经骨隧道钢丝环扎治疗骨性锤状指的临床研究

摘要] 目的 评价经末节指骨骨隧道钢丝环扎治疗指伸肌腱止点撕脱骨折的临床疗效。方法 选取2019年8月～2022年7月安徽医科大学第一附属医院手足显微修复重建病区收治的锤状指患者32例，根据治疗方式的不同分为两组，观察组(15例) 采用经骨隧道钢丝捆扎法， 对照组(17例)采用微型骨锚钉法。记录手术时间、观察切口愈合情况及并发症情况。采用 Patel评分评价术后功能恢复。结果 本研究患者均顺利完成手术，术后随访3～24个月，平均9.4个月。术后两组病例应用 Crawford 等评定标准进行评价，经骨隧道钢丝捆扎法组: 优11例，良4例，优良率100%； 微型骨锚钉法: 优11例，良3例，差3例，优良率82.4%，差异无统计学意义( P＞ 0.05) 。经骨隧道钢丝捆扎法组均一期愈合，未出现切口感染、皮肤坏死等并发症，微型骨锚钉法组2例出现线结反应，取出线结后换药二期愈合，差异无统计学意义(P<0.05)。经骨隧道钢丝捆扎法组手术时间短，手术费用低；微型骨锚钉法组手术时间较长，手术费用较高，两组比较，差异有统计学差异(P＜0.05)。结论 经骨隧道钢丝环扎治疗指伸肌腱止点撕脱骨折，手术操作简单，远指间关节功能恢复满意，是一种较理想的治疗方法。

Clinical study on the treatment of bony mallet finger with steel wire ring ligation through bone tunnel

Abstract] Objective To evaluate the clinical effect of the treatment of avulsion fracture of extensor tendon insertion with steel wire encircling through bone tunnel of the distal phalanx. Methods From August 2019 to July 2022, 32 patients with mallet finger who were admitted to the hand and foot micro repair and reconstruction ward of the First Affiliated Hospital of Anhui Medical University were selected. They were divided into two groups according to the different treatment methods. The observation group (15 cases) used the steel wire binding method through bone tunnel, and the control group (17 cases) used the micro bone anchor method. The operation time, wound healing and complications were recorded. Patel score was used to evaluate the postoperative functional recovery. Results All patients in this study successfully completed the operation, and were followed up for 3 to 24 months, with an average of 9.4 months. The two groups of patients were evaluated by Crawford and other evaluation criteria after operation. In the bone tunnel steel wire binding method group, 11 cases were excellent, 4 cases were good, and the excellent and good rate was 100%; Micro bone anchor method: excellent in 11 cases, good in 3 cases, poor in 3 cases, the excellent and good rate was 82.4%, the difference was not statistically significant (P>0.05). In the bone tunnel steel wire binding method group, all patients healed in the first stage without wound infection, skin necrosis and other complications. In the micro bone anchor nail method group, 2 patients had suture reaction. After taking out the suture, they healed in the second stage with dressing changes, with no significant difference (P<0.05). The operation time and operation cost of the group with steel wire binding through bone tunnel were short; The operation time of the micro bone anchor nail group was longer and the operation cost was higher. There was a statistical difference between the two groups (P<0.05). Conclusion The treatment of avulsion fracture of extensor tendon insertion with steel wire encircling through bone tunnel is an ideal method with simple operation and satisfactory functional recovery of distal interphalangeal joint.