腱性锤状指损伤机制与修复术式选择的解剖学研究

doi:10.3760/cma.j.cn101202-20211102-00313

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (13052 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨腱性锤状指损伤的解剖学机制,为采用伸肌腱断端直接缝合术治疗腱性锤状指损伤提供解剖学依据。方法纳入成人新鲜手标本12只,解剖示、中、环、小指各12指的伸肌装置,观察掌指关节（MP）、近侧指间关节（PIP）和远侧指间关节（DIP）被动活动时伸肌腱与中节指骨头的接触情况,测量伸肌腱Ⅰ~Ⅱ区的最大滑程。伸直位固定伸肌腱于掌骨基底背侧,限制伸肌腱滑动,被动屈曲DIP,在伸肌腱与中节指骨头背侧凸起应力部位切断伸肌腱,模拟腱性锤状指损伤机制,制作腱性锤状指模型;于腱性锤状指模型上被动活动DIP和PIP的同时,观察断端直接缝合法修复伸肌腱的可行性及合适的指间关节角度。结果限制伸肌腱滑动、被动屈曲DIP时,伸肌腱Ⅰ区与中节指骨头背侧最高凸起点紧密接触。MP、PIP和DIP同时最大屈伸活动时,伸肌腱Ⅰ~Ⅱ区最大滑程为3.1~7.4（5.3±0.4）mm;伸直位固定伸肌腱,被动屈曲DIP,伸肌腱Ⅰ区与中节指骨头远端背侧凸起点相接触,距离伸肌腱止点距离2.1~3.4（2.8±0.4）mm。在DIP伸直0°位、PIP屈曲45°位,锤状指模型伸肌腱断端可实现无张力缝合修复。结论手指末节受到突发被动屈曲外力,致使伸肌腱Ⅰ区因受到中节指骨头背侧凸起点的应力折顶作用而断裂时,引发腱性锤状指损伤;通常,腱性锤状指止点残留部分肌腱,可以一期直接缝合修复。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张文静
	高飞
	张文龙

关键词 ：指损伤, 锤状指, 伸肌腱, 修复, 解剖学

Abstract：Objective To explore the anatomical mechanism of mallet finger injury, and provide anatomical basis for the treatment of mallet finger injury by directly sutured the ends of the broken extensor tendon. Methods Twelve hands of fresh adult specimens were included, and 48 fingers were taken from the index finger to little finger. The extensor apparatus of each finger was dissected separately, and the sliding range of extensor tendon zone Ⅰ-Ⅱ was measured during the activity of metacarpophalangeal joints (MP), proximal interphalangeal joints (PIP), and distal interphalangeal joints (DIP). The contact relationship between extensor tendon and the head of the middle phalanges was recorded. The extensor tendon was fixed at the base of the dorsal side of the metacarpal bone in the extension position, and the DIP joint was passively flexed. The extensor tendon was cut at the top of the protrusion and folding position of the extensor tendon and middle phalanx bone, and the tendon-like mallet finger model was made. Results When the extensor tendon was restricted to slide and passive flexion DIP, region Ⅰ of the extensor tendon was in close contact with the highest convex point on the dorsal side of the middle finger bone. Results showed that the sliding range of a point in extensor tendon zone Ⅰ-Ⅱ was 3.1–7.4 (5.3±0.4) mm when MP, PIP and DIP were engaged in maximum flexion and extension. Moreover, the distance between the distal dorsal protrusion of the finger bone and the extensor tendon insertion was 2.1–3.4 (2.8±0.4) mm in the DIP maximum flexion position. The damage mechanism model of mallet finger was reasonable. The DIP joint was straightened, and the PIP joint was flexed 45° to observe the feasibility of repairing the extensor tendon. The repair of the extensor tendon could be achieved in the DIP extension position and PIP flexion position. Conclusion Through sudden passive buckling force at the end of the finger, tendinous mallet finger injury is caused when extensor tendon zone Ⅰ is broken by the stress buckling action of the protruding point on the dorsal side of the middle finger bone. In general, the residual tendon of the most tendinous mallet finger insertion can be repaired directly by primary suturing.

Key words： Finger injuries Mallet finger Extensor tendon Repair Anatomy

收稿日期: 2021-11-02

基金资助:河北省卫生健康委科研基金（20171398）

通讯作者: 张文龙,Email：zhangwenlong2000@163.com

引用本文:

张文静, 高飞, 张文龙. 腱性锤状指损伤机制与修复术式选择的解剖学研究[J]. 中华解剖与临床杂志, 2022, 27(5): 302-306.
Zhang Wenjing, Gao Fei, Zhang Wenlong. Anatomic study of mallet finger injury mechanism and choice of repair operation. Chinese Journal of Anatomy and Clinics, 2022, 27(5): 302-306.

链接本文:

http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20211102-00313 或 http://www.cjac.com.cn/CN/Y2022/V27/I5/302

[1]	贾杰, 魏智辉, 陈伟, 等. 经骨隧道线扣技术腱骨缝合治疗腱性锤状指[J].中华手外科杂志,2018,34(5):336-337. DOI: 10.3760/cma.j.issn.1005-054X.2018.05.006.Jia J, Wei ZH, Chen W, et al.Treatment of tendinous mallet finger with tendon suture by transbone tunnel suture technique[J]. Chin J Hand Surg, 2018,34(5):336-337. DOI: 10.3760/cma.j.issn.1005-054X.2018.05.006.
[2]	张田宇, 李建鹏, 陈玉宏, 等. 纽扣钢板治疗腱性锤状指的临床疗效[J].中国矫形外科杂志,2021,29(15):1428-1431. DOI: 10.3977/j.issn.1005-8478.2021.15.20.Zhang TY, Li JP, Chen YH, et al.Clinical outcomes of button plate used for repairing tendinous mallet finger[J]. Orthopedic Journal of China, 2021, 29(15):1428-1431. DOI: 10.3977/j.issn.1005-8478.2021.15.20.
[3]	朱稷兴, 郭明珂, 韩春明, 等. 可吸收线在锤状指伸肌腱止点重建手术中的临床应用[J].中华手外科杂志,2019,35(2):113-114. DOI: 10.3760/cma.j.issn.1005-054X.2019.02.012.Zhu JX,Guo MK,Han CM,et al.Clinical application of absorbable suture in reconstruction of mallet extensor tendon[J].Chin J Hand Surg,2019,35(2):113-114. DOI: 10.3760/cma.j.issn.1005-054X.2019.02.012.
[4]	尹作祯, 苗传宝, 段伦江, 等. 改良伸肌腱止点重建联合克氏针固定在腱性锤状指中的应用[J].中华手外科杂志,2020,36(5):394-395. DOI: 10.3760/cma.j.cn311653-20200318-00133.Yin ZZ,Miao CB,Duan LJ,et al.Application of modified extensor tendon insertion reconstruction combined with Kirschner wire fixation in tendinous mallet finger[J]. Chin J Hand Surg, 2020,36(5):394-395. DOI: 10.3760/cma.j.cn311653-20200318-00133.
[5]	赵文韬, 赵民. 手指伸肌腱Ⅰ区肌腱末节指骨止点与毗邻组织的应用解剖学研究[J].中国临床解剖学杂志,2021,39(2):126-129. DOI:10.13418/j.issn.1001-165x.2021.02.002.Zhao WT, Zhao M.Applied anatomy study of zone I extensor terminal tendon insertion and its adjacent tissues[J]. Chinese Journal of Clinical Anatomy,2021,39(2):126-129. DOI:10.13418/j.issn.1001-165x.2021.02.002.
[6]	王高飞, 张珠峰, 魏壮. V-Y延长指背腱膜终腱止点重建术治疗陈旧性锤状指的生物力学实验研究[J].中国临床解剖学杂志,2021,39(3):330-335. DOI: 10.13418/j.issn.1001-165x.2021.03.015.Wang GF,Zhang ZF,Wei Z.Biomechanical study on V-Y extending terminal tendon of extensor tendon for distal attachment inhuman cadaver hands[J]. Chinese Journal of Clinical Anatomy, 2021,39(3):330-335. DOI: 10.13418/j.issn.1001-165x.2021.03.015.
[7]	李友, 巨积辉, 熊胜, 等. 原位伸肌腱止点重建治疗腱性锤状指畸形[J].中华手外科杂志, 2018, 34(5):333-335. DOI: 10.3760/cma.j.issn.1005-054X.2018.05.005.Li Y, Ju JH, Xiong S, et al.Reconstruction of extensor tendon insertion in situ for treatment of tendinous mallet finger deformities[J]. Chin J Hand Surg, 2018, 34(5):333-335. DOI: 10.3760/cma.j.issn.1005-054X.2018.05.005.
[8]	林慧鑫, 张振伟, 柯于海, 等. 经末节指骨基底背侧骨隧道双线缝合治疗陈旧性Doyle Ⅰ型锤状指[J].中华手外科杂志,2019, 35(5):342-344. DOI: 10.3760/cma.j.issn.1005-054X.2019.05.009.Lin HX, Zhang ZW, Ke YH, et al.Treatment of old Doyle type Ⅰ mallet finger with double suture through dorsal basal bone tunnel of the distal phalanx[J]. Chin J Hand Surg,2019, 35(5):342-344. DOI: 10.3760/cma.j.issn.1005-054X.2019.05.009.
[9]	刘宏君, 冯清波, 张文忠, 等. 腱性锤状指的治疗[J].中华整形外科杂志,2019,35(7):674-676. DOI: 10.3760/cma.j.issn.1009-4598.2019.07.012.Liu HJ,Feng QB,Zhang WZ,et al.Experiences in the treatment of tendinous mallet finger[J]. Chin J Plastic Surg,2019, 35(7): 674-676. DOI: 10.3760/cma.j.issn.1009-4598.2019.07.012.
[10]	刘宏君, 武文杰, 王天亮, 等. 部分指深屈肌腱重建伸肌腱止点撕脱的可行性研究[J].实用手外科杂志,2020,34(3):333-334. DOI: 10.3969/j.issn.1671-2722.2020.03.028.Liu HJ,Wu WJ,Wang TL,et al.Feasibility study on reconstruction of extensor tendon by partial flexor deep tendon[J]. Journal of Practical Hand Surgery,2020,34(3):333-334. DOI: 10.3969/j.issn.1671-2722.2020.03.028.
[11]	张玉军, 巨积辉, 赵强, 等. 掌长肌腱折叠联合抽出钢丝法治疗陈旧性锤状指[J].中华手外科杂志,2020,36(1):52-54. DOI: 10.3760/cma.j.issn.1005-054X.2020.01.016.Zhang YJ, Ju JH, Zhao Q, et al.Treatment of old mallet finger by folding palmaris longus tendon and pulling out wire technique[J]. Chin J Hand Surg,2020,36(1):52-54. DOI: 10.3760/cma.j.issn.1005-054X.2020.01.016.
[12]	Nagura S, Suzuki T, Iwamoto T, et al.A comparison of splint versus pinning the distal interphalangeal joint for acute closed tendinous mallet injuries[J]. J Hand Surg Asian Pac Vol, 2020, 25(2):172-176. DOI: 10.1142/S2424835520500198.
[13]	孙文弢, 张文龙. 近指间关节活动对伸肌腱Ⅰ~Ⅱ区张力影响的解剖学研究[J].中华手外科杂志,2016,32(3):207-209. DOI: 10.3760/cma.j.issn.1005-054X.2016.03.021.Sun WT,Zhang WL.An anatomic study of the effect of proximal interphalangeal joint motion on the tension of the extensor tendon in zone Ⅰ and Ⅱ[J]. Chin J Hand Surg,2016, 32(3):207-209. DOI: 10.3760/cma.j.issn.1005-054X.2016.03.021.
[14]	Choi H, Seo A, Lee J.Mallet finger lattice casts using 3D printing[J]. J Healthc Eng, 2019,2019:4765043. DOI: 10.1155/2019/4765043.
[15]	Abouna JM, Brown H.The treatment of mallet finger. The results in a series of 148 consecutive cases and a review of the literature[J]. Br J Surg, 1968,55(9):653-667. DOI: 10.1002/bjs.1800550905.
[16]	赵志明, 任东, 陈焱, 等. Thompson法在伴肌腱缺损的陈旧性锤状指中的应用[J].中华创伤骨科杂志,2019,21(2):170-172. DOI: 10.3760/cma.j.issn.1671-7600.2019.02.013.Zhao ZM,Ren D,Chen Y,et al.Thompson procedure for chronic mallet finger with tendon defect[J]. Chin J Orthop Trauma, 2019, 21(2):170-172. DOI: 10.3760/cma.j.issn.1671-7600.2019.02.013.
[17]	施海峰,芮永军,吴柯,等. 陈旧性锤状指的手术治疗[J]. 中华手外科杂志,2017,33(4):264-265. DOI:10.3760/cma.j.issn.1005-054X.2017.04.010.Shi HF, Rui YJ, Wu K, et al.The surgical treatment for chronic mallet finger[J]. Chin J Hand Surg,2017,33(4):264-265. DOI:10.3760/cma.j.issn.1005-054X.2017.04.010.
[18]	Bendre AA, Hartigan BJ, Kalainov DM.Mallet finger[J]. J Am Acad Orthop Surg, 2005,13(5):336-344. DOI: 10.5435/00124635-200509000-00007.
[19]	周晓玲, 李学渊, 胡浩良, 等. 手术治疗与短指支具保守治疗腱性闭合性锤状指疗效比较的回顾性研究[J].中华手外科杂志, 2019, 35(5):337-339. DOI:10.3760/cma.j.issn.1005-054X.2019.05.007.Zhou XL, Li XY, Hu HL, et al.Retrospective study for clinical efficacy comparison of operative treatment and conservative treatment by short finger brace for closed tendinous mallet finger[J]. Chin J Hand Surg,2019,35(5):337-339. DOI:10.3760/cma.j.issn.1005-054X.2019.05.007.