肌腱—骨復(fù)合組織移植治療夾板固定失敗后的錘狀指
發(fā)布時間：2018-10-13 12:12
【摘要】：錘狀指是手指終腱及伸肌腱止點因突然的暴力擢傷,如生活和工作中的意外(打球、擠壓、暴力沖擊),手指末節(jié)屈曲而發(fā)生的斷裂,由于屈肌力量大于伸肌力量,造成屈伸力量不平衡,手指遠(yuǎn)端指間關(guān)節(jié)屈曲畸形。隨著時間延長,畸形會逐漸加重,引起患指疼痛、功能活動受限和生活不便。最大限度的恢復(fù)手指的功能與緩解疼痛。是該研究的主要目的。錘狀指最好的治療方法是夾板固定,但不是每一個患者都能成功。多因殘存著不同程度伸指功能受限而不滿意。歸其原因多為夾板固定的范圍不夠,未固定掌指關(guān)節(jié)和腕關(guān)節(jié)不合理的隨意活動,使肌腱斷端間隙增大,而被瘢痕纖維組織橋接,影響伸肌腱的肌肉-肌腱-骨的力臂結(jié)構(gòu),其延長使力學(xué)效應(yīng)減弱,伸指功能仍然受到限制。加之患者不規(guī)范或不正確的使用夾板,過早去除往往也是治療失敗的原因,使肌腱斷端愈合不牢靠,肌腱斷裂再次發(fā)生,成為陳舊性錘狀指。如果病人保守治療失敗,就需要手術(shù)治療。雖然各種手術(shù)技術(shù)已廣泛使用,但這些治療技術(shù)仍存在很多爭議。外科醫(yī)生試圖將肌腱指點重建,但失敗可能性很大。原因在于肌腱與骨骼之間存在一個間隙,即使在肌腱松解和指間關(guān)節(jié)過伸位置的情況下,在這個間隙任然存在。Levante建議把肌腱的指點縫合在甲床末梢的周圍組織上,在一些患者中獲得成功。腱—骨愈合為不同種組織間愈合,這一過程慢且不可靠,與同種組織間愈合相比要慢很多(如肌腱與肌腱愈合,骨與骨愈合)。綜上所述,錘狀指畸形就會再次發(fā)生。本課題主要介紹通過肌腱—骨復(fù)合組織,移植治療打夾板治療失敗以后剩余角度大于25°的錘狀指,評價其可行性及有效性。肌腱—骨復(fù)合組織是由橈側(cè)腕短伸肌與第三掌骨基底部組成,通過該移植物重建止點,來治療夾板固定失敗后的錘狀指。目的:為了探討肌腱—骨移植組織治療夾板固定失敗后的陳舊性腱性錘狀指的手術(shù)方法與臨床效果。從2010年1月到2012年3月共有28例錘狀指患者接受治療,所有的患者均為在夾板固定了6—8周以后,末節(jié)指間關(guān)節(jié)伸指受限角度仍大于25°,其中還有4位患者進行了第二次夾板固定,治療仍然失敗。采用肌腱—骨復(fù)合組織移植物,移植治療夾板固定失敗后的錘狀指。肌腱—骨移植物是由橈側(cè)腕短伸肌與第三掌骨基底部組成,用來重建止點。受傷與手術(shù)的時間平均為74天(53-105天),術(shù)前平均伸展受限角度為34°,5名患者遠(yuǎn)指間關(guān)節(jié)伴有疼痛。最后對患者進行隨訪評價�；颊哌h(yuǎn)指間關(guān)節(jié)和腕關(guān)節(jié)的疼痛程度采用視覺量表評價,關(guān)節(jié)活動度采用crawford標(biāo)準(zhǔn)進行分級,手功能的評定采用disabilitiesoftheshoulder,arm,andhand(dash)問卷,外觀滿意程度根據(jù)密歇根大學(xué)的手問卷調(diào)查結(jié)果。術(shù)前還觀察到有4根手指為天鵝頸畸形。術(shù)前手功能評價通過dash問卷平均得分是3(范圍:0-7)。通過密歇根手問卷結(jié)果,2例患者對外觀非常不滿意,19人有點不滿意,7人對外觀表示不在意,2例患者遠(yuǎn)指間關(guān)節(jié)處存在不同程度的疼痛。結(jié)果術(shù)后28例患指傷口均為Ⅰ期愈合,所有患者平均在5周后達到骨愈合,移植骨未突出末節(jié)指骨骨面。后續(xù)隨訪12—18個月,(平均15個月),未發(fā)現(xiàn)指甲畸形、未發(fā)現(xiàn)遠(yuǎn)側(cè)指間關(guān)節(jié)或腕關(guān)節(jié)疼痛,未觀察到有天鵝頸畸形。遠(yuǎn)指間關(guān)節(jié)療(dip)平均屈曲角度是65°(范圍57°-75°),對側(cè)指dip測量角度是71°(范圍62°-76°)。關(guān)節(jié)沒有過度伸展位,伸展角度是6°(標(biāo)準(zhǔn)差為4°)。遠(yuǎn)指間關(guān)節(jié)療剩余擴展滯后角度為4°(標(biāo)準(zhǔn)偏差為4°)。通過crawford關(guān)節(jié)活動效果評分調(diào)查,28例患指,優(yōu)24例(86%);良4例(14%),優(yōu)秀率為86%。通過disabilitiesoftheshoulder,arm,andhand(dash)問卷,平均得分是1(范圍0-3)。根據(jù)密歇根大學(xué)的手問卷調(diào)查,27位患者對手外觀滿意,1位患者對手外觀感覺不太滿意。本組治療的28例患者術(shù)后隨訪未發(fā)現(xiàn)畸形復(fù)發(fā)。結(jié)論:通過肌腱—骨復(fù)合組織移植物移植是治療夾板固定失敗后錘狀指的有效可靠的手術(shù)方法。其手術(shù)治療獨特創(chuàng)新點在于,采用自體肌腱—骨復(fù)合組織移植,再造止點,將肌腱—骨愈合界面,轉(zhuǎn)化為容易愈合的肌腱—肌腱和骨—骨界面,由于組織相同,愈合更為可靠快速。我認(rèn)為肌腱—骨方法:復(fù)合組織移植治療夾板固定失敗后的錘狀指,其適應(yīng)征廣泛,骨折和畸形愈合等陳舊性錘狀指都可以應(yīng)用,雖然這種手術(shù)方法比常規(guī)手術(shù)多一個腕背部的切口,破壞了橈側(cè)腕短伸肌,術(shù)后需要外固定,但其愈合過程相對較快,且不需二次手術(shù),同時配合克氏針固定遠(yuǎn)指間關(guān)節(jié)確保愈合固定牢固可靠,為夾板等保守治療失敗后的難治性錘狀指提出一種新的治療方法。
[Abstract]:Hammer refers to the fracture caused by sudden violent injury due to sudden violent injury due to sudden violent injury, such as life and accident (playing, squeezing, violent impact), finger bending and buckling, and because the flexor muscle strength is greater than the extensor force, the flexion and extension force is not balanced, The distal finger of the finger refers to the flexion deformity of the joint. As the time is extended, the deformity will gradually increase, causing pain, limited function, and inconvenience of life. Maximize your finger's function and ease pain. It is the main purpose of this study. Hammer-like means the best treatment method is splint immobilization, but not every patient can succeed. It is not satisfied that the function is limited due to the existence of different degree of extension. due to the fact that the fixation of the splint is not enough, the free movement of the metacarpal bone and the wrist joint is not fixed, the clearance of the broken end of the tendon is increased, and the muscle-tendon-bone force arm structure of the extensor tendon is affected by the bridging of the tendon, and the elongation of the tendon is prolonged, so that the mechanical effect is weakened, extension finger function is still limited. Combined with the patient's irregular or incorrect use of the splint, premature removal is often the cause of failure of treatment, so that the fracture healing of the tendon is not reliable, and the tendon rupture occurs again and becomes an old hammer-like finger. Surgical treatment is required if the patient's conservative treatment fails. Although various surgical techniques have been widely used, there are still many disputes over these techniques. The surgeon attempted to track the tendon for reconstruction, but the probability of failure was great. The reason is that there is a gap between the tendon and the bone, even in the case where the tendon releases and the finger joint overstretched position. Levante recommends suturing the tendon's instructions to the surrounding tissue of the tip of the nail bed to succeed in some patients. Tendon healing is healing for different tissues, which is slow and unreliable, much slower than healing of the same tissue (e.g. tendon and tendon healing, bone and bone healing). To sum up, the hammer-shaped finger deformity will happen again. This topic mainly introduces the feasibility and validity of the hammer-shaped finger with the residual angle of more than 25 擄 after the failure of the treatment of the splint after the failure of the treatment of the splint. The composite tissue of the tendon and bone is composed of the side wrist short extension muscle and the third metacarpal bone base, and a stop point is reconstructed through the graft to treat the hammer-shaped finger after the splint fixation failure. Objective: To investigate the operative method and clinical effect of the old tendon-like finger after splint fixation failure in tendon allograft tissue treatment. From January 2010 to March 2012, a total of 28 hammer-like fingers were treated and all patients had been fixed for 6-8 weeks at the splint, and the finger-to-finger joint extension was still greater than 25 擄, where there were 4 patients who underwent a second splint fixation and the treatment continued to fail. The invention discloses a hammer-shaped finger after fixation failure of a splint by using a tendon and bone-bone composite tissue graft. The tendon and bone graft is composed of the short extension of the wrist and the base of the third metacarpal bone, which is used to reconstruct the stop point. The mean time for injury and surgery was 74 days (53-105 days), and the pre-operative mean extension was 34 擄 and 5 patients were far away from the joints with pain. Finally, the patients were followed up for evaluation. The degree of pain in the patient's distal finger joints and wrist joints was evaluated using a visual scale, and the range of motion was graded according to the crawford standard. The evaluation of hand function was based on the results of the hand survey of the University of Michigan. Four fingers were observed to be swan neck deformity before operation. The average score for preoperative hand function was 3 (range: 0-7). By the results of the Michigan hand questionnaire, 2 patients were very dissatisfied with the appearance, 19 were somewhat dissatisfied, 7 were not interested in appearance, and 2 patients were far from the joints at different levels of pain. Results All the 28 cases were healed with stage 鈪，
本文編號：2268578
[Abstract]:Hammer refers to the fracture caused by sudden violent injury due to sudden violent injury due to sudden violent injury, such as life and accident (playing, squeezing, violent impact), finger bending and buckling, and because the flexor muscle strength is greater than the extensor force, the flexion and extension force is not balanced, The distal finger of the finger refers to the flexion deformity of the joint. As the time is extended, the deformity will gradually increase, causing pain, limited function, and inconvenience of life. Maximize your finger's function and ease pain. It is the main purpose of this study. Hammer-like means the best treatment method is splint immobilization, but not every patient can succeed. It is not satisfied that the function is limited due to the existence of different degree of extension. due to the fact that the fixation of the splint is not enough, the free movement of the metacarpal bone and the wrist joint is not fixed, the clearance of the broken end of the tendon is increased, and the muscle-tendon-bone force arm structure of the extensor tendon is affected by the bridging of the tendon, and the elongation of the tendon is prolonged, so that the mechanical effect is weakened, extension finger function is still limited. Combined with the patient's irregular or incorrect use of the splint, premature removal is often the cause of failure of treatment, so that the fracture healing of the tendon is not reliable, and the tendon rupture occurs again and becomes an old hammer-like finger. Surgical treatment is required if the patient's conservative treatment fails. Although various surgical techniques have been widely used, there are still many disputes over these techniques. The surgeon attempted to track the tendon for reconstruction, but the probability of failure was great. The reason is that there is a gap between the tendon and the bone, even in the case where the tendon releases and the finger joint overstretched position. Levante recommends suturing the tendon's instructions to the surrounding tissue of the tip of the nail bed to succeed in some patients. Tendon healing is healing for different tissues, which is slow and unreliable, much slower than healing of the same tissue (e.g. tendon and tendon healing, bone and bone healing). To sum up, the hammer-shaped finger deformity will happen again. This topic mainly introduces the feasibility and validity of the hammer-shaped finger with the residual angle of more than 25 擄 after the failure of the treatment of the splint after the failure of the treatment of the splint. The composite tissue of the tendon and bone is composed of the side wrist short extension muscle and the third metacarpal bone base, and a stop point is reconstructed through the graft to treat the hammer-shaped finger after the splint fixation failure. Objective: To investigate the operative method and clinical effect of the old tendon-like finger after splint fixation failure in tendon allograft tissue treatment. From January 2010 to March 2012, a total of 28 hammer-like fingers were treated and all patients had been fixed for 6-8 weeks at the splint, and the finger-to-finger joint extension was still greater than 25 擄, where there were 4 patients who underwent a second splint fixation and the treatment continued to fail. The invention discloses a hammer-shaped finger after fixation failure of a splint by using a tendon and bone-bone composite tissue graft. The tendon and bone graft is composed of the short extension of the wrist and the base of the third metacarpal bone, which is used to reconstruct the stop point. The mean time for injury and surgery was 74 days (53-105 days), and the pre-operative mean extension was 34 擄 and 5 patients were far away from the joints with pain. Finally, the patients were followed up for evaluation. The degree of pain in the patient's distal finger joints and wrist joints was evaluated using a visual scale, and the range of motion was graded according to the crawford standard. The evaluation of hand function was based on the results of the hand survey of the University of Michigan. Four fingers were observed to be swan neck deformity before operation. The average score for preoperative hand function was 3 (range: 0-7). By the results of the Michigan hand questionnaire, 2 patients were very dissatisfied with the appearance, 19 were somewhat dissatisfied, 7 were not interested in appearance, and 2 patients were far from the joints at different levels of pain. Results All the 28 cases were healed with stage 鈪，
本文編號：2268578
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