一种治疗指关节外伤性强直的方法(附42例报告)

作者自1979～1989年采用自己设计的“V”形截骨指关节成形术,治疗指关节和掌指关节外伤性强直42例,效果满意. 手术方法:(以近侧指间关节为例)用臂丛麻醉、止血带。取侧方弧形切口,避开指血管神经束,牵向掌侧,沿指关节向两侧分离,游离侧腱束、中央腱束和屈指肌腱,保留中央腱束在中节指骨基部背部的止点。从近节指骨远端向下剥离关节囊,牵开伸指肌腱,用微型指骨锯或小骨刀在已骨性融合的关节两端,做开口朝向中节指骨的“V”形杵臼状截骨,锉平塑形,杵臼间保留2～3mm间隙。将从近     

腱移植治疗手指腱鞘内屈腱损伤

<正> 作者近年来用掌长肌腱移植治疗手指腱鞘内屈腱损伤12例,疗效满意,现报告如下:临床资料一、一般资料男10例,女2例。年龄15岁～43岁。拇长厨腱断裂8例;6例在掌指关节水平,2例在拇指近节中分。中指指深、浅屈腱断裂2例;断裂在近节指骨中分,作浅腱部分切除,只缝接指深屈腱。环指指深屈腱断裂2例,     

手指屈指腱鞘功能的测定

本文报告了手指屈指腱鞘功能测定的实验研究,比较了不同数量和不同位置的腱环对屈指功能的影响。实验结果表明:随着腱环数量减少,肌腱拉力引起屈指作用也逐渐减弱;靠近掌指关节的腱环对肌腱滑动的作用大于靠近指间关节的腱环。建议在做肌腱手术时保留3个腱环效果较好。若保留2个腱环时,     

楔形截骨矫正掌骨颈成角畸形愈合

掌骨颈骨折处理不当,而致掌骨头向掌侧倾斜,颈部向背侧成角畸形愈合,使患指伸屈受限,并可引起掌侧压迫性疼痛.近年来,我们采用楔形截骨的方法治疗掌骨颈成角畸形愈合10人15指.其中小指7例,环指5例,示指3例。解剖特点掌指关节由掌骨头和近节指骨基底组成。掌骨头非一规则球形,其在掌侧较为突出,掌侧面的半径大于远侧面的半径.掌指关节囊较为松弛,两侧由起自掌骨头略背侧、斜向掌侧、止于近节指骨基底的侧副韧带加强,侧副韧带向掌面呈扇形止于掌板,并与屈指肌腱鞘相连。另有骨间背侧肌止于近节指骨基底侧方略偏掌侧面及指伸肌腱扩张部,骨间掌侧肌止于近节指骨基底及腱     

小指固有伸肌移位拇对掌功能重建术及其术后并发症

探讨小指固有伸肌腱移位拇对掌功能重建术的优点，并发症及其处理方法，方法：采用以小指固有伸肌为力源，以尺骨下端尺侧缘为滑车，将移位腱分二束后，将其近侧束固定于拇掌指关节近侧拇长伸肌腱，而将另一束固定于拇掌指关节远侧拇长伸肌腱或将远侧束固定部位改为近节指骨桡背侧骨内。     

指浅屈肌腱束修复指间关节侧副韧带断裂

目的:应用指浅屈肌腱束加强修复近节指间关节侧副韧带断裂,观察该方法疗效。方法:自2003年以来,对6例23指近节指间关节侧副韧带断裂,采用部分指浅屈肌腱显微技术加强修复。用细克氏针在侧副韧带起点处向健侧钻两个相距2~3mm的骨孔穿过钢丝,切开屈肌腱鞘,从指浅屈肌腱一侧近端切取所需长度肌腱束,此肌腱束穿过钢丝孔,保持肌腱束的合适张力,用5/0~7/0无创线缝合于浅腱止点,应用8/0针线将肌腱束缝合于韧带上。术后伸直位夹板固定4~6周。结果:经6~12个月随访,优4例,良1例,可1例,优良率83.33%。结论:应用指浅屈肌腱束显微技术加强修复近节指间关节侧副韧带断裂,手术损伤小,就地取材,是一种较简便、有效的手术方法。     

手部肌腱滑动距离的测定

了解手部肌腱的滑动范围,对肌腱损伤的诊断、治疗及预后都有帮助。为此,我们用一组新鲜肢体标本,做了肌腱滑动距离的测量。材料:新鲜尸体右上肢7个测量方法: 剥去前臂、手掌及手背皮肤和深肌膜,暴露屈、伸腕肌及屈、伸指肌的肌腱及肌腹,保持屈指腱鞘及腕掌侧、背侧横韧带完整。     

手侧副韧带损伤研究进展

手侧副韧带损伤比较常见,损伤后可引起手指畸形、疼痛、肿胀、活动受限,产生手功能障碍,在临床上应引起高度重视。现将近年来手侧副韧带损伤研究综述如下。1手侧副韧带的应用解剖掌指关节是由球状的掌骨头和凹陷的近节指骨底构成的多轴性球窝关节。掌指关节的稳定性主要由侧副韧带和掌板提供。侧副韧带在关节的两侧增强关节囊,它起于掌骨头下方的凹陷,止于近节指骨底侧方,与副侧副韧带和背侧关节囊的纤维相混合[1]。一般情况下,侧副韧带在掌指关节屈曲时紧张,伸展时松驰[2]。指间关节为滑车关节,由近侧指骨头和远侧指骨底组成。指间关节侧副…     

屈指肌腱鞘内麻醉在手指外伤中的应用

屈脂肌腱鞘内麻醉在手指外伤手术中应用简单、方便。在２６９例手指外伤中应用,取得了良好的效果。１操作方法 嘱患者掌心向上,常规消毒后在手指近侧掌横纹中点进针,针头斜向远心端约３０度,穿过皮肤、皮下组织及腱鞘滑膜,有脱空感,回抽无血液回流后注入２％的利多卡因３～４ｍｌ。如注药时感阻力较大,可能力针头注入肌腱内,可退出少许续注入药物,可见注射部位向两侧膨胀,进针处按压１分钟即可见效。如鞘管在近节指间关节以近开放破损或近节指关节以内手指离断伤则不用此法;如鞘管在近节指关节以远开放损伤则应减慢注药速度及增…     

扳机指的简易手术治疗

扳机指为拇指或其他手指屈肌腱遭受反复的轻微损伤引起的狭窄性腱鞘炎。也可能是静止型或亚临床型胶原疾病的后果。受累的小段肌腱呈结节性肿胀。造成屈指肌腱鞘的相对狭窄，受累段肌腱一般位于掌指关节平面肌腱进入近端滑车的入口处（这里的肌腱纤维鞘起着滑车的作用，摩擦最大）。临床表现为手指‘铰锁’状，屈伸活动受限，伴有弹响声。掌骨头掌侧皮下可触及压痛性结节。狭窄严重者手指固定于伸直位不能屈曲或固定于屈曲位不能伸直。传统的手术治疗方法口’为掌指关节掌侧皮横纹远侧作2cm左右横切口，切开或切除狭窄腱鞘，使肌腱压迫得到松解。我院1995-2005年，采用微创纵行小切口（0．5cm长）手术治疗扳机指。效果确切，手术时间短（约3min），无并发症发生。     

骨间背神经损伤28例分析

<正> 我院于1987～1998年共收治骨间背侧神经损伤28例,其中神经断裂12例,粘连卡压16例。均行手术治疗。经随访1～12个月功能恢复满意,报告如下。 1.临床资料 一般资料 本组28例,男20例,女8例,年龄6～48岁。陈旧性切割伤12例,陈旧性孟氏骨折4例,小夹板应用不当造成压迫3例,前臂摔伤5例,动物踢伤1例,过劳损伤3例。发病至就诊时间1～6个月。     

Effect of A3 pulley and adjacent sheath integrity on tendon excursion and bowstringing

Effect of A3 pulley and adjacent sheath integrity on tendon excursion and bowstringing@Xie RG     

Effect of pulley integrity on excursions and work of flexion in healing flexor tendons

Effect of pulley integrity on excursions and work of flexion in healing flexor tendons@Wang YH @Gu YT @Chen F     

腱鞘移植在严重腱周组织损伤中肌腱修复的应用

为探索屈指肌腱鞘背侧重建技术的屈指肌腱修复效果。对24例屈指肌腱Ⅱ区损伤手指,运用游离腱鞘移植修复其屈指腱背侧腱鞘。游离腱鞘取自同侧手腕背第一间隔。屈指腱鞘背侧重建技术用于早期或延迟早期屈指肌腱损伤、二期肌腱移植修复和肌腱粘连松解术时有骨面裸露或挫伤者。根据Strickland评价标准,结果优7指,良11指,中5指,差1指,优良率为75％。用游离自体移植腱鞘重建背侧屈指腱鞘,是提高严重腱周组织损伤的肌腱修复的一种有效方法。     

手指屈肌健实验研究常用动物筛选

本文对国外手指屈肌腱动物实验中常用的狗、兔、鸡在解剖显微镜下进行了解剖,通过对肌腱、腱鞘、滑车、腱纽等结构的观察比较,认为:鸡具有指蹊与人相似,趾分节均衡,有握持本能。肌腱易显露,腱鞘、腱纽等结构清楚,可应用多个趾等优点,是研究手指屈肌腱较理想的实验动物。     

微创治疗指屈肌腱狭窄性腱鞘炎的临床应用

目的 探讨关节镜下微创施行腱鞘切开术治疗指屈肌腱狭窄性腱鞘炎的解剖学基础及临床治疗效果。方法在5具新鲜成人上肢标本上,对手掌部指屈肌腱及肌腱周围神经血管组织进行解剖学研究,确定关节镜下治疗指屈肌腱狭窄性腱鞘炎手术入路点及出口、操作标志线、镜下操作层面。依据解剖学研究结果,实施关节镜下治疗指屈肌腱狭窄性腱鞘炎82例,与同期行传统腱鞘切开手术的87例患者进行对比。结果5具解剖标本上关节镜下微创治疗指屈肌腱狭窄性腱鞘炎具有合适的手术入路点及出口、操作标志线、镜下操作层面。临床行关节镜下微创治疗指屈肌腱狭窄性腱鞘炎手术82例,术后按照治疗效果、视觉模拟评分法(visual analogue scale,VAS)进行比较,治疗效果满意,疼痛情况明显改善,手指弹响消失。微创治疗指屈肌腱狭窄性腱鞘炎手术切口细小,伤口不需缝合,术后无明显瘢痕疼痛,恢复时间短,较传统腱鞘切开手术具有优点。结论关节镜下微创治疗指屈肌腱狭窄性腱鞘炎有其解剖学基础,能达到解除肌腱卡压及腱鞘切开的手术目的,是指屈肌腱狭窄性腱鞘炎的有效治疗方法。     

Surgical management of the tendon sheath at different repair stages. Biomechanical and morphological evaluations of direct sheath closure, partial sheath excision, and interposing sheath grafting.

The effects of direct sheath closure, partial sheath excision, and interposing sheath grafting at different repair stages were evaluated in the chicken model. Primary repair was done after sheath incision and tendon transection, and delayed primary repair was done 4 days after sheath and tendon injuries. The sheath grafting was accomplished by interposing a patch of sheath between the longitudinal incision of the plantar sheath. Six weeks later, biomechanical tests for measuring gliding excursions of the repaired tendons, morphological examinations of the extent of adhesions, and histological observations of the closed sheath or the grafted sheath were carried out. At the primary repair stage, the sheath interposing graft achieved more significant gliding excursion than the groups of direct sheath closure (P less than 0.01) and partial sheath excision (P less than 0.001), and no difference was found between the latter two groups (P greater than 0.05). At the delayed primary repair stage, the sheath interposing graft group was better than the partial excision graft group (P less than 0.05), and the partial excision group was better than the direct closure group (P less than 0.001). The sheath graft and sheath closure at the primary repair stage prevented adhesion formation, but the directly closed sheath did not keep intact after the delayed primary repair and extensive adhesion occurred. In this paper, the importance of volume of the repaired sheath tunnel and possible reasons for results of the delayed primary sheath closure were discussed and the management of flexor tendon sheath for different injuries at different repair stages was suggested.

     

小指固有伸肌移位拇对掌功能重建术及其术后并发症

目的：探讨小指固有伸肌腱移位拇对掌功能重建术的优点、并发症及其处理方法。方法：采用以小指固有伸肌为力源,以尺骨下端尺侧缘为滑车,将移位腱分二束后,将其近侧束固定于拇掌指关节近侧拇长伸肌腱,而将另一束固定于拇掌指关节远侧拇长伸肌腱（津下法２３例）或将远侧束固定部位改为近节指骨桡背侧骨内（我们的改良法５８例）。其中后期１８例针对术后小指伸直不全,采用切断环、小指指总伸肌腱间腱联合的方法。结果：７２例术后随访平均２９个月,无明显并发症、效果满意者６６例,总满意率为９１６％ 。其中,早期５４例中发生小指伸直不全者３例、“鹅颈畸形”３例;后１８例采用切断环、小指指总伸肌腱间腱联合的方法后,无一例发生小指伸直不全现象。结论：在拇对掌功能重建术中,将小指固有伸肌腱可作为首选力源,但术后可能发生小指伸直不全,切断环、小指指总伸肌腱间腱联合的方法是预防该并发症的有效手段。术后发生的“鹅颈畸形”可以用改进移位固定部位的方法予以预防。     

腱鞘修复对屈指肌腱损伤修复影响的实验研究

本文报告了对兔进行的①切除腱鞘;②从侧面切开腱鞘;③从掌面正中切开腱鞘等3种手术后,吻合后的不全横断深腱与腱鞘的愈合情况。术后各术趾的活动范围、腱滑动距离在3种手术问无统计学差异;组织学显示3种方法中,3周时深腱与鞘间粘连最明显,以后减少。说明在一定条件下,不修复腱鞘,也可有较好的手术效果。     

Biomechanical and Macroscopic Evaluations of the Effects of 5-Fluorouracil on Partially Divided Flexor Tendon Injuries in Rabbits

Background:

The main goals of flexor tendon surgery are to restore digital motion by providing tendon healing and to preserve tendon gliding. Our purpose was to investigate the effects of 5-fluorouracil (5-FU) on tendon adhesions in partially divided profundus flexor tendons (flexor digitorum profundus [FDPs]) following surgical repair and in partially divided FDPs without surgical repair, and to compare the results of the repair versus the nonrepair of zone two injuries via macroscopic and biomechanical evaluations of tendon adhesions.

Methods:

We used 32 adult male European rabbits (Oryctolagus cunniculus) weighing from 2.5 to 3.5 kg. The study was performed on the deep flexor tendons of the second and third digits of the right hind paws of the rabbits; thus, a total of 64 tendons were examined in this study.

Results:

Based on the results achieved in our experimental study, the load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared with subgroup 2a in which tendons were surgically repaired and treated with 5-FU.

Conclusions:

The load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared to subgroup 2a in which the tendons were surgically repaired and treated with 5-FU. Therefore, these results revealed a decrease in adhesion formation in the subgroup that was treated with 5-FU due to increased resistance to tendon adhesions during their excursion through the tendon sheath, which in this case required greater traction force.