指浅屈肌腱腱条修复指间关节侧副韧带23例

介绍指浅屈肌腱腱条修复近节指间关节侧副韧带的方法及疗效。方法： 对２３ 例近节指间关节侧副韧带断裂, 采用部分指浅屈肌腱修复。用细克氏针在侧副韧带起点处向健侧钻２ 个相距２－０ ～３－０ ｍ ｍ 骨孔并穿过钢丝。从指浅屈肌腱相邻侧近端切取所需长度肌腱条, 此肌腱条穿过钢丝孔, 调整好张力, 用５ － ０ 或７ － ０ 无创线缝合于浅腱止点, 用８ － ０ 无创性针线将腱条缝合于韧带止点上。术后伸直位夹板固定４ ～６ 周。结果： 优１５ 指, 良６ 指,可２ 指, 优良率９１－３４ ％ 。结论： 本手术损伤小, 就地取材, 是一种较简单有效的方法。     

近节指间关节侧副韧带断裂三种治疗方法的疗效比较

目的比较非手术治疗、韧带修复和韧带重建三种方法对治疗近节指间关节侧副韧带断裂的疗效。方法１９７５～１９９５年间，用上述方法治疗近节指间关节侧副韧带断裂６１例６７指。结果术后随访２．５～１９年，按Ｓａｅｔａ等评定标准评定疗效，１９指用保守疗法者其优良率为５５％，２３指行侧副韧带修复术和２５指行掌长肌腱移植重建侧副韧带者，其优良率为６８％和９４％。结论近节指间关节侧副韧带断裂时应首选侧副韧带重建术。     

阶梯状修复指屈肌腱Ⅱ区损伤的解剖学研究

目的探讨阶梯状修复指屈肌腱Ⅱ区损伤后肌腱滑动幅度的实验效果,为临床治疗指屈肌腱损伤提供解剖学依据。方法对2015年12月-2017年8月上肢损伤截肢成人患者新鲜手标本15例进行前瞻性研究。按抽签法随机分为三组制作指屈肌腱Ⅱ区断裂模型,每组5例,每例取示指、中指、环指、小指,共20指。A组模拟手指掌指关节、近指间关节和远指间关节屈0°伸直位时,切断指深屈肌腱和指浅屈肌腱;B组模拟手指掌指关节屈60°、近指间关节和远指间关节屈0°安全位时,切断指深屈肌腱和指浅屈肌腱;C组模拟手指掌指关节屈80°、近指间关节屈90°位和远指间关节屈10°握拳位时,切断指深屈肌腱和指浅屈肌腱。切断屈肌腱后,三组标本均屈曲手指至掌指关节60°,近侧、远侧指间关节屈曲0°安全位,用石膏固定。测量三组指浅屈肌腱远端断口和指深屈肌腱远端断口间的长度差,根据娄义忠提出将肌腱缝合处与损伤腱鞘错开,有利于肌腱愈合和塑形的观点,对远端肌腱进行修剪,使指浅屈肌腱的缝线和指深屈肌腱的缝线不产生重叠,减少粘连的程度和范围,采用MTang缝合法修复指深屈肌腱和指浅屈肌腱。肌腱修复后,观察手指标本被动屈伸活动。结果 (1)三组指深屈肌腱断口和指浅屈肌腱断口安全位长度差测量数据利用方差分析,P=0.000 0.05,即三组实验的指深屈肌腱断口和指浅屈肌腱断口间的长度差不全相等,可以研究三组实验。(2)肌腱修复后手指标本被动屈伸活动度与实验前相同,被动牵拉肌腱近端各关节活动度与实验前相同。结论不同指位下屈肌腱Ⅱ区断裂时,术中短缩0.6～1.0 cm远端指深屈肌腱或指浅屈肌腱,利用指深屈肌腱断口和指浅屈肌腱断口在安全位长度差为1.0 cm,保持两个断口位于正常组织环境包围,可以促进愈合。阶梯状修复法为临床指屈肌腱Ⅱ区损伤提供新的手术选择。     

保留指深屈肌腱止点肌腱移位重建远指间关节侧副韧带

目的 研究保留指深屈肌腱止点部分肌腱腱条移位重建远指间关节侧副韧带的方法及疗效.方法 2005年至2011年,对14例16指新鲜远指间关节侧副韧带中部损伤及陈旧性损伤的患者,采用保留指深屈肌腱止点部分肌腱腱条移位重建侧副韧带.结果 术后14例16指获得6个月至3年的随访,平均2.3年.按Saetta等评定标准评定疗效:优10例12指,良3例3指,可1例1指;优良率为93.8％.结论 该方法对于肌腱移位后的手指屈伸功能及肌力无影响,保留指深屈肌腱止点部分肌腱腱条移位重建远指间关节侧副韧带,是治疗手指远指间关节侧副韧带损伤的一种简单、有效的方法.     

儿童小指旋转撕脱性断指再植

1997年 2月～ 1999年 8月 ,我们对 7例儿童小指旋转撕脱性断指进行再植 ,取得了比较满意的疗效。1　资料与方法1. 1　一般资料本组共 7例 ,男性 3例 ,女性 4例 ;年龄 7～ 13岁 ,平均 10岁。致伤原因 :机器皮带轮伤 4指 ,摩托车链条伤 3指 ,均为单指完全离断。受伤平面 :中节 4指 ,近节 3指。1. 2　手术方法(1)骨、关节修复 :7个手指骨缩短 0 5ｃｍ～ 0 8ｃｍ ,重建骨支架采用纵行克氏针或交叉克氏针固定 ,其中远侧指间关节融合 2指 (2 )肌腱修复 :屈肌腱缝合用ｋｅｓｓｌｅｒ法 ,伸肌腱用褥式法。其中环指浅屈肌腱转位修复指深屈肌腱 3指 …     

4V-Y皮瓣矫正近指间关节屈曲挛缩

目的: 介绍4V-Y皮瓣矫正近指间关节屈曲挛缩的手术方法。方法: 4V-Y皮瓣矫正近指间关节屈曲挛缩的手术方法, 即平指屈皱褶作短的横切口, 切断指浅屈肌腱, 松解掌侧关节囊, 甚至部分侧副韧带, 达到近指间关节伸直的目的。结果: 本组50例(65个手指), 除3个手指术后由于伤口感染功能恢复较差外, 其余均较满意。结论: 用此方法均能达到矫正近指间关节屈曲挛缩的目的。     

手指中节远端毁损伤术后屈曲畸形的预防

手指中节远端毁损伤，常规残端缝合术后，常可因指浅屈肌键与伸肌键中央束肌力不平衡，导致近指间关节屈曲畸形，影响手的正常功能。我们自1997年1月-2000年1月，行伸肌腱加强及克氏针内固定术21例，预防近指间关节屈曲畸形，均取得满意效果，现报道如下。     

双侧等长指浅屈肌腱外侧腱束治疗纽扣指畸形

目的探讨应用双侧等长指浅屈肌腱外侧腱束转至指背侧治疗纽扣指畸形的临床效果。方法回顾性分析2021年2月至2022年5月, 南京江北医院手足显微外科收治的纽扣指畸形患者的临床资料。将指浅屈肌腱外侧近止点处向近端各劈出1束, 形成双侧等长外侧腱束, 于中节指骨基底部钻孔, 再将双侧等长外侧腱束经骨孔转至背侧, 与伸肌腱中央腱近断端编织缝合。术后用支具将患指伸直位固定4周, 逐步加强患指近指间关节伸屈运动。术后随访观察近指间关节主、被动伸屈活动, 参照美国手外科协会总主动活动度(TAM)系统评定手指功能。结果共纳入7例(7指)患者, 男5例5指, 女2例2指;年龄22～64岁, 平均42岁。受伤指别:示指1例, 中指2例, 环指2例, 小指2例。所有病例均获随访6～8个月, 平均7个月, 术后7例(7指)切口均无感染, 一期愈合, 纽扣指畸形均完全矫正。末次随访时患指近指间关节均能主动屈曲、伸直, 近指间关节、远指间关节伸直均达至正常范围, 患指近指间关节主动活动度平均为92.4°, 患指TAM平均为271.3°。参照TAM功能评定法进行评价:优6指, 良1指。结论应用双侧等长指浅屈肌腱外侧...     

微型骨锚钉修复近侧指间关节侧副韧带断裂

目的探讨微型骨锚钉修复近侧指间关节侧副韧带断裂。方法25例近侧指间关节侧副韧带断裂患者采用微型锚钉修复断裂侧副韧带,稳定近侧指间关节。结果25例患者随访6～18个月,按TAM评定标准,优8例,良13例,差4例,优良率84％。结论微型骨锚钉修复近侧指间关节侧副韧带断裂疗效可靠,手术简单。     

近节指间关节处屈肌腱腱鞘的功能研究

目的探索Ａ３、Ｃ１和Ｃ２滑车对指深屈肌腱及近节指间关节活动的影响。方法采用１０只尸体手示、中、环指，将掌指关节及远节指间关节固定后，进行以下４个阶段的实验：（１）腱鞘完整；（２）Ａ３滑车切除；（３）Ａ３及其近端切开；（４）Ａ４与Ａ２滑车间的腱鞘切开。牵拉指深屈肌腱至近节指间关节屈曲到１１０度时，测量指深屈肌腱的滑动距离。用方差分析法比较各实验阶段结果的差异。结果Ａ３及其周围腱鞘切除后，指深屈肌腱的滑动距离显著增加（Ｐ＜０．０５或＜０．０１），并出现明显的“弓弦＂状畸形。结论研究结果提示临床上行肌腱修复时应注意保留近节指间关节附近滑车的功能。     

应用显微外科技术修复儿童手指屈指肌腱损伤

目的 减少儿童手指屈指肌腱损伤在处理上的失误,最大限度地恢复患儿手指功能。方法 １９９０年１月～１９９７年１０月收治１２例儿童屈指肌腱损伤,均在显微镜下清创,用３／０或５／０无损伤线,采用改良Ｋｅｓｓｌｅｒ方法缝合,７／０或８／０无损伤线周边内翻缝合,术后进行有控制条件的功能锻炼。结果 患指术后均１期愈合。经过６个月～１年随访,按ＴＡＭ测定法评定,优７例,良４例,可１例,优良率９１．６７％。结论：     

不同手术方式治疗糖尿病患者手指屈肌腱止点断裂的临床研究

目的分析传统术式（皮下隧道细钢丝加压缝合术）及微型带线锚钉修复术治疗外伤性手指屈肌腱止点断裂糖尿病患者的疗效，以评估微型带线锚钉修复糖尿病患者屈肌腱止点断裂的临床疗效及可行性。 方法前瞻性收集石家庄市第二医院和唐山市第二医院的外伤性手指屈肌腱止点断裂的糖尿病患者60例，随机分为试验组（微型带线锚钉修复）及对照组（皮下隧道细钢丝加压缝合术）。两组患者术后2、3、4个月行患指功能、伤口愈合评定，比较行两种术式后手指屈伸功能。 结果60例患者均获得随访，末次随访时试验组与对照组相比MP和PIP屈伸活动度，差异无统计学意义；试验组与对照组相比DIP屈伸活动度和TAM值差异有统计学意义，且试验组DIP屈伸活动度和TAM值大于对照组；手运动功能TAM分级：试验组优23例，良6例，可1例；对照组优22例，良6例，可2例。 结论微型带线锚钉修复糖尿病患者屈肌腱止点断裂能够有效地防止和减少肌腱粘连，显著提高患指术后的屈伸功能，是一种有效的、可行的术式，较传统术式具有较大优势。     

单枚克氏针固定并切开修复肌腱治疗锤状指畸形

目的 探讨应用单枚克氏针贯穿固定远、近侧指间关节治疗锤状指的临床疗效.方法 2005年2月-2007年8月,对18例锤状指行手术治疗.采用单枚1mm克氏针将远侧指间关节(DIP)固定于过伸位,同时贯穿固定近侧指间关节(PIP)于屈曲45°～60°位;修复伸肌腱,如伸肌腱止点处断裂或伴有撕脱骨折者,用微型骨锚或抽出式钢丝法固定.术后3周解除近侧指间关节固定,6周完全拔除克氏针.结果 术后随访2～6个月,远侧指间关节伸屈活动度为O°～70°11例,0°～600°4例,0.～55°2例,0°～35°1例.将患指与健指远侧指间关节的活动度相比较,参照TAM系统评定方法评定:本组优11例.良6例,差1例;优良率为94.4%.结论 应用单枚克氏针固定并切开修复肌腱.操作简单,固定牢靠,是治疗锤状指的有效方法.     

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。     

The isolated scapho-trapezio-trapezoid ligament injury : Diagnosis and surgical treatment in four cases

Isolated injuries of the scapho-trapezial ligament complex are not well recognized. The ligament complex comprises the stout scapho-trapezial ligament, the floor of the flexor carpi radialis (FCR) tendon sheath and the scapho-capitate ligament.Between August 1991 and May 1992, we diagnosed and treated four cases of partial chronic post-traumatic lesions of this ligament complex. There was chronic pain at the base of the thenar eminence and instability of the thumb-index-middle finger pinch. Standard X-rays were normal. The diagnosis of ligament rupture was confirmed by mid-carpal arthrography showing filling of the sheath of FCR tendon. Surgical exploration showed complete rupture of the tendon sheath of FCR in two cases, associated in the other two cases with complete rupture of the scapho-trapezial ligament. Direct repair of the ligamentous elements was performed in all cases. The tendon of FCR was sutured to the tubercle of scaphoid to protect and to reinforce the ligament repair.The patients have been followed-up for between 6 and 12 months. All four patients recovered normal pinch strength to the middle finger. One patient suffered from chronic pain at work.     

Closed rupture of flexor tendon by hyperextension mechanism in wrist level (zone V): a report of three cases

Closed flexor tendon ruptures due to trauma without external wound are rare. When the flexor tendon has excessive loading, failure occurs at the tendon insertion or its origin from the bone. It is likely to result in avulsion fracture rather than rupture of the proper portion of the tendon by forceful grasping with hyperextension. However, we have experienced three cases of closed flexor tendon ruptures at zone V, caused by forceful grasping or hyperextension mechanism against resistance. On physical examination, these patients could not flex interphalangeal joint of thumb or distal interphalangeal joint of the fifth finger. All patients underwent MRI or ultrasonography to find out the location of loss in continuity of the flexor tendons before the operation. After identifying the location, flexor tendon repair or tendon graft using palmaris longus were performed.     

Subcutaneous rupture of the flexor tendon of the little finger associated with anomalous flexor digitorum superficialis.

A 59-year-old man suffered from subcutaneous rupture of the flexor tendon of the little finger associated with fracture of the hook of hamate. He could not flex his little finger completely at the distal interphalangeal joint, but incomplete flexion of the proximal interphalangeal joint was possible. Surgical exploration revealed anomaly of the flexor digitorum superficialis of the little finger, as it originated from the palmar aspect of the carpal ligament, and a small portion of the muscle belly was traversed toward the A1 pulley over the profundus tendon and then it ran into the A1 pulley as a normal superficialis tendon. The flexor digitorum superficialis of the little finger is well known to show variations, but our case is extremely rare, and furthermore there are no reports in the available literatures about the function of this anomalous muscle.     

Reconstruction of Neglected Flexor Hallucis Longus Tendon Rupture: A Case Report

Isolated rupture of the flexor hallucis longus tendon is an unusual injury. We present the case of a neglected flexor hallucis longus tendon closed traumatic rupture at the plantar aspect of the first phalangeal head of the great toe in a middle-age male. The injury occurred while he was dancing. Because end-to-end tendon suture was impossible, the ensuing gap was repaired using a free plantaris tendon graft. We present the operative repair benefit of the flexor hallucis longus tendon rupture to regain the function and strength of the interphalangeal joint of the hallux, avoid extension of the distal phalanx, and maintain the longitudinal arch of the foot.     

吻合口无结Kessler缝合法修复指屈肌腱的疗效观察

目的通过与传统Kessler缝合法比较,分析吻合口无结Kessler缝合法修复指屈肌腱的疗效及优势。方法回顾分析2005年2月-2010年2月采用吻合口无结Kessler缝合法治疗的122例163指243根指屈肌腱断裂患者临床资料(试验组),术中一期显微缝合指屈肌腱,修复腱外膜、腱鞘及腱周组织,应用透明质酸钠充填治疗。并与2001年2月-2005年2月采用传统Kessler缝合法治疗的96例130指186根指屈肌腱断裂患者(对照组)临床资料进行比较。两组患者性别、年龄、损伤原因、损伤部位、病程等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术后3周内采用Kleinert橡皮筋牵引疗法(动态支具保护),并于24 h后开始手指功能锻炼。结果术后试验组2例、对照组5例切口发生感染,经换药后2周愈合;其余患者切口均Ⅰ期愈合。患者均获随访,随访时间6～14个月,平均9个月。术后6个月手指功能采用主动活动度(total active movement,TAM)法评定,试验组TAM为(192.0±13.1)°;其中获优54例,良58例,中8例,差2例,优良率为92%。对照组TAM为(170.0±15.2)°;其中获优23例,良30例,中22例,差21例,优良率为55%。两组TAM比较,差异有统计学意义(P<0.01)。结论吻合口无结Kessler缝合法治疗指屈肌腱断裂,辅以腱外膜、腱鞘及腱周组织修复后,手指功能恢复优于传统Kessler缝合法,但远期疗效仍需进一步观察。     

Rupture of small finger flexor tendons secondary to asymptomatic nonunion of the hamate hook

The incidence of fractures of the hamate hook (hamulus) has been reported to be between 2% and 4% of all carpal fractures. Untreated hamulus nonunion can cause attritional rupture of the ulnar digits' flexor digitorum profundum tendons. Rupture of flexor tendons due to nonunion of the hook of the hamate is an uncommon injury. Most surgeons treat the tendon lesion by a graft, transfer of the superficial flexor of the ring finger, or terminolateral suture of the distal stump of the deep flexor tendon of the little finger to the deep flexor tendon of the ring finger. This article reports a case of a 52-year-old right-handed man who presented with weakness of grip and loss of active flexion of both distal and proximal interphalangeal joints of the right small finger lasting 2 weeks due to grip strength while working. The clinical history and the physical examination were dissonant, and a computed tomography scan revealed a nonunion of the hamulus. Intraoperatively, the nonunion of the hamate hook was identified and the bony ossicle excised. The flexor digitorum profundus and superficialis to the small finger were both ruptured. The flexor digitorum profundus tendon was repaired with a termino-terminal suture. The patient returned to work within 3 months without restriction. Six months postoperatively, the patient had no pain and achieved full active flexion of the small finger.