小儿患者的屈肌腱损伤

Flexor tendon injuries in pediatric patients.

作者信息

Nietosvaara Yrjänä, Lindfors Nina C, Palmu Sauli, Rautakorpi Sanna, Ristaniemi Nadja

机构信息

Children's Hospital, Helsinki University Hospital, Helsinki, Finland.

出版信息

J Hand Surg Am. 2007 Dec;32(10):1549-57. doi: 10.1016/j.jhsa.2007.08.006.

DOI:10.1016/j.jhsa.2007.08.006

PMID:18070643

Abstract

PURPOSE

The purpose of this research was to study the incidence and outcome of flexor tendon injuries in pediatric patients.

METHODS

A survey of flexor tendon repair in children less than 16 years of age was performed in the City of Helsinki during 2000-2005. A retrospective clinical outcome study of all consecutive 28 patients with 45 involved fingers treated in Children's Hospital was also performed at a mean 38 months (range 12-53 months) after surgery. Active motion program after multistrand tendon repair was used in 33 fingers, cast immobilization in 11 fingers, and elastic bands in 1 finger. Functional and cosmetic subjective result was evaluated by a visual analog scale (VAS, 0-100). Range of motion (ROM) of metacarpophalangeal (MCP) and interphalangeal (IP) joints were measured. Grip strength was recorded. Functional outcome methods of Buck-Gramcko, ASSH, Strickland, and distal interphalangeal joint (DIP) ROM methods were applied.

RESULTS

The calculated annual incidence of finger flexor injury per child in Helsinki was 0.036 per 1000. There were no ruptures of the multistrand repairs with active motion program, but three 2-strand core sutures failed within 1 month of the repair. Mean functional and cosmetic VAS scores (all 28 patients) were 87 and 84. Mean ROM ratio of the DIP joint in zone 1 and 2 injuries was 60%, compared to 98% in zone 3 and 5 injuries. Ranges of motion of the proximal interphalangeal (PIP) and MCP joints were practically normal in all patients. There was a discrepancy among the functional outcome scores, with good and excellent results in all 45 fingers (Buck-Gramcko), in 39 fingers (ASSH), in 36 fingers (original Strickland), and in 32 fingers (DIP ROM).

CONCLUSIONS

Flexor tendon injuries in children are rare. Both subjective and objective outcomes are generally good. Active motion program is an effective technique after multistrand flexor tendon repair at all levels in children. Range of motion of the DIP joint may be a more effective means of evaluating outcome in pediatric flexor tendon injuries.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

摘要

目的

本研究旨在探讨小儿患者屈指肌腱损伤的发生率及治疗结果。

方法

于2000年至2005年期间在赫尔辛基市对16岁以下儿童的屈指肌腱修复情况进行了一项调查。同时，对儿童医院连续收治的28例患者共45根患指进行了回顾性临床疗效研究，术后平均随访38个月（范围12 - 53个月）。33根手指采用多股肌腱修复术后主动活动方案，11根手指采用石膏固定，1根手指采用弹力带固定。采用视觉模拟评分法（VAS，0 - 100）评估功能和外观主观结果。测量掌指关节（MCP）和指间关节（IP）的活动范围（ROM）。记录握力。应用Buck - Gramcko、美国手外科协会（ASSH）、Strickland以及远侧指间关节（DIP）ROM等功能结果评估方法。

结果

赫尔辛基市儿童手指屈肌腱损伤的年计算发病率为每1000人中有0.036例。采用主动活动方案的多股修复均未出现断裂，但3根双股核心缝合在修复后1个月内失败。（所有28例患者的）功能和外观VAS平均得分分别为87分和84分。1区和2区损伤的DIP关节平均ROM比例为60%，而3区和5区损伤为98%。所有患者的近端指间关节（PIP）和MCP关节活动范围基本正常。功能结果评分之间存在差异，45根手指（Buck - Gramcko法）、39根手指（ASSH法）、36根手指（原Strickland法）以及32根手指（DIP ROM法）的评估结果为优或良。