Tang J B, Shi D
Department of Orthopedics, Affiliated Hospital of Nantong Medical College.
Chin Med J (Engl). 1992 Jan;105(1):60-8.
"No man's land" of the flexor tendon system is divided into 4 subdivisions based on our anatomical study. Clinically, a total of 72 flexor tendon injuries in "no man's land" were repaired during the primary and delayed primary stages. Different treatments of flexor tendons, sheath, vincula and postoperative exercises were used according to the degree of injury and anatomical and functional characteristics of each subdivision. The multiple intratendinous suture method, autogenous sheath graft and vincular repair were designed and attempted preliminarily in clinical practice. In 80.4% of the cases, excellent or good results were achieved. Comparison of treatment results in each sub-zone reveals that the IIc sub-zone is the most difficult area for satisfactory functional recovery in "no man's land". The significance of the subdivision of Bunnell's "no man's land" is discussed, and the preoperative assessment method of noting the extent of injury and selection of the treatment method for each sub-zone are presented in this paper. We believe that primary or delayed primary repair can restore good function to the repaired tendons. The effective way of enhancing treatment results of the tendon injury is to apply comprehensive treatment according to the extent of injury to the intrinsic healing capacity of the flexor digitorum profundus tendon.
根据我们的解剖学研究，屈肌腱系统的“无人区”可分为4个亚区。临床上，在一期和延期一期阶段共修复了72例“无人区”屈肌腱损伤。根据损伤程度以及各亚区的解剖和功能特点，采用了不同的屈肌腱、腱鞘、腱纽处理方法及术后康复锻炼。在临床实践中初步设计并尝试了多种肌腱内缝合方法、自体腱鞘移植和腱纽修复。80.4%的病例取得了优良效果。各亚区治疗结果比较显示，IIc亚区是“无人区”功能恢复最困难的区域。本文讨论了Bunnell“无人区”亚区划分的意义，并介绍了术前评估损伤范围的方法以及各亚区治疗方法的选择。我们认为一期或延期一期修复能够使修复后的肌腱恢复良好功能。根据屈指深肌腱自身愈合能力的损伤程度进行综合治疗是提高肌腱损伤治疗效果的有效途径。
