腱缝合后鞘内置入法在Ⅱ区屈肌腱修复中的临床应用

目的介绍用腱缝合后鞘内置入法，治疗Ⅱ区屈肌腱损伤的方法和疗效。方法按该法治疗屈肌腱损伤４６例７７指。伸直型１２例２６指：经原腱鞘伤口缝合肌腱，术毕将肌腱缝合部置于近侧健康鞘管内。屈曲型３４例５１指：在肌腱远断端以远约０．５ｃｍ处另作腱鞘切口，经此切口将损伤腱近端拉出进行缝合，术毕将腱缝合口置于远端切口和原伤口间的完整鞘管内。结果术后随访到３８例５９指，随访时间为２个月～３年，平均１年８个月。按ＴＡＭ评定法评定疗效，优级：３０指，良级：１７指，余为中差级；总优良率达到７９．７％。锐器切割伤４３指，疗效优良者４２指占９７．７％；合并腱鞘及周围组织损伤１６指，疗效优良者５指占３１．３％。结论该术式对单纯指屈肌腱损伤疗效满意，这可能和术时腱鞘损伤轻，肌腱缝合口被健康鞘管包绕后，有利于肌腱的内源性愈合并减少了外源性愈合的参与有关

Intrasheath embedding of the suturing site in flexor tendon repair in Zone II

Objective To introduce a new surgical procedure to lessen the postoperative adhesion of flexor tendons and improve the operative quality. Methods Flexor tendon injuries were divided into two types according to the digital position at the moment of injury: the extension type and the flexion type. The flexor tendons of the extension type were repaired via the original cut on the sheath. The suture site of the tendon slided into the proximal intact part of the sheath canal after repair. For the flexion type, an additional incision was made on the sheath 0.5cm distal to the distal tendon stump, and the tendon was repaired via this incision. The suture site was then placed in the intact sheath canal between the two cuts. The procedure was applied in 46 cases, among which 12 were extension type and 34 were flexion type. Results 59 tendons of 38 cases were followed up for an average of 1.8 years. 43 tendons were clear cut injuries. Assessed by TAM standard, the excellent or good rate was 79.7% whereas that of clear cut tendons 97.7%. Conclusion Intrasheath embedding of the suture site is an optimal surgical procedure in flexor tendon repair in Zone II.