单纯钢丝加压固定法治疗骨性锤状指的解剖学研究

doi:10.13418/j.issn.1001-165x.2023.2.02

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中国临床解剖学杂志 ›› 2023, Vol. 41 ›› Issue (2) : 128-131. DOI: 10.13418/j.issn.1001-165x.2023.2.02

应用解剖

单纯钢丝加压固定法治疗骨性锤状指的解剖学研究

张玉军¹, 巨积辉²,　赵强²,　王本元²,　程贺云²,　鞠文¹*

作者信息 +

Anatomical study on the treatment of osseous mallet finger by simple wire compression fixation.

Zhang Yujun¹, Ju Jihui², Zhao Qiang², Wang Benyuan², Cheng Heyun², Ju Wen¹*

Author information +

文章历史 +

摘要

目的　探讨单纯钢丝加压固定法治疗骨性锤状指的手术方法的可行性。方法　选用4只成人尸体手标本，示、中、环、小指共16指，测量并研究伸肌腱止点处肌腱的宽度、伸肌腱止点距甲基质距离、末节指骨全长、甲基质长度。选取12指（示、中、环、小指各3指）成人手指标本进行模拟手术，人为设计骨性锤状指模型。钢丝从肌腱与骨块连接处横穿并折弯，找到末节指骨的钢丝穿出点。沿穿出点及远、近端侧方用克氏针横向钻孔3个，钢丝穿出后与另一头拧紧，埋于皮下。观察不同穿出点的钢丝在骨块上方交叉加压点的位置变化。结果　末节指骨穿出点移动方向与钢丝交叉点的移动方向一致，穿出点向两端移动后撕脱骨块均不稳定。当穿出点为末节指骨的近端1/3时，钢丝交叉于骨块正上方，撕脱骨块无松动。结论　钢丝的最适合穿出点为骨块交叉点的延长线与末节指骨的交点。单纯钢丝加压法治疗骨性锤状指是可行的。

Abstract

Objective To investigate the feasibility of simple wire compression fixation in the treatment of osseous mallet finger. Methods Four adult cadavers hand specimens, with a total of 16 fingers including index finger, middle finger, ring finger and little finger, were collected to measure and study the width of the extensor tendon insertion, the distance from the extensor tendon insertion to the nail matrix, the total length of the distal phalanx, and the nail matrix length. A total of 12 finger specimens (three fingers each in index finger, middle finger, ring finger and little finger) were selected for imitated operation. The model of bony mallet finger was artificially designed. The wire was traversed and bent from the junction of the tendon and the bone fragment, and the wire exit point on the distal phalanx was found. Three horizontal holes were drilled with Kirschner wires along the piercing point and the sides of the distal and proximal ends. After the wire was pierced, it was tightened with the other end and buried under the skin. The position changes of cross pressure points above the bone block were observed. Results The final phalanx exit point moved in the same direction as the wire crossing point. The avulsion bone was unstable after the penetration point moved to both ends. When the penetration point was the proximal 1/3 of the end phalanx, the wire was crossed over the bone block without loosening the avulsion bone block. Conclusions The most suitable point of bone penetration is the intersection of the extension line and the phalangette. It is feasible to treat mallet fingers by wire compression fixation.

导出引用

张玉军, 巨积辉, 赵强, 王本元, 程贺云, 鞠文. 单纯钢丝加压固定法治疗骨性锤状指的解剖学研究[J]. 中国临床解剖学杂志. 2023, 41(2): 128-131 https://doi.org/10.13418/j.issn.1001-165x.2023.2.02

Zhang Yujun, Ju Jihui, Zhao Qiang, Wang Benyuan, Cheng Heyun, Ju Wen. Anatomical study on the treatment of osseous mallet finger by simple wire compression fixation. [J]. Chinese Journal of Clinical Anatomy. 2023, 41(2): 128-131 https://doi.org/10.13418/j.issn.1001-165x.2023.2.02

中图分类号： R686.1

参考文献

[1] 付记乐，张家盛，王兮，等. 克氏针不通过关节固定治疗骨性锤状指畸形13例疗效分析[J].中华显微外科杂志，2019，42(6):597-599.DOI：10.3760/cma.j.issn.1001-2036.2019.06.022.
[2] 韩春明，郭明珂，朱稷兴，等. 改良双克氏针加压固定治疗陈旧性骨性锤状指疗效观察[J].中华手外科杂志，2019，35(5):345-346.DOI：10.3760/cma.j.issn.1005-054X.2019.05.010.
[3] 张玉军，巨积辉，周广良，等. 三种治疗骨性锤状指手术方式的疗效分析[J].中华手外科杂志，2018，34(1):24-26.DOI：10.3760/cma.j.issn.1005-054X.2018.01.010.
[4] 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.
[5] 李春江，王保苍，王斌，等. 免激惹张力带技术治疗髌骨下极骨折[J].中华骨科杂志，2021，41(24):1776-1784.DOI：10.3760/cma.j.cn121113-20201224-00749.
[6] 王红胜，袁海平，袁勇，等.张力带技术治疗骨性锤状指的临床应用[J].中华手外科杂志，2017，33(4):273-274.DOI：10.3760/cma.j.issn. 1005-054X.2017.04.014.
[7] Sugiura S, Matsuura Y, Kuniyoshi K, et al. Anatomic study of the first extensor compartment and the relationship between the extensor tendon width and its distal insertion[J]. Surg Radiol Anat. 2017 ,39(11):1223-1226.DOI : 10.1007/s00276-017-1867-2.
[8] Kim BJ, Kim J, Hu J, et al. Functional surgery for subungual melanoma: surgical tips based on histological analysis of 21 cadavers[J]. Dermatol Surg. 2022,48(1):7-11. DOI:10.1097/DSS.0000000000003232.
[9] 赵文韬，赵民.手指伸肌腱Ⅰ区肌腱末节指骨止点与毗邻组织的应用解剖学研究[J].中国临床解剖学杂志，2021，39(2):126-129.DOI：10.13418/j.issn.1001-165x.2021.02.002.
[10] Reardon CM, McArthur PA, Survana SK, et al. The surface anatomy of the germinal matrix of the nail bed in the finger[J]. J Hand Surg Br. 1999,24(5):531-533. DOI :10.1054/jhsb.1999.0227.
[11] Palomo-López P, Becerro-de-Bengoa-Vallejo R, López-López D, et al. Anatomic association of the proximal fingernail matrix to the extensor pollicis longus tendon: A morphological and histological study[J]. J Clin Med. 2018,7(12):465. DOI:10.3390/jcm7120465.
[12] Koh SH, You Y, Kim YW, et al. Long-term outcomes of nail bed reconstruction[J]. Arch Plast Surg. 2019,46(6):580-588. DOI: 10.5999/aps.2019.00997 .
[13] 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.
[14] 张玉军，巨积辉，徐磊，等. 指浅屈肌腱束经骨隧道重建中央腱止点的解剖学研究[J]. 中国临床解剖学杂志，2020，38(1):6-9.DOI：10.13418/j.issn.1001-165x.2020.01.002.
[15] Wehbe MA，Schneider LH．Mallet fractures[J]．J Bone Joint Surg(Am)，1984，66(5)：658-669．
[16] Dzidek BM, Adams MJ, Andrews JW, et al. Contact mechanics of the human finger pad under compressive loads[J]. J R Soc Interface. 2017,14(127):20160935. DOI: 10.1098/rsif.2016.0935 .
[17] 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. DOI：10.13418/j.issn.1001-165x.2021.03.015.