Kapickis Martins
Center of Plastic Surgery and Microsurgery of Latvia, Riga, Latvia.
Tech Hand Up Extrem Surg. 2009 Sep;13(3):141-4. doi: 10.1097/BTH.0b013e3181abc9c.
There are many methods describing distal juncture fixation techniques of the injured flexor digitorum profundus (FDP) or flexor tendon graft. We have noted a tendency in the surgical repair of tissues toward the more expensive and technology-dependent methods. New suture type was developed to find better FDP distal juncture suture not indulging into expensive technology-dependent techniques. The positive aspect of the most popular Bunnell pullout technique is eventual removal of the suture. The negative aspect is necessity to use tie over button to secure the end of the tendon in the bone canal and thus externalizing suture. This can be complicated with maceration, decubitus, and infection. In addition, any device secured to the finger nail can be caught by external objects.
We propose buttonless method of the tendon-to-bone fixation. The only negative aspect is retaining suture. Suture is easy to perform and cheaper than any of the anchor sutures. Twelve patients were included in this preliminary study. Seven patients had acute FDP tendon zone I bone juncture injuries. Five patients had second stage flexor tendon reconstruction with tendon grafts. No infections, ruptures of the FDP or nail growth disturbances were noted. Three patients presented with slight DIP joint flexion contracture. One patient had "mallet" deformity.
Our tendon-to-bone fixation is easy to perform. It is as cheap as standard Bunnell fixation and excludes complications encountered in standard pullout sutures. Although bone suture anchors with modified Becker core suture are superior in tensile strength to 2-stranded sutures, many hand surgeons are limited by the price of the bone anchors and can find our suture more affordable.
有许多方法描述受伤的指深屈肌（FDP）或屈肌腱移植的远端连接固定技术。我们注意到在组织的外科修复中有一种倾向，即采用更昂贵且依赖技术的方法。开发了一种新的缝合类型，以找到更好的FDP远端连接缝合方法，而不依赖于昂贵的技术相关技术。最常用的邦内尔抽出技术的积极方面是最终可去除缝线。消极方面是需要使用纽扣固定来将肌腱末端固定在骨管中，从而使缝线外露。这可能会因浸渍、褥疮和感染而变得复杂。此外，任何固定在指甲上的装置都可能被外部物体钩住。
我们提出了一种无纽扣的肌腱与骨固定方法。唯一的消极方面是保留缝线。这种缝合操作简便，且比任何锚定缝线都便宜。12名患者纳入了这项初步研究。7名患者有急性FDP肌腱I区骨连接损伤。5名患者进行了二期屈肌腱移植重建。未发现感染、FDP断裂或指甲生长障碍。3名患者出现轻微的远侧指间关节屈曲挛缩。1名患者有“锤状指”畸形。
我们的肌腱与骨固定方法操作简便。它与标准的邦内尔固定一样便宜，并且排除了标准抽出缝线中遇到的并发症。尽管带有改良贝克尔芯缝线的骨缝合锚在抗张强度方面优于双股缝线，但许多手外科医生受骨锚价格的限制，可能会发现我们的缝线更经济实惠。
