Mercer Deana, Fitzpatrick Jennifer, Firoozbakhsh Keikhosrow, Carvalho Alex, Moneim Moheb
Department of Orthopaedics and Rehabilitation, University of New Mexico, School of Medicine, Albuquerque, NM 87131-0001, USA.
J Hand Surg Am. 2009 Jan;34(1):108-11. doi: 10.1016/j.jhsa.2008.08.021. Epub 2008 Dec 10.
Swanson's technique for repair of the extensor tendon of the proximal interphalangeal (PIP) joint, entailing bony reattachment of the extensor tendon to the base of the middle phalanx, is a common procedure. We introduce a repair technique that is less complicated and that may be equally appropriate for approach to the PIP joint. The extensor tendon is incised longitudinally directly over the PIP joint. The insertion of the central slip and capsule are elevated off of the base of the middle phalanx. This allows excellent visualization of the PIP joint. The extensor tendon is then repaired by side-to-side approximation using Ethibond suture. The purpose of this study was to test and compare the strength of this proposed technique with that of Swanson in a cadaver model.
The index, long, and ring fingers from 4 pairs of fresh-frozen cadaver hands were harvested (24 digits total). One technique was performed and tested in all digits of the 3-digit contralateral pairings from 2 pairs of hands (3 digits x 4 hands; 12 digits total per technique). Twelve control digits were used to measure the fixation strength and stiffness of the Swanson approach, and the other 12 digits were used to measure the fixation strength and stiffness of the new procedure.
All tendon repairs tolerated physiologic loading of 25 N. There was no statistically significant difference in stiffness between the control and experimental groups (mean +/- SD, 4.74 N/mm +/- 0.46 and 4.62 N/mm +/- 0.30, respectively; p >.05).
Simple repair of the central slip without reattachment to bone preserves the function of the extensor mechanism at the PIP joint and provides excellent exposure to the joint.
斯旺森（Swanson）修复近端指间（PIP）关节伸肌腱的技术，即将伸肌腱重新附着于中节指骨基部，是一种常见的手术方法。我们介绍一种不太复杂且可能同样适用于处理PIP关节的修复技术。在PIP关节正上方纵向切开伸肌腱。将中央束和关节囊的附着点从中节指骨基部掀起。这能很好地显露PIP关节。然后使用Ethibond缝线通过侧对侧缝合来修复伸肌腱。本研究的目的是在尸体模型中测试并比较这种新提出的技术与斯旺森技术的强度。
从4对新鲜冷冻尸体手中获取示指、中指和环指（共24个手指）。对来自2对尸体手的3个手指对侧的所有手指（3个手指×4只手；每种技术共12个手指）实施并测试一种技术。使用12个对照手指测量斯旺森方法的固定强度和刚度，另外12个手指用于测量新手术方法的固定强度和刚度。
所有肌腱修复均能耐受25 N的生理负荷。对照组和实验组之间的刚度无统计学显著差异（平均值±标准差分别为4.74 N/mm±0.46和4.62 N/mm±0.30；p>.05）。
不重新附着于骨骼的中央束简单修复可保留PIP关节伸肌机制的功能，并能很好地显露关节。
