改良Kessler交叉缝合法修复屈指肌腱断裂

目的总结用改良Kessler交叉缝合法修复屈指肌腱断裂的临床应用及体会。方法自2006年1月-2008年12月间我院共收治96例296条急性屈指肌腱断裂的患者，其中男51例，女45例，左侧33例，右侧63例，其中屈拇长肌腱40条，示指屈指浅肌腱29条，示指屈指深肌腱20条，中指屈指浅肌腱27条，中指屈指深肌腱21条，环指屈指浅肌腱32条，环指屈指深肌腱24条。小指屈指浅肌腱27条，小指屈指深肌腱24条；I区损伤61条，II区损伤78条，III区损伤64条，IV区损伤52条。V区损伤41条；年龄8～56岁，平均41岁。本组96例296条肌腱均采用改良Kessler交叉缝合法修复。结果本组病例伤口一期愈合89例。二期愈合7例。有86例251条获得随访，随访时间8个月～1年7个月，平均11．5个月。随访期内肌腱再断裂3例4条．术后肌腱粘连15例31条。肌腱再断裂及术后肌腱粘连的病例二期手术治愈。根据1975年美国手外科学会推荐的TAM（total active movement，TAM）系统评定方法：优146条，良89条，可11条，差5条，优良率93．6％。结论采用改良Kessler交叉缝合法修复屈指肌腱断裂是一种安全、有效的方法。

Repair of Flexor Tendon Injury by Modified Kessler Cross-stitch Suture

Objective To summarize the clinical application and experience of repairing the flexor tendon injury by modified Kessler Cross-stitch Suture. Methods From January 2006 to December 2008, our hospital totally accepted and treated 96 cases （296 pieces） of acute flexor tendon injury; among which 51 patients were male, 45 patients were female; 33 cases were left side and 63 cases were right side. 40 pieces were flexor pollicis longus tendon, 29 pieces were flexor digitorum superficialis tendon of forefinger, 20 pieces were flexor digitorum profundus tendon of forefinger, 27 pieces were flexor digitomm superficiatis tendon of middle finger, 21 pieces were flexor digitomm profundus tendon of middle finger, 32 pieces were flexor digitorum superficialis tendon of ring ginger, 24 pieces were flexor digitorum profundus tendon of ring finger, 27 pieces were flexor digitorum superficialis tendon of little fmger and 24 pieces were flexor digitomm profundus tendon of littler finger. These cases of rupture had 61 pieces in Zone I, 78 pieces in Zone II, 64 pieces in Zone III, 52 pieces in Zone IV, as well as 41 pieces in Zone V. The ages of patients were 8 - 56 years＇ old with an average of 41 years＇ old. 96 cases of 296 pieces in this group were all repaired by modified Kessler Cross-Stitch Suture method. Results 89 cases in this group healed in the first phase and 7 cases healed in the second phase. The hospital followed up 86 cases of 251 tendons. The follow-up period was 8 months - 19 months with an average of 11.5 months. During the follow-up term, three cases of 4 pieces ruptured again, and 15 cases of 31 pieces had tendon adhesion after surgery. The rupture and adhesion of tendon after surgery were cured in the second phase by surgery. According to the evaluation method of TAM （total active movement, TAM） system recommended by American Society for Surgery of the Hand in 1975, 146 pieces were excellent, 89 pieces were good, 11 pieces were passable and 5 pieces were not good. The excellent rate was 93.6%. Conclusion The modified Kessler Cross-Stitch method is a safe and effective method for repairing flexor tendon injury.