本文選題：肌腱損傷 + 肌腱粘連��； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:屈肌腱損傷在臨床中十分常見,修復術后的肌腱粘連是肌腱損傷術后最常見的并發(fā)癥之一,屈肌腱修復術后肌腱粘連更是手外科亟待解決的難題之一。血液供應、淋巴液參與是營養(yǎng)肌腱的兩種主要形式。內源性愈合機制和外源性愈合機制是肌腱愈合的兩種主要形式,肌腱愈合中這兩種形式同時存在。內源性愈合占主導時粘連發(fā)生較少,外源性愈合占主導時粘連發(fā)生較多。因此,促進內源性愈合機制是預防粘連的關鍵�，F(xiàn)在普遍認為早期功能鍛煉可以促進內源性愈合機制從而預防肌腱粘連,這就要求縫合方法需不斷改進以期擁有足夠高的生物力學強度能夠滿足早期功能鍛煉的要求。按照縫線對肌腱的作用方式不同,肌腱縫合方法可以分為鎖式縫合方法和抓握式縫合方法。相較于抓握式縫合方法,鎖式縫合方法的抗拉力強度更大,可以滿足修復術后早期功能鍛煉的需要。我們提出了一種新型鎖式肌腱縫合方法。經過生物力學實驗已經得出結論,其抗拉力強度和抗間隙形成能力大于手指在無阻力主動屈曲時的最大張力,能夠滿足早期主動功能鍛煉的需要。本研究組將ZM縫合法結合3-0TICRON聚酯縫合線運用于臨床,術后輔助早期主動功能鍛煉,旨在觀察評估ZM縫合法通過早期主動功能鍛煉在預防肌腱粘連中的臨床效果,以期指導臨床,為解決預防肌腱粘連這一難題提供一種新方法。方法:自2016年4月至2017年1月,研究者篩選出就診于我院的符合納入標準的33例41指Ⅰ、Ⅱ、Ⅲ區(qū)指屈肌腱損傷患者,其中伴有神經血管損傷者9例。致傷原因:切割傷22例,電鋸傷11例。其中拇指為6指,示指為10指,中指為9指,環(huán)指為9指,小指為7指。指深指淺屈肌腱全部斷裂指數(shù)為28指,指深屈肌腱斷裂為6指,指淺屈肌腱斷裂為7指。所有患者均為急診病人,全部一期縫合修復,指深淺屈肌腱均斷裂時全部縫合修復。從受傷至手術時間為2-4小時左右。手術中修整肌腱斷端后,應用美國泰龍?zhí)┛凭埘タp合線(3-0TICRON聚酯縫合線)行ZM肌腱中心縫合法修復,修復過程嚴格按照ZM中心縫合法的要求進行縫合。中心縫合完畢后以5-0PROLENE縫合線在肌腱吻合口處進行連續(xù)周邊縫合。術后均給予腕關節(jié)中立位,掌指關節(jié)屈曲60度,指間關節(jié)伸直位(圖7-8),石膏均固定4周。術后均常規(guī)給予對癥治療,術后24-48h時即拆除繃帶,放開指間關節(jié),只固定腕關節(jié)和掌指關節(jié)。指導患者進行早期功能鍛煉,方法為:早中晚各2-3組,每組被動屈曲主動伸直活動3-5次,減少因關節(jié)僵硬帶來的阻力,主動屈曲2次。主動屈曲應緩慢適度,以感到有阻力時為止,被動屈曲則應充分,以手指掌側面接觸手掌為止。術后2周左右,適當減少早期功能鍛煉的次數(shù),避免主動屈伸手指活動。術后12-14天拆線,于術后2周、4周、8周、12周時隨訪病人,記錄患指活動度,并使用國際通用的TAM評價系統(tǒng)標準評價優(yōu)良率,并計算優(yōu)良率。結果:32例患者傷口一期愈合,僅有1例患者出現(xiàn)傷口滲液,紅腫現(xiàn)象等炎癥反應,后經過傷口換藥、抗炎治療,傷口愈合。但并未對最終結果產生影響。33例患者均獲得隨訪,隨訪率達到100%。術后1月優(yōu)良率為42.3%,術后2月優(yōu)良率97.0%,術后3月優(yōu)良率100%,且未發(fā)生術后并發(fā)癥,無一例肌腱再次斷裂患者。結論:33例肌腱損傷患者術后無一例肌腱二次斷裂證明了臨床應用ZM肌腱縫合法結合3-0TICRON聚酯縫合線可以滿足早期主動功能鍛煉的需要。且術后3個月優(yōu)良率達到100%。證實了ZM縫合法結合3-0TICRON聚酯縫合線修復斷裂指屈肌腱安全可靠,可以滿足早期主動功能鍛煉的需求,是修復斷裂屈肌腱的優(yōu)選方法之一。
[Abstract]:Objective: flexor tendon injury is very common in clinic. Tendon adhesion after repair is one of the most common complications after tendon injury. Tendon adhesion after flexor tendon repair is one of the difficult problems to be solved in hand surgery. Blood supply, lymph involvement is the two main form of nourishment tendon. Endogenous healing mechanism and exogenous mechanism Healing mechanism is the two main form of tendon healing. These two forms exist simultaneously in tendon healing. Endogenous healing is dominated by less adhesion and exogenous healing is dominant when the adhesion occurs more. Therefore, promoting endogenous healing mechanism is the key to prevent adhesion. It is now widely believed that early functional exercise can promote endogenous origin. The mechanism of sexual union prevents tendon adhesion, which requires that the suture method should be continuously improved to meet the requirements of early functional exercise with a high enough biomechanical strength. The action of the tendon to the tendon is different according to the suture. The tendon suture method can be divided into the lock suture method and the grasping suture method. A new method of locking tendon suture is proposed. A new method of locking tendon suture is proposed. Through biomechanical experiments, we have concluded that the tensile strength and the ability to resist the gap are greater than the maximum tension of the finger without resistance and active flexion. To meet the needs of early active functional exercise, the study group used the ZM suture method combined with the 3-0TICRON polyester suture to carry out the clinical and adjuvant early active functional exercises. The purpose of this study was to evaluate the clinical effects of ZM suture in the prevention of tendon adhesion through early active functional exercise, so as to guide the clinical and prevent the adhesion of tendon. A new method was provided for this problem. Methods: from April 2016 to January 2017, the researchers screened 33 cases of 41 fingers I, II, III and 9 cases of flexor tendon injury in our hospital, including 9 cases of neurovascular injury. The cause of injury was 22 cases of cutting and 11 cases of electric saw injury. Among them, the thumb was 6 fingers and the finger finger was 10 fingers. 9 finger, 9 ring finger and 7 finger. Finger deep flexor tendon rupture index is 28 fingers, finger deep flexor tendon rupture to 6 fingers, finger flexor tendon rupture to 7 fingers. All patients are emergency patients, all one period suture repair is repaired. The operation time is 2-4 hours from injury to operation time of 2-4 hours. After the repair of the broken end of the tendon, the ZM tendon suture was repaired by the tyon Tyco polyester suture (3-0TICRON polyester suture). The repair process was sutured strictly according to the requirements of the ZM center suture. After the central suture, the suture of the tendon was sutured at the tendon anastomosis with the 5-0PROLENE suture. All the wrist joints were given after the operation. In the neutral position, the flexion of the metacarpophalangeal joint was 60 degrees, the interphalangeal joint was extended (Figure 7-8) and the plaster was fixed for 4 weeks. After the operation, all the patients were routinely treated with symptomatic treatment. After 24-48h, the bandages were removed, the interphalangeal joints were removed, the wrist joint and the metacarpophalangeal joints were fixed only. The patients were instructed to perform early functional exercise, the method was the passive flexion extension of each group in each group. Activity 3-5 times, reduce the resistance caused by joint stiffness and 2 times of active flexion. Active flexion should be slow and moderate, so that the passive flexion should be sufficient to contact the palm side of the hand so far. 2 weeks after the operation, the number of early functional exercises should be reduced, and the active flexion and extension of the fingers are avoided. 12-14 days after the operation, the line is disassembled. The patients were followed up for 2 weeks, 4 weeks, 8 weeks and 12 weeks, and the patients were followed up to record the activity of the affected finger, and the excellent rate was evaluated by the international general TAM evaluation system standard. Results: the wounds healed in 32 cases, only 1 cases had inflammatory reaction such as wound leakage, redness and swelling, and then wound dressing, anti-inflammatory treatment, wound healing. .33 patients were followed up without effect on the final results. The good rate was 42.3% in January after 100%. operation, 97% in January after operation, 100% in March after operation, and no postoperative complications and no one case of tendon rupture. Conclusion: no one case of tendon rupture in 33 cases of tendon injury proved to be clinical. The combination of ZM tendon suture and 3-0TICRON polyester suture can meet the needs of early active functional exercise, and the excellent rate of 3 months after operation proves that ZM suture combined with 3-0TICRON polyester suture is safe and reliable for repairing flexor tendon, and it can meet the needs of early active function forging, and it is the best choice for repairing flexor tendon. One of the methods.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.2

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