【摘要】：目的：近指間關節(jié)側副韌帶起止點損傷臨床較常見，若治療不當，可引起慢性疼痛、關節(jié)不穩(wěn)，嚴重時甚至形成關節(jié)炎。經典的治療方法為Bunnell法，但操作復雜，恢復時間長。隨著骨錨系統(tǒng)成功應用于大關節(jié)內韌帶的修復，很多學者將其應用于腕、肘關節(jié)，在生物力學及臨床方面均有較為深入的研究。我們采用微型骨錨修復急性閉合性近指間關節(jié)側副韌帶起點或止點損傷，重建側副韌帶起點或止點，并采用多項觀察指標，系統(tǒng)評價術后療效，取得了滿意效果。 方法：我院2011年至2013年共收治14例14指急性閉合性近指間關節(jié)側副韌帶起點或止點損傷患者，傷后就診時間為1-5天，平均2.2天，患者受到側方暴力或旋轉暴力，均主訴手指疼痛，查體見關節(jié)腫脹，壓痛明顯，指神經阻滯麻醉下行側方應力試驗，屈曲和伸直位傾斜角度大于20°，患指X線檢查見關節(jié)間隙增寬，伴或不伴撕脫骨折。明確診斷后采用手術治療，術中切開暴露斷端，見側副韌帶自起點或止點處撕脫，應用微型骨錨植入，重建斷裂側副韌帶起點或止點。術后石膏固定，第2天開始保護性練習，防止關節(jié)僵硬，2周拆除縫線，3周拆除石膏，逐漸進行功能練習。根據患者情況，進行電話隨訪，并囑患者在特定時間內來醫(yī)院復診，復診內容包括患者主觀滿意度，患指有無腫脹、畸形、疼痛，關節(jié)活動度大小，行側方應力試驗，X線檢查觀察骨錨有無松動、脫落等，再采用seatta功能評定標準評估療效。 結果：術后患者均得到隨訪，隨訪時間為6～15個月，平均為10.7個月，所有患者主觀滿意度均較高，贊同該治療方案，并表示若有其他手指再受傷，可繼續(xù)按該治療方案處理；患指指間關節(jié)被動活動穩(wěn)定、無疼痛，與健側相比未見明顯差異；關節(jié)活動度（ROM）70°-110°，平均為91.4°；關節(jié)腫痛均在術后2個月內緩解，未見關節(jié)畸形；側方應力試驗陰性，關節(jié)側方穩(wěn)定性良好；復查X線，，骨錨位置確切，無松動、脫落現(xiàn)象。采用seatta評價標準進行評定，優(yōu)12例，良1例，可1例，優(yōu)良率92.8%。 結論：骨錨系統(tǒng)價格昂貴，部分文獻報道有免疫排斥、皮膚過敏等風險，但我們治療的臨床病例，恢復效果均較好，未見術后并發(fā)癥。與傳統(tǒng)的Bunnell法重建側副韌帶起止點相比，采用微型骨錨治療急性閉合性近指間關節(jié)側副韌帶起點或止點損傷的方法簡便易行，節(jié)約時間，患者及醫(yī)生可接受性強，且術后韌帶固定牢固，可早期行功能鍛煉，療效滿意，值得臨床推廣。
[Abstract]:OBJECTIVE: The injury of the collateral ligament near the interphalangeal joint is common in clinic. If not treated properly, it can cause chronic pain, joint instability and even arthritis. The classical treatment is Bunnell's method, but the operation is complicated and the recovery time is long. The miniature bone anchor was used to repair the acute closed injury of the collateral ligament of the proximal interphalangeal joint and reconstruct the collateral ligament of the wrist and elbow joints.
Methods: From 2011 to 2013, 14 patients with acute closed injury of the collateral ligament of the proximal interphalangeal joints were admitted to our hospital. The average time of treatment was 2.2 days, ranging from 1 to 5 days. All patients complained of finger pain caused by lateral violence or rotational violence. Experiments showed that the inclination angle of flexion and extension was greater than 20 degrees. X-ray examination showed widening of joint space with or without avulsion fracture. Protective exercises were started on the 2nd day to prevent joint stiffness, sutures were removed for 2 weeks, plaster was removed for 3 weeks, and functional exercises were carried out gradually. Force test and X-ray examination were used to observe whether the bone anchor was loose or shedding. Seatta criteria were used to evaluate the curative effect.
Results: All patients were followed up for 6 to 15 months, with an average of 10.7 months. All patients had high subjective satisfaction. They agreed with the treatment plan and said that if other fingers were injured again, they could continue to be treated according to the treatment plan. The ROM ranged from 70 degrees to 110 degrees, with an average of 91.4 degrees. The swelling and pain of the joints were relieved within 2 months after operation without any joint deformity. The lateral stress test was negative and the lateral stability of the joints was good.
CONCLUSIONS: Bone anchor system is expensive, and some literatures have reported the risk of immune rejection and skin allergy, but in our clinical cases, the recovery effect is good without postoperative complications. The method of point injury is simple, time-saving, acceptable to patients and doctors, and the ligament is firmly fixed after operation. It can be used for early functional exercise, and the effect is satisfactory. It is worthy of clinical promotion.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R686

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