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

doi:10.13418/j.issn.1001-165x.2021.03.015

摘要/Abstract

摘要： 目的　探讨V-Y延长指背腱膜终腱（terminal tendon，TT）止点重建术治疗陈旧性锤状指（腱-骨型或部分骨性）的生物力学优势。方法　冰冻成人手指标本12例，随机分为实验组与对照组，每组6指。对照组TT止点处切除腱膜1.0 mm，以“牵出纽扣”法重建止点；实验组TT止点处切除腱膜1.0 mm，近端TT“V”字切开、“Y”字缝合，远端“牵出纽扣”法重建止点，两组分别进行力学测试并对结果进行统计学分析。结果　最大载荷时实验组V-Y缝合处缝线断裂占33.3%（2/6）、肌腱切割占66.7%（4/6），止点重建处缝线拉长；对照组均为止点重建处缝线断裂，最大载荷实验组低于对照组（P<0.05）；最大位移两组无统计学差异（P>0.05）。腱-骨间隙达到1.0 mm时100%标本止点重建处缝线拉长，实验组V-Y缝合处腱-腱贴合紧密；位移实验组长于对照组（P<0.05）；载荷、刚度两组比较均无统计学差异（P>0.05）。结论　测量成人手指标本腱-骨间隙1.0 mm时载荷、位移、刚度，相较最大载荷、最大位移更具临床指导意义；V-Y缝合重建止点能有效延长TT，使腱-骨紧密贴合同时不影响TT生物力学特性。

关键词: 陈旧性锤状指, 　V-Y延长, 　止点重建, 　生物力学

Abstract: Objective　To discuss the biomechanics of V-Y extending terminal tendon (TT) for distal attachment to treat chronic mallet fingers (tendon-bone or partial bony).　Methods　Twelve fingers were randomly divided into the following two groups based upon the repair technique. A control group: 1mm TT was removed at the insertion, the distal TT was attached by pull-out; an experimental group: 1mm TT was removed at the insertion, the proximal portion of the TT was cut with a “V” incision which was then repaired in a “Y” fashion, and the distal TT was attached by pull-out. Biomechanics experimental outputs were calculated and statistically analyzed.　Results　As the rupture (load failure) occurred, the experimental group: 2 specimens (accounting for 33.3%) failed by suture breakages and 4 cases (accounting for 66.7%) failed by suture pulled out from the tendon at V-Y suture and all sutures were prolonged at attachment. Suture breakages happened in all specimens of the control group. There was significant difference between the two groups (P<0.05) in the load failure while no significant difference (P>0.05) in the maximum displacement. All sutures were prolonged at the attachment when the tendon-bone gap reached 1mm in both groups and the tendon-tendon was closely sticked at V-Y suture. There was significantly different between the two groups (P＜0.05) in the displacement while no significant difference (P>0.05) in the load and stiffness. Conclusions The load, displacement and stiffness of 1mm tendon-bone gap were more clinically meaningful than the repair failure force and maximum displacement. Reattachment with V-Y suture effectively extended TT and repaired tendon-bone gap, while unaffected the biomechanical properties of TT.

Key words: , Chronic mallet finger, 　V-Y suture, 　Distal reattachment, 　Biomechanics

中图分类号:

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.

Wang Gaofei, Zhang Zhufeng, Wei Zhuang. 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.

参考文献 23

[1]	Bendre AA. Mallet finger[J]. J Am Acad Orthop Surg, 2005, 13(5): 336-344. DOI: 10.5435/00124635-200509000-00007.
[2]	胡洪涌, 赵小伟, 窦庆寅, 等. 指伸肌腱止点形态特点与损伤分型及治疗方法[J]. 中国临床解剖学杂志, 2011, 29(4): 458-460. CNKI: SUN:ZLJZ.0.2011-04-031.
[3]	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.
[4]	Bellemère P. Treatment of chronic extensor tendons lesions of the fingers[J]. Chir Main, 2015, 34(4): 155-181. DOI: 10.1016/j.main.2015.05.001.
[5]	谭周勇, 谭亮, 傅小宽, 等. 可吸收线治疗骨性锤状指皮肤切口的解剖研究[J]. 中国临床解剖学杂志, 2020, 38(3): 250-253. DOI: 10.13418/j.issn.1001-165x.2020.03.003.
[6]	Ülkür E, Açikel C, Ergun O, et al. Repair of chronic mallet finger deformity using Mitek micro arc bone anchor[J]. Ann Plast Surg, 2005, 54(4): 393-396. DOI: 10.1097/01.sap.0000151464.03967.a2.
[7]	Chao JD, Vishal S, Yong SSDS, et al. Central slip tenotomy for the treatment of chronic mallet finger: an anatomic study[J]. J Hand Surg Am, 2004, 29(2): 216-219. DOI: 10.1016/j.jhsa.2003.10.025.
[8]	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.
[9]	Savvidou C, Thirkannad S. Hemilateral band technique for reconstructing gap defects in the terminal slip of the extensor tendon[J]. Tech Hand Up Extrem Surg, 2011, 15(3): 177-181. DOI: 10.1097/BTH.0b013e31820ab73c.
[10]	陆新颜, 刘义强, 周攀, 等. 陈旧性骨性锤状指手术方式选择及疗效分析[J]. 中华手外科杂志, 2014, 30(2): 101-103. DOI: 10.3760/cma.j.issn.1005-054X.2014.02.010.
[11]	Malagelada F, Clark C, Dega R. Management of chronic Achilles tendon ruptures-a review[J]. Foot (Edinb), 2016, 28: 54-60. DOI: 10.1016/j.foot.2016.05.001.
[12]	Schweitzer TP , Rayan GM . The terminal tendon of the digital extensor mechanism: part II, kinematic study[J]. J Hand Surg Am, 2004, 29(5): 903-908. DOI: 10.1016/j.jhsa.2004.04.025.
[13]	Crawford GP. The molded polythene splint for mallet finger deformities[J]. J Hand Surg, 1984, 9(2): 231-237. DOI: 10.1016/s0363-5023(84)80148-3.
[14]	Zhang X, Meng H, Shao XZ, et al. Pull-out wire fixation for acute mallet finger fractures with K-wire stabilization of the distal interphalangeal joint[J]. J Hand Surg, 2010, 35(11): 1864-1869. DOI: 10.1016/j.jhsa.2010.07.021.
[15]	Hong CK , Lin CL , Kuan FC, et al. A biomechanical evaluation of various double krackow suture techniques for soft-tissue graft fixation[J]. Arthroscopy, 2018, 34(3): 663-668. DOI: 10.1016/j.arthro.2017.09.025.
[16]	Türker T, Hassan K, Capdarest-Arest N. Extensor tendon gap reconstruction: a review[J]. J Plast Surg Hand Surg, 2016, 50(1): 1-6. DOI: 10.3109/2000656X.2015.1086363.
[17]	Gu YP, Zhu SM. A new technique for repair of acute or chronic extensor tendon injuries in zone 1[J]. J Bone Joint Surg Br, 2012, 94(5): 668-670. DOI: 10.1302/0301-620X.94B5.28296.
[18]	Libberecht K , Lafaire C , Hee RV . Evaluation and functional assessment of flexor tendon repair in the hand[J]. Acta Chir Belg, 2006, 106(5): 560-565. DOI: 10.1080/00015458.2006.11679952.
[19]	Miller H. Repair of severed tendons of the hand and wrist: statistical analysis of 300 cases[J]. Surg Gynecol Obstet, 1942, 75: 693–698.
[20]	杨帅智, 陈禄, 刘学贵. 新式缝合法重建指伸肌腱终腱止点的临床研究[J]. 中国临床解剖学杂志, 2014, 32(4): 491-493. DOI: 10.13418/j.issn.1001-165x.2014.04.029.
[21]	Wei Z, Thoreson AR, Amadio PC, et al. Distal attachment of flexor tendon allograft: a biomechanical study of different reconstruction techniques in human cadaver hands[J]. J Orthop Res, 2013, 31(11): 1720-1724. DOI: 10.1002/jor.22403.
[22]	胡燕青, 蒋海, 李棋, 等. 不同肌腱缝合方法的生物力学比较研究[J]. 中国修复重建外科杂志, 2017, 31(10): 1208-1213. DOI: 10.7507/1002-1892.201705007.
[23]	王学磊, 康志秋. V-Y腱成形术联合Krackow缝合法治疗跟腱再断裂[J]. 临床骨科杂志, 2016, 19(2): 251-251. DOI: 10.3969/j.issn.1008-0287.2016.02.046.