Pillukat T, Schädel-Höpfner M, Prommersberger K-J, van Schoonhoven J
Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland.
Oper Orthop Traumatol. 2011 Jul;23(3):184-91. doi: 10.1007/s00064-011-0023-0.
Treatment of pyogenic flexor tenosynovitis within the osteofibrous channel of the thumb and finger by insertion of a closed irrigation system.
Pyogenic tenosynovitis of the flexor tendons of the hand.
Necrosis of the flexor tendons or flexor tendon sheath, gangrene of the finger, extensive loss of soft tissue.
Insertion of a flexible irrigation catheter via a guide wire into the flexor tendon sheath and a vacuum suction drain into the finger or the palm of the hand. Extensive exploration of the flexor tendon sheath is not mandatory.
On days 0-3 continuous irrigation, on day 4 change of the irrigation catheter to suction, on day 5 removal of the irrigation catheter, on day 6 removal of the suction drain, on day 7 start of exercise. Irrigation volume: about 500-1500 ml/24 h isotonic solution.
Of 35 patients treated for flexor tenosynovitis by closed irrigation, 33 were reviewed. There were 19 male patients and 14 female patients. The average age at the time of surgery was 51 (8-85) years. Hospital stay was 8.9 (3-26) days on average. At the time of follow-up, the average grip strength was 84% (23-163%) of the unaffected side. Pain at rest was 0.2 (0-4), pain during exercise 1.2 (0-8) on the analogue scale, the DASH score was 16.8 (0-58) points. According to the rating system for flexor tendon function, there were one poor, one fair, five good, and 26 excellent results.
通过插入封闭冲洗系统治疗拇指和手指骨纤维通道内的化脓性屈指肌腱腱鞘炎。
手部屈指肌腱化脓性腱鞘炎。
屈指肌腱或屈指肌腱腱鞘坏死、手指坏疽、软组织广泛缺损。
通过导丝将柔性冲洗导管插入屈指肌腱腱鞘，并在手指或手掌置入负压引流管。不必对屈指肌腱腱鞘进行广泛探查。
术后0至3天持续冲洗，第4天更换为负压吸引，第5天拔除冲洗导管，第6天拔除负压引流管，第7天开始功能锻炼。冲洗液量：约500 - 1500毫升/24小时等渗溶液。
35例采用封闭冲洗治疗屈指肌腱腱鞘炎的患者中，33例接受了随访。男性患者19例，女性患者14例。手术时的平均年龄为51（8 - 85）岁。平均住院时间为8.9（3 - 26）天。随访时，平均握力为健侧的84%（23 - 163%）。静息痛评分为0.2（0 - 4），运动痛评分为1.2（0 - 8）（采用视觉模拟评分法），DASH评分为16.8（0 - 58）分。根据屈指肌腱功能评分系统，结果为差1例、中1例、良5例、优26例。
