[1]金少枫,苏坤阳,陈毕能,等.超声引导下经皮松解术治疗老年桡骨远端骨折非手术治疗后腕部指屈肌腱粘连[J].中医正骨,2022,34(08):12-19,24.
　JIN Shaofeng,SU Kunyang,CHEN Bineng,et al.Ultrasound-guided percutaneous release for treatment of wrist digital flexor tendon adhesions following non-surgical treatment of distal radius fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(08):12-19,24.
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超声引导下经皮松解术治疗老年桡骨远端骨折非手术治疗后腕部指屈肌腱粘连()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年08期
页码:
12-19,24
栏目:
临床研究
出版日期:
2022-08-20

文章信息/Info

Title:
Ultrasound-guided percutaneous release for treatment of wrist digital flexor tendon adhesions following non-surgical treatment of distal radius fractures in the aged
作者:
金少枫; 苏坤阳; 陈毕能; 林友聪; 吕辉照
(中国人民解放军联勤保障部队第九一〇医院,福建 泉州 362000)
Author(s):
JIN Shaofeng; SU Kunyang; CHEN Bineng; LIN Youcong; LYU Huizhao
The 910th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army,Quanzhou 362000,Fujian,China
关键词:
桡骨骨折;  老年人;  指浅屈肌腱;  指深屈肌腱;  肌腱粘连;  肌腱粘连松解;  超声引导;  临床试验
Keywords:
radius fractures;  aged;  tendon of flexor digitorum superficialis;  flexor digitorum profundus tendon;  tendon adhesion;  tenolysis;  ultrasound-guided;  clinical trial
摘要:
目的:探讨超声引导下经皮松解术治疗老年桡骨远端骨折非手术治疗后腕部指屈肌腱粘连的临床疗效和安全性。方法:将58例老年桡骨远端骨折非手术治疗后腕部指浅、深屈肌腱粘连患者随机分为2组,其中经皮松解组(33例)采用超声引导下经皮肌腱粘连松解术治疗,切开松解组(25例)采用切开肌腱粘连松解术治疗。分别于术前和术后1周,采用视觉模拟量表(visual analogue scale,VAS)评分评价手指疼痛程度; 分别于术前和术后3个月,采用手指关节总主动活动度(total active movement,TAM)评价手指活动能力,采用手部功能独立性量表(functional independence measure,FIM)评价手指日常生活活动能力,采用明尼苏达手灵巧度测验(Minnesota manual dexterity test,MMDT)评价手指灵巧度,通过超声测量肌腱移动度和粘连带厚度以评价肌腱粘连程度; 并观察并发症发生情况。结果:①手指疼痛VAS评分。术前,2组患者的手指疼痛VAS评分比较,差异无统计学意义[(1.9±1.0)分,(2.0±0.9)分,t=-0.323,P=0.748]; 术后1周,经皮松解组的VAS评分低于切开松解组[(1.6±0.9)分,(3.4±1.4)分,t=-6.191,P=0.001],经皮松解组的VAS评分与术前的差异无统计学意义(t=0.964,P=0.339),切开松解组的VAS评分高于术前(t=-5.309,P=0.001)。②手指关节TAM。术前和术后3个月,2组患者的手指关节TAM比较,组间差异均无统计学意义[136.2°±19.4°,140.1°±17.9°,t=-0.909,P=0.366; 211.8°±18.6°,203.8°±14.3°,t=1.378,P=0.062]; 术后3个月,2组患者的手指关节TAM均高于术前(t=-4.597,P=0.001; t=-6.211,P=0.001)。③手部FIM评分。术前和术后3个月,2组患者的手部FIM评分比较,组间差异均无统计学意义[(17.4±3.4)分,(16.7±3.3)分,t=0.213,P=0.832;(36.7±4.2)分,(35.8±4.8)分,t=0.291,P=0.772]; 术后3个月,2组患者的手部FIM评分均高于术前(t=-3.000,P=0.004; t=-5.214,P=0.001)。④MMDT结果。术前和术后3个月,2组患者的放置测验所需时间比较,组间差异均无统计学意义[(339.6±19.2)s,(336.6±18.9)s,t=0.686,P=0.495;(208.65±18.2)s,(211.9±17.7)s,t=-0.429,P=0.620]; 术后3个月,2组患者的放置测验所需时间均短于术前(t=5.691,P=0.001; t=4.929,P=0.001)。术前和术后3个月,2组患者的翻转测验所需时间比较,组间差异均无统计学意义[(287.7±16.3)s,(284.3±15.0)s,t=0.928,P=0.356;(171.7±12.2)s,(174.0±14.7)s,t=-0.506,P=0.583]; 术后3个月,2组患者的翻转测验所需时间均短于术前(t=2.539,P=0.014; t=2.799,P=0.009)。⑤肌腱移动度和粘连带厚度。术前和术后3个月,2组患者的肌腱移动度比较,组间差异均无统计学意义[(10.6±3.3)mm,(9.7±3.9)mm,t=0.503,P=0.586;(25.9±4.5)mm,(24.2±5.2)mm,t=0.784,P=0.443]; 术后3个月,2组患者的肌腱移动度均大于术前(t=-25.132,P=0.001; t=-31.986,P=0.001)。术前和术后3个月,2组患者的肌腱粘连带厚度比较,组间差异均无统计学意义[(6.7±0.3)mm,(6.5±0.4)mm,t=0.622,P=0.541;(3.1±0.2)mm,(3.1±0.3)mm,t=0.133,P=0.982]; 术后3个月,2组患者的肌腱粘连带厚度均小于术前(t=13.349,P=0.001; t=18.573,P=0.001)。⑥并发症发生情况。经皮松解组出现切口浅表感染、切口延迟愈合、切口血肿、正中神经损伤、腕部肌腱再粘连各1例,切开松解组出现切口浅表感染2例、切口血肿1例、切口延迟愈合3例、正中神经损伤1例、腕部肌腱再粘连5例。经皮松解组患者的并发症发生率低于切开松解组(χ2=7.408,P=0.006)。结论:超声引导下经皮松解术与切开松解术治疗老年桡骨远端骨折非手术治疗后腕部指屈肌腱粘连的疗效相当,但前者较后者创伤更小、安全性更高。
Abstract:
Objective:To explore the clinical outcomes and safety of ultrasound-guided percutaneous release for treatment of wrist digital flexor tendon(DFT)adhesions in aged patients who underwent non-surgical treatment for distal radius fractures.Methods:Fifty-eight aged patients suffered from superficial and deep DFT adhesions in wrist after non-surgical treatment of distal radius fractures were randomly divided into percutaneous adhesiolysis group(33 cases)and open adhesiolysis group(25 cases).The patients in percutaneous adhesiolysis group were treated with ultrasound-guided percutaneous tendon adhesiolysis,while the ones in open adhesiolysis group with open tendon adhesiolysis.The finger pain degree was evaluated by using visual analogue scale(VAS)score before the surgery and at postsurgical week 1 respectively.The activity ability,activity of daily living(ADL)and dexterity of finger were evaluated by using finger total active movement(TAM),hand functional independence measure(FIM)and Minnesota manual dexterity test(MMDT)respectively,and the tendon adhesion degree was evaluated by measuring tendon range of motion(ROM)and adhesion band thickness using ultrasound before the surgery and at postsurgical month 3 respectively.Moreover,the complications were observed.Results:①There was no statistical difference in finger pain VAS score between the 2 groups before the surgery(1.9±1.0 vs 2.0±0.9 points,t=-0.323,P=0.748).The finger pain VAS scores were lower in percutaneous adhesiolysis group compared to open adhesiolysis group at postsurgical week 1(1.6±0.9 vs 3.4±1.4 points,t=-6.191,P=0.001),and it was not significantly different from each other between pre-surgery and postsurgical week 1 in percutaneous adhesiolysis group(t=0.964,P=0.339),while it increased in open adhesiolysis group at postsurgical week 1 compared to pre-surgery(t=-5.309,P=0.001).②There was no statistical difference in finger TAM between the 2 groups before the surgery and at postsurgical month 3(136.2±19.4 vs 140.1±17.9 degrees,t=-0.909,P=0.366; 211.8±18.6 vs 203.8±14.3 degrees,t=1.378,P=0.062).The finger TAM increased in the 2 groups at postsurgical month 3 compared to pre-surgery(t=-4.597,P=0.001; t=-6.211,P=0.001).③There was no statistical difference in hand FIM score between the 2 groups before the surgery and at postsurgical month 3(17.4±3.4 vs 16.7±3.3 points,t=0.213,P=0.832; 36.7±4.2 vs 35.8±4.8 points,t=0.291,P=0.772).The hand FIM scores increased in the 2 groups at postsurgical month 3 compared to pre-surgery(t=-3.000,P=0.004; t=-5.214,P=0.001).④There was no statistical difference in the time spent in placing test between the 2 groups before the surgery and at postsurgical month 3(339.6±19.2 vs 336.6±18.9 seconds,t=0.686,P=0.495; 208.65±18.2 vs 211.9±17.7 seconds,t=-0.429,P=0.620).The time spent in placing test decreased in the 2 groups at postsurgical month 3 compared to pre-surgery(t=5.691,P=0.001; t=4.929,P=0.001).There was no statistical difference in the time spent in turning test between the 2 groups before the surgery and at postsurgical month 3(287.7±16.3 vs 284.3±15.0 seconds,t=0.928,P=0.356; 171.7±12.2 vs 174.0±14.7 seconds,t=-0.506,P=0.583).The time spent in turning test decreased in the 2 groups at postsurgical month 3 compared to pre-surgery(t=2.539,P=0.014; t=2.799,P=0.009).⑤There was no statistical difference in tendon ROM between the 2 groups before the surgery and at postsurgical month 3(10.6±3.3 vs 9.7±3.9 mm,t=0.503,P=0.586; 25.9±4.5 vs 24.2±5.2 mm,t=0.784,P=0.443).The tendon ROM increased in the 2 groups at postsurgical month 3 compared to pre-surgery(t=-25.132,P=0.001; t=-31.986,P=0.001).There was no statistical difference in the thickness of tendon adhesion band between the 2 groups before the surgery and at postsurgical month 3(6.7±0.3 vs 6.5±0.4 mm,t=0.622,P=0.541; 3.1±0.2 vs 3.1±0.3 mm,t=0.133,P=0.982).The thickness of tendon adhesion band decreased in the 2 groups at postsurgical month 3 compared to pre-surgery(t=13.349,P=0.001; t=18.573,P=0.001).⑥The superficial incision infection,incision delayed healing,incision hematoma,median nerve injury and wrist tendon readhesion were found in 1 patient respectively in percutaneous adhesiolysis group,while the superficial incision infection(2 cases),incision hematoma(1 case),incision delayed healing(3 cases),median nerve injury(1 case)and wrist tendon readhesion(5 cases)were found in open adhesiolysis group.The incidence rate of postoperative complications was lower in percutaneous adhesiolysis group compared to open adhesiolysis group(χ2=7.408,P=0.006).Conclusion:Ultrasound-guided percutaneous tendon adhesiolysis is similar to open tendon adhesiolysis in the clinical outcomes in treatment of wrist DFT adhesions in aged patients who underwent non-surgical treatment for distal radius fractures,while the former displays the advantages of less surgical injury and higher safety compared to the latter.

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(收稿日期:2022-01-13 本文编辑:时红磊)

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