闭合性锤状指手术治疗后并发症的防治

目的探讨手指末节闭合性损伤致I区指伸肌腱损伤手术治疗后的并发症及其防治方法。方法2005年1月-2012年1月收治手指末节闭合性损伤致I区指伸肌腱损伤未合并末节指骨撕脱骨折患者262例，首诊时间在伤后2h-4周。早期采取保守外固定治疗，其q-147例痊愈：115例因外固定去除后仍有DIP背伸受限，欠伸度在250～350，而再次就诊。于伤后6～13周改行手术治疗。术后110例获平均6个月的随访。结果5例并发伤指末节背侧皮肤坏死，8例合并PIP，DIP关节囊挛缩、关节僵硬，3例合并切口及针道感染，2例合并末节指体血运障碍，6例病情复发。结论重视围手术期的术区皮肤准备，循序的指间关节活动度练习以及合理的手术切口设计，“无创操作”是手术治疗闭合性锤状指取得良好预后避免手术并发症发生的可靠保证。

Prevention and treatment of surgical complication in closed mallet finger

Objective To explore the prevention and treatment of surgical complication in closed mallet finger. Methods Between January 2005 and January 2012, 262 patients with closed mallet finger were treated with method of external fixation, 147 patients were healed and 115 patients were retreated by surgical procedure （due to poor result of external fixation）, the interval from injury to operation was 6~13 weeks. 110 patients were followed-up for 3~9 months, with an averge of 6 months. Results There were 24 cases with postoperative complication： contracture of PIP and DIP in 8 cases, incision and pin infection in 3 cases, blood disorder on distal part of finger in 2 cases, skin necrosis on dorsal aspect of finger in 5 cases, recurrence in 6 cases. Conclusion The key points for avoiding occurrence of surgical complication and achieving satisfactory prognosis in treatment of closed mallet finger include reasonable design of surgical in- cision and functional exercises, minimally invasive procedure, and aseptic management in perioperative period.