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目的总结小儿屈肌腱损伤治疗的经验,探讨合理的手术治疗方法。方法对近5年来收治的11例小儿屈肌腱损伤患儿(其中Ⅰ区屈肌腱损伤2例,Ⅱ区屈肌腱损伤9例)行手术治疗。所有操作均在手术放大镜下完成,缝合方法选择常规的改良Kessler法,同时修复损伤的鞘管;不进行成人患者使用的支具下早期主动伸指、被动屈指功能练习,术后每日被动屈指练习3次,其余时间皆于外固定下;早期(3周)去石膏行自由状态下的功能练习。结果Ⅰ区屈肌腱损伤的2例患儿的TAM值和%TAM值分别为220°、270°和83%、98%。Ⅱ区屈肌腱损伤的9例患儿治疗结果为:TAM值178°～265°(平均230°),%TAM值67%～100%(平均82%),优2例,良5例,中2例。其中评价结果为中的2例患儿分别于术后3个月和4.5个月行肌腱松解术,松解术后2例患儿的TAM值皆大于200°,恢复了满意的效果。所有病例中无一例发生肌腱断裂者。结论小儿屈肌腱损伤早期采用显微外科修复可取得满意的疗效。
Objective To summarize the experience of treatment of infantile flexor tendon injury and to explore a reasonable surgical treatment. Methods 11 children with infantile flexor tendon injury (including 2 cases of flexor tendon injury in region Ⅰ and 9 cases of flexor tendon injury in region Ⅱ) were treated surgically in the past 5 years. All operations were performed under a surgical magnifying glass. The conventional modified Kessler method was used for the suture method, and the damaged sheath was repaired at the same time. In the case of adult patients, the active early flexing finger and passive flexor finger exercises were not performed. Exercise 3 times, the rest of the time in the external fixation; early (3 weeks) to plaster free exercise mode. Results The TAM value and% TAM value of two cases of flexor tendon injury in zone Ⅰ were 220 °, 270 °, 83% and 98% respectively. The results of 9 children with flexor tendon injury in zone Ⅱ were TAM ranging from 178 ° to 265 ° (mean 230 °),% TAM 67% to 100% (average 82%), excellent in 2, good in 5 2 cases. Twenty-two of the two children were evaluated with tendon release at 3 months and 4.5 months respectively. The TAM values of two children after the operation were both greater than 200 °, which restored the satisfactory results. None of the cases had a tendon rupture in all cases. Conclusion Pediatric flexor tendon injury early microsurgery repair can achieve satisfactory results.