鸡跖骨骨折4种内固定方法对肌腱损伤后粘连的影响

目的　探讨鸡跖骨骨折伴肌腱断裂采用不同的内固定方法对肌腱粘连的影响。方法　选用健康鸡 3 3只 ,分成 4组 ,人为造成第三跖骨骨折并切断伸、屈趾肌腱。骨折处分别采用克氏针纵行贯穿、交叉、单根斜向及钢丝十字四种内固定方法 ,同时修复伸、屈趾肌腱并石膏外固定。术后进行主、被动功能锻炼。八周后取材 ,进行大体观察、组织学检查和生物力学测定。结果　骨折大部分愈合 ,除钢丝组及交叉克氏针组外其余组均见有旋转或成角畸形发生 ,纵行克氏针固定组有关节面损伤及关节僵直。屈伸肌腱均完全愈合 ,纵行克氏针固定组与其他各组比较 ,从肌腱滑动度、屈肌腱粘连带长度测定、模拟TAM评分结果可看出 ,肌腱粘连程度相对重 ,功能差 ,经统计学处理P <0 0 5。结论　临床宜选用牢固的、不通过关节的内固定方法 ,有利于预防肌腱粘连 ,促进伤指的功能恢复。

Four metatarsal fracture fixation methods and their impact on repaired tendons: an experimental study in chicken

ObjectiveThe correlation of fracture healing and tendon adhesion in different internal fixation methods was investigated to provide a reliable basis for clinical application.MethodsTransverse fracture of the 3rd metatarsal was created in 33 leon chickens. Meanwhile the extensor and flexor tendons were transected at the same level. 4 types of fixation method were applied according to group assignment. In group A ( n=9 ), the fracture was fixed with longitudinal Kirshner wire. Cross Kirshner wire fixation of the metatarsal was done in group B ( n=8 ). Single oblique Kirshner wire fixation and crucial tension band fixation was carried out in group C ( n=8 ) and group D ( n=8 ) respectively. The extensor and flexor tendons were repaired simultaneously and the legs were immobilized in plaster of Paris cast. Rehabilitation started from the 2nd postoperative week on in an increasing regime. 8 weeks postoperatively fracture and tendon healing and joint movement were observed. Tendon gliding and biomechanic testing were also conducted.ResultsObservation made at the end of the 8th week revealed that most fractures achieved bony union. Various degrees of rotational and angular deformity were seen in groups A and C. In group A, cartilage damage and joint stiffness were present. Extensor and flexor tendons healed in all samples. Tendon adhesion was most severe in tendons of group A, showing reduced excursion and denser adhesion. Total range of motion of the joints in group A was also much limited. There were no significant differences among those of the other 3 groups.ConclusionStrong and joint sparing internal fixation methods should be used for fracture fixation. They are important principles for preventing tendon adhesion and achieving better final function.