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环指血管神经肌腱一期移位再植拇指

伴近侧指间关节骨折脱位的手指套状撕脱离断伤再植研究

目的总结伴近侧指间关节骨折脱位的手指套状撕脱离断伤再植方法与疗效。 方法2010年7月-2014年12月，收治外伤导致的伴近侧指间关节骨折脱位的手指套状撕脱离断伤患者8例（8指）。男6例，女2例；年龄18～43岁，平均28岁。损伤指别：环指4例，示指1例，中指3例。伤后1～4 h行再植术，近侧指间关节骨折脱位予以复位固定，修复损伤韧带及掌板，吻合动、静脉，缝合指神经。术后系统康复锻炼。 结果术后再植指均顺利成活。1例发生少量皮肤坏死，经换药后切口愈合；其余患者切口均Ⅰ期愈合。患者均获随访，随访时间8～12个月，平均10个月。X线片复查示近侧指间关节清晰，无明显骨质吸收。手指外形良好，末次随访时2例感觉恢复至S2，4例恢复至S3，2例恢复至S3+。掌指关节活动度恢复正常；近侧指间关节稳定，活动无疼痛，末次随访时，主动活动度50～85°，平均70°。末次随访时，按中华医学会手外科学会断指再植功能评定试用标准评价：获优2例，良5例，中1例，优良率87.5%。 结论伴近侧指间关节骨折脱位的手指套状撕脱离断伤可行保留关节再植术，术后经系统康复锻炼，近期疗效满意。

Clinical application of Wide-awake technique in flexor tendon tenolysis

ObjectiveTo discuss the method and effectiveness of Wide-awake technique in flexor tendon tenolysis.MethodsThe clinical data of 16 patients (22 fingers) with flexor tendon adhesion treated by Wide-awake technique for flexor tendon tenolysis between May 2019 and December 2019 were retrospectively analyzed. The patients were all male, aged from 18 to 55 years old, with an average of 35 years old. Among them, 4 cases (7 fingers) after replantation of severed fingers, 4 cases (7 fingers) after flexor tendon rupture repair, and 8 cases (8 fingers) after open reduction and internal fixation of proximal fractures. The time from the original operation to this operation was 6-18 months, with an average of 8 months. The visual analogue scale (VAS) score was used to evaluate the patient’s pain during local anesthesia (when the first needle penetrated the skin), intraoperative, and 24 hours postoperatively; and the recovery of finger movement was evaluated by total finger joint active range of motion (TAM) evaluation system and Strickland (1980) standard after operation.ResultsIntraoperative hemostasis and anesthesia were satisfactory, and the patient could fully cooperate with the surgeon in active finger movements. There were different degrees of pain during local anesthesia (VAS score was 2-4), no pain during operation (VAS score was 0), and different degrees of pain after operation (VAS score was 1-8, 9 patients needed analgesics). All incisions healed by first intention after operation. All 16 cases were followed up 9-15 months with an average of 12 months. Finger function was significantly improved, no tendon rupture occurred. At last follow-up, the patients after proximal fracture open reduction and internal fixation were rated as excellent in 4 fingers and good in 4 fingers according to the TAM standard, and both were excellent according to the Strickland (1980) standard; and the patients after replantation of severed fingers and flexor tendon rupture repair were rated as excellent in 4 fingers and good in 10 fingers according to TAM standard, and as excellent in 6 fingers and good in 8 fingers according to Strickland (1980) standard.ConclusionWide-awake technique applied in flexor tendon tenolysis can accurately judge the tendon adhesion and release degree through the patient’s active activity, achieve the purpose of complete release, and the effectiveness is satisfactory; the effectiveness of tendon adhesion release surgery after fracture internal fixation is better than that of patients after tendon rupture suture and replantation.