in this prospective study. The fingers affected were nine small fingers, eight ring fingers, and one long finger. Surgical indications included fractures involving more than 33% of the articular surface and fractures associated with subluxation of the distal phalanx that could not be corrected by closed reduction. The average joint surface involvement was 39.8%. At followup, only one patient had pain, and that was graded as minimal. Objectively, congruous and satisfactory joint surfaces were present in 17 patients. No patient had pseudarthrosis. The average active flexion of the distal interphalangeal joint was 81.1 degrees and the average extensor lag was 1.6 degrees. Neither pin tract infections nor migration of the pins occurred. The average followup was 27.3 months. This modification increased range of motion at the distal interphalangeal joint and showed a trend toward reduced permanent extensor lag when compared with the original method. This technique should be considered when treatment of the mallet fracture is being planned using the extension block Kirschner wire technique.