Fujihara Yuki, Ota Hideyuki, Watanabe Kentaro
Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonen-Cho, Nakagawa-Ku, Nagoya, 454-8502, Japan.
Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonen-Cho, Nakagawa-Ku, Nagoya, 454-8502, Japan.
Injury. 2018 Dec;49(12):2248-2251. doi: 10.1016/j.injury.2018.10.022. Epub 2018 Oct 22.
Flexor tendon injury often occurs with concomitant injuries such as fracture, vascular injury, and extensor tendon injury. These injuries are repaired independently, without a comprehensive strategy. We aimed to identify the effect of concomitant injuries and treatment choice on the outcome of flexor tendon repair.
We evaluated 118 fingers of 102 adult patients with zone 1-3 flexor digitorum profundus (FDP) tendon injuries who underwent primary surgery at our hospital between April 2009 and December 2017. The 2-strand pull-out, 4-strand Tsuge, 6-strand Lim & Tsai, and 8-strand cross-locked cruciate suturing techniques were used. We performed multivariate analyses, with the active range of motion (AROM) of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints as dependent variables, and age, existence of concomitant injuries, and their treatment as independent variables.
The average AROM of the PIP + DIP joints was 130° at the last follow-up, and 'excellent' or 'good' function was obtained in 74 (63%) of 118 fingers by using the Strickland criteria. Old age, concomitant diaphyseal fractures, and specific methods of osteosynthesis, such as pinning, flexor digitorum superficialis injury, and immobilisation for 3 weeks, significantly worsened the results. However, wiring for osteosynthesis and early active motion protocol improved postoperative functional outcome. Although the outcome did not differ among the suture techniques, the 4-strand Tsuge procedure was performed for the two surgically confirmed ruptures of repair that occurred in our series.
We clarified the superiority of early mobilisation protocols with rigid osteosynthesis procedure, other than pinning. To minimise tendon adhesion or joint stiffness, surgeons should repair the tendon and fractured bone appropriately, to ensure early mobilisation without serious complications.
屈指肌腱损伤常伴有诸如骨折、血管损伤和伸指肌腱损伤等合并伤。这些损伤是独立修复的，缺乏综合策略。我们旨在确定合并伤和治疗选择对屈指肌腱修复结果的影响。
我们评估了2009年4月至2017年12月期间在我院接受一期手术的102例成年患者的118根手指，这些手指存在1-3区指深屈肌腱（FDP）损伤。采用了2股拔出法、4股津下法、6股林蔡法和8股交叉锁定十字缝合法。我们进行了多因素分析，以近端指间关节（PIP）和远端指间关节（DIP）的主动活动范围（AROM）作为因变量，年龄、合并伤的存在及其治疗作为自变量。
末次随访时，PIP + DIP关节的平均AROM为130°，根据斯特里克兰标准，118根手指中有74根（63%）获得了“优”或“良”的功能。高龄、合并骨干骨折以及诸如穿针固定、指浅屈肌损伤和固定3周等特定的骨固定方法显著恶化了结果。然而，骨固定用钢丝和早期主动活动方案改善了术后功能结果。尽管缝合技术之间的结果没有差异，但对于我们系列中发生的两例手术证实的修复断裂，采用了4股津下法。
我们阐明了采用刚性骨固定方法而非穿针固定的早期活动方案的优越性。为了尽量减少肌腱粘连或关节僵硬，外科医生应适当修复肌腱和骨折的骨头，以确保早期活动而无严重并发症。
