Dawood Alaa A
F.I.C.M.S. (Ortho.), Consultant Orthopedic Surgeon, Assistant Professor Orthopaedic Surgeon, Basrah College of Medicine, Basrah, Iraq.
J Clin Orthop Trauma. 2020 Jul-Aug;11(4):646-649. doi: 10.1016/j.jcot.2020.05.038. Epub 2020 Jun 3.
Flexor tendon injuries are commonly encountered and the surgical repair still represents a challenging problem. Many repair techniques are present but there is still no ideal one that achieves the best functional outcome This study was undertaken to compare four-strand locked cruciate repair technique and modified Kessler technique in forty eight patients by assessing the functional outcome.
Forty eight patients (114 digits) with flexor tendon injury were assigned into two groups based on suture repair technique; Group A: 24 cases by Modified Kessler repair (50%). Group B: 24cases by 4-strand cruciate repair (50%). Adults in Both groups were rehabilitated by combined Duran protocol and early active mobilization while no specific rehabilitation program was used for pediatric age group. Follow up was from 6 to 36 months (mean 21.5). Functional outcome was assessed by White criteria to all patients after 6 months.
Functional outcome was better in 4 strand cruciate repair with excellent result in 66.6%, good in 29.1% and fair in 4.1%, as compared to modified Kessler technique in which excellent results were found in 45.8%, good in 37.5%, fair in 12.5% and poor in 4.1% of cases. A better functional result was achieved in 4 strand cruciate repair especially in zone II, with excellent results in 33.3%, good in 50% and fair in 16.6% of cases, as compared to modified Kessler repair with no excellent results, 33.3% good, 50% fair and 16.6% poor results. In zone III, 4 strand cruciate technique showed a better functional outcome with 77.7% excellent and 22.2% good results, as compared to 55.5% excellent and 44.4% good results found in Modified Kessler repair. Zone V showed almost comparable results between the two types of repairs.
The 4-strand cruciate repair technique had better functional outcome compared to modified Kessler repair technique, especially in zone II and III.
屈指肌腱损伤较为常见，手术修复仍是一个具有挑战性的问题。目前存在多种修复技术，但仍没有一种理想的技术能实现最佳功能结果。本研究旨在通过评估功能结果，比较四股锁定十字缝合法与改良凯斯勒缝合法在48例患者中的应用情况。
48例（114指）屈指肌腱损伤患者根据缝合修复技术分为两组；A组：采用改良凯斯勒修复法24例（50%）。B组：采用四股十字缝合法24例（50%）。两组成人患者均采用杜兰方案联合早期主动活动进行康复治疗，而儿童年龄组未采用特定的康复方案。随访时间为6至36个月（平均21.5个月）。6个月后根据怀特标准对所有患者的功能结果进行评估。
与改良凯斯勒技术相比，四股十字缝合法的功能结果更好，其中66.6%为优，29.1%为良，4.1%为可；而改良凯斯勒技术中，45.8%为优，37.5%为良，12.5%为可，4.1%为差。四股十字缝合法尤其在Ⅱ区取得了更好的功能结果，其中33.3%为优，50%为良，16.6%为可；而改良凯斯勒修复法无优级结果，33.3%为良，50%为可，16.6%为差。在Ⅲ区，四股十字缝合法显示出更好的功能结果，77.7%为优，22.2%为良；而改良凯斯勒修复法中，55.5%为优，44.4%为良。Ⅴ区两种修复方法的结果几乎相当。
与改良凯斯勒修复技术相比，四股十字缝合法具有更好的功能结果，尤其是在Ⅱ区和Ⅲ区。
