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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2022, Vol. 08 ›› Issue (01) : 29 -34. doi: 10.3877/cma.j.issn.2096-0263.2022.01.006

临床论著

锚钉技术治疗糖尿病与非糖尿病患者腱性锤状指畸形的疗效分析
周彤1, 尚运涛2, 马莹莹3, 张延祠2, 李军勇2,†()   
  1. 1. 063000　唐山市第二医院手外科
    2. 050000　石家庄市第二医院骨科
    3. 050000　石家庄，中国人民解放军联勤保障部队第980（白求恩国际和平）医院急诊科
  • 收稿日期:2021-01-22 出版日期:2022-02-05
  • 通信作者: 李军勇
  • 基金资助:
    石家庄市科学技术研究与发展指导计划(191460603)

Analysis of the efficacy of anchor technique in the treatment of tendinous mallet finger deformity in patients with diabetes and non-diabetes

Tong Zhou1, Yuntao Shang2, Yingying Ma3, Yanci Zhang2, Junyong Li2,†()   

  1. 1. Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China
    2. Department of Orthopedics, the Second Hospital of Shijiazhuang City, Shijiazhuang 050000, China
    3. Department of Emergency, 980 hospital of PLA joint logistics support forces, Shijiazhuang 050000, China
  • Received:2021-01-22 Published:2022-02-05
  • Corresponding author: Junyong Li
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周彤, 尚运涛, 马莹莹, 张延祠, 李军勇. 锚钉技术治疗糖尿病与非糖尿病患者腱性锤状指畸形的疗效分析[J/OL]. 中华老年骨科与康复电子杂志, 2022, 08(01): 29-34.

Tong Zhou, Yuntao Shang, Yingying Ma, Yanci Zhang, Junyong Li. Analysis of the efficacy of anchor technique in the treatment of tendinous mallet finger deformity in patients with diabetes and non-diabetes[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(01): 29-34.

目的

探讨应用锚钉技术治疗糖尿病与非糖尿病患者腱性锤状指畸形的疗效，评估锚钉技术在治疗糖尿病患者腱性锤状指畸形的临床可行性。

方法

前瞻性收集石家庄市第二医院和唐山市第二医院的腱性锤状指畸形糖尿病（试验组）与非糖尿病（对照组）患者各30例，试验组男性15例，女性12例，平均年龄（44.54±4.55）岁，对照组男性13例，女性13例，平均年龄（43.63±4.37）岁，均应用锚钉技术治疗。术后比较两组患者伤口愈合时间；2、3，4个月的患指屈伸运动功能；肌腱愈合情况；并发症发生情况。

结果

试验组30例，其中3例失去随访；对照组30例，其中4例失去随访。伤口愈合时间：试验组平均（14.0±1.0）d；对照组平均（13.0±1.1）d，两组比较差异无统计学意义（t=0.087，P>0.05）。末次随访时MP、PIP，DIP屈伸活动度分别为试验组：（89.7±2.4）°、（84.2±5.4）°，（76.3±5.2）°；对照组：（89.0±3.2）°、（84.0±5.3）°，（75.3±5.2）°，两组比较差异分别无统计学意义[（t=1.325，P>0.05）、（t=1.079，P>0.05），（t=1.553，P>0.05）]。手运动功能TAM分级：试验组优23例，良3例，可1例；对照组优22例，良2例，可2例，两组比较差异无统计学意义（χ2=0.343，P>0.05）。肌腱彩超提示，两组患者均腱骨愈合良好。两组患者术后均无明显并发症发生，可从事正常工作及生活。

结论

锚钉技术可有效防止伸肌腱粘连，使患指获得良好的屈伸运动功能，术后并发症少，同样可以用于糖尿病患者腱性锤状指畸形的治疗。

关键词: 锚钉技术, 糖尿病, 锤状指, 伸肌腱, 止点
Objective

To analyze the efficacy of anchor technique in the treatment of tendinous mallet finger deformity in diabetic and non-diabetic patients and evaluate the clinical feasibility of anchor technique in the treatment of tendinous mallet finger deformity in diabetic patients.

Methods

Prospectively collecting 30 diabetic (treatment group) and 30 non-diabetic (control group) patients with tendinous mallet finger deformity who were treated with anchor technique in the Second Hospital of Shijiazhuang and the Second Hospital of Tangshan. After operation, the wound healing time, the affected finger function of flexion and extension at 2, 3 and 4 months, the tendon healing, the complications were compared in 2 groups.

Results

Among the 30 cases in the treatment group, 3 cases were lost follow-up, while 4 cases lost follow-up in the control group. The average wound healing time was (14.0±1.0) days in the treatment group while (13.0±1.1) days in the control group, there was no significant difference between the two groups (t=0.087, P>0.05). At the last follow-up, the range of flexion and extension of MP, PIP and DIP were (89.7±2.4)°, (84.2±5.4)° and (76.3±5.2)° respectively while the control group were (89.0±3.2)°, (84.0±5.3)°, (75.3±5.2)° respectively, there was no significant difference between the two groups [(t=1.325, P>0.05), (t=1.079, P>0.05), (t=1.553, P>0.05)]. According to the TAM classification of hand motor function, 23 cases were excellent, 3 cases were good and 1 case was fair in the treatment group, while 22 cases, 2 cases and 2 cases in the control group, there was no significant difference between the two groups (χ2=0.343, P>0.05). Tendon ultrasound showed that the tendon and the bone healed well in both groups. There were no obvious postoperative complications in the two groups and they could engage in normal work and life.

Conclusions

Anchor technique can effectively prevent the adhesion of extensor tendon, obtain good flexion and extension function of the affected finger and reduce postoperative complications. It can also be used for the treatment of tendinous mallet finger deformity in patients with diabetes.

Key words: Anchor technique, Diabetic, Tendinous mallet finger deformity, Extensor tendon, Attachment
表1 两组腱性锤状指畸形患者入组前的一般特征比较
组别 例数 性别（例，男/女） 年龄（岁， ±s） 伤口长度（cm， ±s） 受伤时间（h， ±s） 肌腱质量（例，拔丝/切割）
试验组 30/27 15/12 44.54±4.55 3.46±0.33 4.23±0.84 11/16
对照组 30/26 13/13 43.63±4.37 3.39±0.31 4.11±0.92 9/17
统计值 - χ2=1.763 t=0.049 t=0.177 t=0.542 χ2=0.068
P值 - 0.185 0.964 0.843 0.745 0.785
图1~9 患者男性，44岁，糖尿病病史6年，左环指电锯割伤致指伸肌腱Ⅰ区止点处断裂，行微型锚钉伸肌腱止点重建术。图1~2术前X线片，提示左环指无骨折；图3术中行左环指伸肌腱Ⅰ区止点重建术，锚钉固定于远节指骨基底背侧，尾线缝合固定伸肌腱Ⅰ区止点；图4~5术中X线片，提示左环指克氏针及锚钉固定良好，位置良好；图6~8术后4个月手指功能，提示左环指屈伸功能良好；图9术后4个月患指伸肌腱止点高频超声提示：肌腱止点处回声、肌腱厚度接近健侧肌腱组织，较周围组织分层清晰，屈伸活动时肌腱止点无明显滑动
表2 两组腱性锤状指畸形患者术中、术后各项指标比较
组别 例数 手术时间（min， ±s） 出血量（ml， ±s） 拆线时间（d，±s） 伤口感染（例，是/否） 肌腱粘连（例，是/否） 皮肤感觉障碍（例，是/否） 内固定物断裂或松动（例，是/否）
试验组 27 90±4 10.8±0.4 14.0±1.0 0/27 2/25 0/27 0/27
对照组 26 90±5 11.0±0.5 13.0±1.1 0/26 3/23 0/26 0/26
统计值 - t=0.056 t=0.049 t=0.087 - χ2=0.047 - -
P值 - 0.188 0.154 0.079 - 0.897 - -
表3 两组腱性锤状指畸形患者治疗后末次随访手指屈伸功能比较
组别 例数 TAM值（°， ±s） 根据TAM值分级（例） 屈伸活动度（DIP， ±s） 屈伸活动度（PIP， ±s） 屈伸活动度（MP， ±s）
优 良 可
试验组 27 253±7 23 3 1 76.3±5.2 84.2±5.4 89.7±2.4
对照组 26 253±7 22 2 2 75.3±5.2 84.0±5.3 89.0±3.2
统计值   t=1.036 χ2=0.343 t=1.553 t=1.079 t=1.325
P值   0.232 0.634 0.243 0.277 0.138
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