【摘要】：目的：近指間關(guān)節(jié)側(cè)副韌帶起止點(diǎn)損傷臨床較常見，若治療不當(dāng)，可引起慢性疼痛、關(guān)節(jié)不穩(wěn)，嚴(yán)重時(shí)甚至形成關(guān)節(jié)炎。經(jīng)典的治療方法為Bunnell法，但操作復(fù)雜，恢復(fù)時(shí)間長(zhǎng)。隨著骨錨系統(tǒng)成功應(yīng)用于大關(guān)節(jié)內(nèi)韌帶的修復(fù)，很多學(xué)者將其應(yīng)用于腕、肘關(guān)節(jié)，在生物力學(xué)及臨床方面均有較為深入的研究。我們采用微型骨錨修復(fù)急性閉合性近指間關(guān)節(jié)側(cè)副韌帶起點(diǎn)或止點(diǎn)損傷，重建側(cè)副韌帶起點(diǎn)或止點(diǎn)，并采用多項(xiàng)觀察指標(biāo)，系統(tǒng)評(píng)價(jià)術(shù)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(guān)節(jié)側(cè)副韌帶起點(diǎn)或止點(diǎn)損傷患者，傷后就診時(shí)間為1-5天，平均2.2天，患者受到側(cè)方暴力或旋轉(zhuǎn)暴力，均主訴手指疼痛，查體見關(guān)節(jié)腫脹，壓痛明顯，指神經(jīng)阻滯麻醉下行側(cè)方應(yīng)力試驗(yàn)，屈曲和伸直位傾斜角度大于20°，患指X線檢查見關(guān)節(jié)間隙增寬，伴或不伴撕脫骨折。明確診斷后采用手術(shù)治療，術(shù)中切開暴露斷端，見側(cè)副韌帶自起點(diǎn)或止點(diǎn)處撕脫，應(yīng)用微型骨錨植入，重建斷裂側(cè)副韌帶起點(diǎn)或止點(diǎn)。術(shù)后石膏固定，第2天開始保護(hù)性練習(xí)，防止關(guān)節(jié)僵硬，2周拆除縫線，3周拆除石膏，逐漸進(jìn)行功能練習(xí)。根據(jù)患者情況，進(jìn)行電話隨訪，并囑患者在特定時(shí)間內(nèi)來醫(yī)院復(fù)診，復(fù)診內(nèi)容包括患者主觀滿意度，患指有無腫脹、畸形、疼痛，關(guān)節(jié)活動(dòng)度大小，行側(cè)方應(yīng)力試驗(yàn)，X線檢查觀察骨錨有無松動(dòng)、脫落等，再采用seatta功能評(píng)定標(biāo)準(zhǔn)評(píng)估療效。 結(jié)果：術(shù)后患者均得到隨訪，隨訪時(shí)間為6～15個(gè)月，平均為10.7個(gè)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(guān)節(jié)被動(dòng)活動(dòng)穩(wěn)定、無疼痛，與健側(cè)相比未見明顯差異；關(guān)節(jié)活動(dòng)度（ROM）70°-110°，平均為91.4°；關(guān)節(jié)腫痛均在術(shù)后2個(gè)月內(nèi)緩解，未見關(guān)節(jié)畸形；側(cè)方應(yīng)力試驗(yàn)陰性，關(guān)節(jié)側(cè)方穩(wěn)定性良好；復(fù)查X線，，骨錨位置確切，無松動(dòng)、脫落現(xiàn)象。采用seatta評(píng)價(jià)標(biāo)準(zhǔn)進(jìn)行評(píng)定，優(yōu)12例，良1例，可1例，優(yōu)良率92.8%。 結(jié)論：骨錨系統(tǒng)價(jià)格昂貴，部分文獻(xiàn)報(bào)道有免疫排斥、皮膚過敏等風(fēng)險(xiǎn)，但我們治療的臨床病例，恢復(fù)效果均較好，未見術(shù)后并發(fā)癥。與傳統(tǒng)的Bunnell法重建側(cè)副韌帶起止點(diǎn)相比，采用微型骨錨治療急性閉合性近指間關(guān)節(jié)側(cè)副韌帶起點(diǎn)或止點(diǎn)損傷的方法簡(jiǎn)便易行，節(jié)約時(shí)間，患者及醫(yī)生可接受性強(qiáng)，且術(shù)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(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R686

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