微型骨锚在急性近指间关节侧副韧带起点或止点损伤治疗中的应用

发布时间：2018-08-26 18:30

【摘要】：目的：近指间关节侧副韧带起止点损伤临床较常见，若治疗不当，可引起慢性疼痛、关节不稳，严重时甚至形成关节炎。经典的治疗方法为Bunnell法，但操作复杂，恢复时间长。随着骨锚系统成功应用于大关节内韧带的修复，很多学者将其应用于腕、肘关节，在生物力学及临床方面均有较为深入的研究。我们采用微型骨锚修复急性闭合性近指间关节侧副韧带起点或止点损伤，重建侧副韧带起点或止点，并采用多项观察指标，系统评价术后疗效，取得了满意效果。方法：我院2011年至2013年共收治14例14指急性闭合性近指间关节侧副韧带起点或止点损伤患者，伤后就诊时间为1-5天，平均2.2天，患者受到侧方暴力或旋转暴力，均主诉手指疼痛，查体见关节肿胀，压痛明显，指神经阻滞麻醉下行侧方应力试验，屈曲和伸直位倾斜角度大于20°，患指X线检查见关节间隙增宽，伴或不伴撕脱骨折。明确诊断后采用手术治疗，术中切开暴露断端，见侧副韧带自起点或止点处撕脱，应用微型骨锚植入，重建断裂侧副韧带起点或止点。术后石膏固定，第2天开始保护性练习，防止关节僵硬，2周拆除缝线，3周拆除石膏，逐渐进行功能练习。根据患者情况，进行电话随访，并嘱患者在特定时间内来医院复诊，复诊内容包括患者主观满意度，患指有无肿胀、畸形、疼痛，关节活动度大小，行侧方应力试验，X线检查观察骨锚有无松动、脱落等，再采用seatta功能评定标准评估疗效。结果：术后患者均得到随访，随访时间为6～15个月，平均为10.7个月，所有患者主观满意度均较高，赞同该治疗方案，并表示若有其他手指再受伤，可继续按该治疗方案处理；患指指间关节被动活动稳定、无疼痛，与健侧相比未见明显差异；关节活动度（ROM）70°-110°，平均为91.4°；关节肿痛均在术后2个月内缓解，未见关节畸形；侧方应力试验阴性，关节侧方稳定性良好；复查X线，，骨锚位置确切，无松动、脱落现象。采用seatta评价标准进行评定，优12例，良1例，可1例，优良率92.8%。结论：骨锚系统价格昂贵，部分文献报道有免疫排斥、皮肤过敏等风险，但我们治疗的临床病例，恢复效果均较好，未见术后并发症。与传统的Bunnell法重建侧副韧带起止点相比，采用微型骨锚治疗急性闭合性近指间关节侧副韧带起点或止点损伤的方法简便易行，节约时间，患者及医生可接受性强，且术后韧带固定牢固，可早期行功能锻炼，疗效满意，值得临床推广。
[Abstract]:OBJECTIVE: The injury of the collateral ligament near the interphalangeal joint is common in clinic. If not treated properly, it can cause chronic pain, joint instability and even arthritis. The classical treatment is Bunnell's method, but the operation is complicated and the recovery time is long. The miniature bone anchor was used to repair the acute closed injury of the collateral ligament of the proximal interphalangeal joint and reconstruct the collateral ligament of the wrist and elbow joints.
Methods: From 2011 to 2013, 14 patients with acute closed injury of the collateral ligament of the proximal interphalangeal joints were admitted to our hospital. The average time of treatment was 2.2 days, ranging from 1 to 5 days. All patients complained of finger pain caused by lateral violence or rotational violence. Experiments showed that the inclination angle of flexion and extension was greater than 20 degrees. X-ray examination showed widening of joint space with or without avulsion fracture. Protective exercises were started on the 2nd day to prevent joint stiffness, sutures were removed for 2 weeks, plaster was removed for 3 weeks, and functional exercises were carried out gradually. Force test and X-ray examination were used to observe whether the bone anchor was loose or shedding. Seatta criteria were used to evaluate the curative effect.
Results: All patients were followed up for 6 to 15 months, with an average of 10.7 months. All patients had high subjective satisfaction. They agreed with the treatment plan and said that if other fingers were injured again, they could continue to be treated according to the treatment plan. The ROM ranged from 70 degrees to 110 degrees, with an average of 91.4 degrees. The swelling and pain of the joints were relieved within 2 months after operation without any joint deformity. The lateral stress test was negative and the lateral stability of the joints was good.
CONCLUSIONS: Bone anchor system is expensive, and some literatures have reported the risk of immune rejection and skin allergy, but in our clinical cases, the recovery effect is good without postoperative complications. The method of point injury is simple, time-saving, acceptable to patients and doctors, and the ligament is firmly fixed after operation. It can be used for early functional exercise, and the effect is satisfactory. It is worthy of clinical promotion.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R686

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