同种异体肌腱移植修复手部肌腱缺损及指功能重建的疗效

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1792 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨应用同种异体肌腱移植修复手部肌腱缺损及重建屈/伸指功能的临床效果。方法 2015年3月至2017年6月间，我科应用同种异体肌腱移植修复手部肌腱缺损18例22指，男12例，女6例；年龄为20～45岁，平均(32.9±8.3)岁。其中伸肌腱缺损6例8指，屈肌腱缺损12例14指。手部伸肌腱缺损范围6～10 cm，平均(7.8±2.1)cm；屈肌腱缺损范围5～8 cm，平均(6.6±1.3)cm。患者受伤至手术时间为1.5～8个月，平均(5.0±2.8)个月。术前皮肤软组织缺损者行皮瓣转移修复，骨折及骨缺损者行切开复位或植骨内固定术，手部各指间或掌指关节积极行锻炼至被动活动正常，若关节挛缩则行关节松解术。伸肌腱缝合方法采用编织缝合法，屈肌腱缝合方法采用津下套圈或编织缝合法，屈肌腱滑车缺损者在手术同时重建滑车。术后应用抗生素预防感染，伤口定期换药，所有病例均没有使用免疫抑制剂。术后3d~4周伸肌腱移植者以主动屈曲、被动伸直锻炼为主，屈肌腱移植者以主动伸直、被动屈曲锻炼为主，每天活动3次。4周后逐渐增加活动次数及强度，以主动伸屈活动为主。采用国际手外科联合会制定的手指关节总活动度(total active movement，TAM)评定标准评价手部功能。结果 3例术后出现伤口脂肪液化，细菌培养证实为无菌性渗出，予以伤口定期换药后均于术后20d内愈合；其余病例伤口均一期愈合。3例5指因屈肌腱黏连行肌腱松解术。术后随访8～24个月，平均(14.7±4.8)个月。TAM评价结果，优9指，良7指，可3指，差3指，优良率为72.7%。结论同种异体肌腱移植是代替自体肌建移植修复手部肌腱缺损及重建屈/伸指功能的较好方法之一，具有手部功能恢复满意、临床效果显著等优点，但仍存在术后肌腱黏连导致手功能优良率降低，伤口局部存在无菌性渗出导致愈合时间延长等问题，上述问题需在日后的临床应用过程中加以研究解决。

	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
	胡雷鸣
	段虹昊 *

关键词 ：同种异体肌腱, 移植, 手部, 肌腱缺损, 指功能重建

Abstract：Objective To investigate the therapeutic effect of allogeneic tendon transplantation for repairing tendon defect of hand and functional reconstruction.Methods From March 2015 to June 2017，tendon defect of hand of 18 patients (22 fingers) was repaired by allogeneic tendon transplantation.There were 12 males and 6 females with an average age of (32.9±8.3) ranging from 20 to 45 years old.There were extensor tendon defect of 6 patients (8 fingers)，flexor tendon defect of 12 patients (14 fingers).The length of extensor tendon defect was 6 to 10 cm，the average length was (7.8±2.1) cm.The length of flexor tendon defect was 5 to 8 cm，the average length was (6.6±1.3) cm.The time from injury to operation was 1.5 to 8 months，the average time was (5.0±2.8) months.Skin and soft tissue defect should be repaired by flap transfer before operation，open reduction or bone graft and internal fixation should be performed for fracture and bone defect.The interphalangeal joint or metacarpophalangeal joint of the hand should be actively exercised until the passive activity was normal.Patients of contracture of joint underwent arthrolysis.Extensor tendon was sewed up by the method of weave stitching，and flexor tendon was sewed up by the method of Tsuge or weave stitching，the trochlea of flexor tendon should be repaired or reconstructed.The postoperative antibiotics should be used to prevent infection.The wound should be given regular dressing change，and all patients accepted no the therapy of immunodepressant.From 3 days to 4 weeks after operation patients with extensor tendon transplantation underwent the active finger flexion exercise and passive finger straightening exercise，patients with flexor tendon transplantation underwent the active finger straightening exercise and passive finger flexion exercise，exercise three times a day.After 4 weeks frequency and intensity of the exercise of active flexion and extension should be increased gradually.Total Active Movement evaluation criteria which established by international hand surgery union was used for evaluating the therapeutic effect.Results Fat liquefaction occurred in 3 patients after operation，and the bacterial culture confirmed aseptic exudation，patients of fat liquefaction were given wound dressing and reached to wound healing within 20 days，the rest were healed by first intention.3 patients (5 fingers) were accepted the operation of tendon release due to flexor tendon adhesion.The follow up time was 8~24 months，the average time was (14.7±4.8) months.According to the evaluation result，nine fingers were the best grade，seven fingers were the secondary grade，three fingers were the acceptable grade，three fingers were the lowest grade，the fineness rate was 72.7%.Conclusion Allogeneic tendon transplantation can take the place of autoallergic tendon transplantation for repairing tendon defect of hand，which also can get the hand function recovery.Postoperative tendon adhesion could lead to reduction of fineness rate，aseptic exudation of wound could lead to prolonged wound healing time，the above problems needed to be solved in the future clinical work.

Key words： allogeneic tendon transplantation hand tendon defect functional reconstruction

基金资助:陕西省重点研发计划(2019SF-212)

通讯作者: 段虹昊

作者简介: 胡雷鸣(1982－ )，男，主治医师，西安交通大学医学院附属红会医院手外中心一病区，710054。

引用本文:

胡雷鸣，段虹昊 *. 同种异体肌腱移植修复手部肌腱缺损及指功能重建的疗效[J]. 实用骨科杂志, 2020, 26(1): 23-26.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I1/23

［1］张友乐，杨克非，高新生，等.冷冻干燥异体肌腱移植的实验研究及临床应用［J］.中华骨科杂志，1997，17(1)：59-62.
［2］Tang JB.Tendon injuries across the world：Treatment ［J］ Injury，2006，37( 11)：1036-1042.
［3］Cerulli G，Placella G，Sebastiani E，et al.ACL reconstruction：choosing the graft［J］.Joints，2013，l(1)：18-24.
［4］邓万祥，赵胡環，董晖，等.异体肌腱移植在临床修复中的应用［J］.中国修复重建外科杂志，2005，19(8)：666-668.
［5］Wang G，Xie R，Mao T，et al.Treatment of AC dislocation by reconstructing CC and AC ligaments with allogenic tendons compared with hook plates［J］.J Orthop Surg Res，2018，13 (1)：175.
［6］侯召猛，陈彦华，姜平.同种异体肌腱结合克氏针治疗陈旧性肩锁关节脱位［J］.中国矫形外科杂志，2019，27(8)：757-759.
［7］卢启贵，王平，黄东红.自体镜下腘绳肌与同种异体半腱肌重建膝前交叉韧带对比研究［J］.实用骨科杂志，2013，19(8)：709-712.
［8］Giannini S，Buda R，Di Caprio F，et al.Effects of freezing on the biomechanical and structural properties of human posterior tibial tendons［J］.Int Orthop，2008，32(2)：145-151.
［9］杨雄刚，张元德，胡永成.同种异体肌腱免疫原性相关的基础研究进展［J］.中华骨科杂志，2019，38(22)：1395-1402.
［10］唐林俊，陈浩贤，崔太安，等.同种异体肌腱修复肌腱缺损的远期疗效观察［J］.中国修复重建外科杂志，2011，25(3)：341-343.
［11］Zeng XY，Cao JT.The experimental study of deep hypothermic handling tendon allograft with the biomechanical properties［J］.China Medical Herald，2007，4(33)：75-77.
［12］徐光辉，孙康，徐强，等.深低温冷冻异体肌腱移植的组织学和生物力学研究［J］.中华矫形外科杂志，2008，16(24)：1883-1886.
［13］孙燕琨，张友乐，李祥邓，等.异体肌腱移植术后黏连原因分析［J］.中国修复重建外科杂志，2008，22(3)：346-348.
［14］胡海波，禹宝庆，刘辉.同种异体肌腱移植的前景及问题［J］.中国组织工程研究与临床康复，2008，12(53)：10522-10526.
［15］郭峭峰，张春，黄凯，等.同种异体肌腱移植修复多条指伸肌腱缺损的疗效观察［J］.中华手外科杂志，2014，30(6)：475-476.
［16］张志才，段德宇，邵增务.应用同种异体肌腱加强修复治疗陈旧性跟腱断裂［J］.实用骨科杂志，2013，19(10)：891-893.
［17］崔胜宇，刘巍，朱新辉.使用同种异体肌腱修复重建膝关节多发韧带伤3～9年随访［J］.实用骨科杂志，2017，23(2)：124-127.
［18］付有伟，张前法.肌腱移植材料的研究进展［J］.实用骨科杂志，2010，16(6)：432-435.