CAJ | 학술논문

目的探讨瘢痕折叠缝合和指伸肌腱侧腱束转位治疗陈旧性腱性锤状指的手术方法及临床疗效.方法对30例腱性锤状指患者,根据术中所见采用不同的手术方法.其中8例采用指伸肌腱远、近断端瘢痕折叠缝合+克氏针内固定；22例采用指伸肌腱远端与近端伸肌腱单侧侧腱束转位后钢丝Kessler钮扣肌腱缝合+克氏针固定.术后均用石膏固定患指于远指间关节过伸位、近指间关节屈曲位6周.结果术后30例患者伤口均Ⅰ期愈合,随访6～24个月,平均(13.0±4.5)个月,疗效评价采用Dargan功能评定法评分:优22例,良6例,可2例；优良率为93.3％.结论陈旧性腱性锤状指断端间若形成松弛瘢痕连接,可采用瘢痕折叠缝合法强化；若断端分离短缩,可采用指伸肌腱单侧侧腱束转位治疗.依术中所见不同采用合适的方法治疗陈旧性腱性锤状指可取得满意的疗效.
목적 탐토반흔절첩봉합화지신기건측건속전위치료진구성건성추상지적수술방법급림상료효.방법 대30례건성추상지환자,근거술중소견채용불동적수술방법.기중8례채용지신기건원、근단단반흔절첩봉합+극씨침내고정；22례채용지신기건원단여근단신기건단측측건속전위후강사Kessler뉴구기건봉합+극씨침고정.술후균용석고고정환지우원지간관절과신위、근지간관절굴곡위6주.결과 술후30례환자상구균Ⅰ기유합,수방6～24개월,평균(13.0±4.5)개월,료효평개채용Dargan공능평정법평분:우22례,량6례,가2례；우량솔위93.3％.결론 진구성건성추상지단단간약형성송이반흔련접,가채용반흔절첩봉합법강화；약단단분리단축,가채용지신기건단측측건속전위치료.의술중소견불동채용합괄적방법치료진구성건성추상지가취득만의적료효.
Objective To introduce the method of scar tissue folding suture and extensor tendon lateral band transposition for the management of old mallet fingers and evaluate the clinical outcomes.Methods This study included 30 cases of tendinous mallet fingers.Different procedures were chosen according to intraoperative findings.The distal interphalangral (DIP) joint was fixed with a Kirschner wire and the stretched scarring ends of the extensor tendon were folded and sutured together in 8 cases.In 22 cases the rupture tendon ends were separated.The lateral band was transposed to the distal extensor tendon stump and fastened with Kessler button suture when the DIP joint was fixed in a hyperextension position with a Kirschner wire.Postoperatively cast immobilization was used to maintain DIP joint hyperextension and proximal interphalangeal joint flexion for 6 weeks.Results Primary wound healing was achieved in all the patients who were follow-up for 6 to 24 months postoperatively (average,13 months).According to Dargan criteria,the results were graded as excellent in 22 cases,good in 6 cases and fair in 2 cases,with 93.3％ overall satisfactory rate.Conclusion If the ruptured extensor tendon in old mallet fingers formed loose scar connection,folding and suturing of the scarring tissue can be used to strengthen the tendon insertion.If the ruptured ends were separated,extensor tendon lateral band transposition is the method to use.Applying appropriate methods for old tendinous mallet fingers according to intraoperative findings can achieve satisfactory outcomes.