应用微型骨锚亚急诊修复指关节侧副韧带撕脱伤

目的 探讨微型骨锚在亚急诊指关节侧副韧带近点撕脱伤修复中的疗效.方法 对2例拇指掌指关节和7例手指近侧指间关节侧副韧带断裂伤的患者早期应用Mitek微型骨锚植入侧副韧带指骨附着处,再用锚尾部的Ethibond缝合线与撕脱的侧副韧带缝合.结果 9例术后随访10～12个月,平均11.1个月.按Saetta评定标准评定疗效,优6例,良3例.结论 微型骨锚用于修复指关节侧副韧带止点撕脱,操作简便,疗效可靠.     

应用Mitekmicro微型骨锚修复手指侧副韧带损伤

目的研究微型骨锚用于修复和重建手指侧副韧带损伤的临床疗效。方法2011年4月至2012年4月,对6例手指侧副起止点损伤采用微型骨锚进行修复或重建。结果6例8指均获得6～12个月随访,平均7．5个月。按TAM功能评定方法评定：优6例良2例。x线片示骨锚未见松动、脱落。结论微型骨锚用于修复与重建手指侧副韧带起止点损伤其操作容易掌握,简便快捷,疗效可靠,是较理想的方法。     

应用微型骨锚重建指伸肌腱终腱止点--附6例报告

目的 探讨微型骨锚在指伸肌腱终腱止点撕脱伤修复中的临床疗效。方法 对6例指伸肌腱终腱止点撕脱患指，先用克氏针将远侧指间关节固定于过伸位，然后将Mitek mcro微型骨锚植人远节指骨基底背侧指伸肌腱附着处，再用锚尾部的4-0 Ethibond缝合线与撕脱的指伸肌腱缝合，重建止点。结果 6例全部获得随访，术后随访3～6个月，平均4．1个月。按Dargan功能评定方法评定：优4例，良2例。术后X线片未见骨锚松动、脱落。结论 微型骨锚用于修复与重建指伸肌腱终腱，操作简便，易掌握，疗效可靠。     

微型骨锚在手指侧副韧带损伤修复中的应用

目的研究微型骨锚用于修复和重建手指侧副韧带损伤的临床疗效。方法对15例手指侧副韧带损伤采用微型骨锚进行修复或重建,术后随访6～12个月。按Saetta评定标准进行疗效评定。结果术后功能恢复总体优良率为93.3。复查X线片未见骨锚松动、脱落。结论微型骨锚用于修复与重建手指侧副韧带损伤操作简便、疗效可靠。     

微型骨锚一期重建急性拇指掌指关节尺侧副韧带损伤

目的 评估应用微型骨锚对急性拇指掌指关节尺侧副韧带损伤进行手术修补的临床疗效.方法 2004年7月至2009年5月,对11例急性拇指掌指关节尺侧副韧带完全损伤的患者,采用Mitek micro微型带线骨锚一期植入第一掌骨头或拇指近节指骨基底侧方尺侧副韧带断裂的附着处,用锚尾部的缝合线缝合撕脱的侧副韧带重建起止点.结果 术后随访6个月至4年,平均2.4年.按Saetta标准评定:优7例,良3例,可1例;优良率为90.9%.X线片显示骨锚未见松动、脱落.结论 应用骨锚对急性拇指掌指关节尺侧副韧带损伤进行手术修补不仅操作简便,而且容易掌握,疗效可靠.     

微型骨锚在远指间关节侧副韧带起止点损伤中的应用

目的探讨应用微型锚钉修复远指间关节侧副韧带起止点损伤的临床疗效。方法 2017年5月-2018年8月,对15例远指间关节侧副韧带起止点损伤患者在中节指骨头或末节指骨基底应用1.3 mm微型骨锚重建侧副韧带起止点以修复损伤,术后评价效果。结果术后均一期愈合,无感染及皮肤坏死、锚钉外露,所有患者获得随访3～14个月,平均9个月。根据Dargan功能评定,优11例,良3例,可1例,优良率93%,查体关节稳定。结论应用微型骨锚修复远指间关节侧副韧带起止点损伤是一种快捷、可靠的方法,适于临床推广应用。     

微型锚钉联合克氏针固定治疗手指伸肌腱止点撕脱损伤的应用

目的研究应用锚钉联合克氏针固定治疗手指伸肌腱止点撕脱损伤的临床效果。方法对30例患者采用切开微型锚钉固定肌腱止点,由指端将直径0．8mm克氏针经远节指骨和中节指骨固定远节指间关节伸直位、近节指间关节固定屈曲90。位,手术后不用石膏及其他外固定。手术后3周将克氏针退至中节指骨加强近节指间关节功能锻炼,手术后6周拔除克氏针。结果随访1．5～6月,按TAM法评定治疗效果,优21例（70．0％）;良6例（20．0％）;3例病例失去随访,优良率达90％。结论应用微型锚钉联合克氏针固定治疗手指末节伸指肌腱止点撕脱损伤,手术时间短、固定确切,患者痛苦小,疗效明显,可以广泛应用。     

微型骨锚钉修复近侧指间关节侧副韧带断裂

目的探讨微型骨锚钉修复近侧指间关节侧副韧带断裂。方法25例近侧指间关节侧副韧带断裂患者采用微型锚钉修复断裂侧副韧带,稳定近侧指间关节。结果25例患者随访6～18个月,按TAM评定标准,优8例,良13例,差4例,优良率84％。结论微型骨锚钉修复近侧指间关节侧副韧带断裂疗效可靠,手术简单。     

双微型骨锚重建伸指肌腱终腱止点的临床应用

锤状指是由于末节指骨基底背侧至中央腱束止点间伸肌健断裂或撕脱部分指骨所致。若处理不当锤状指畸形长期存在,影响手部功能及外观。针对当前骨锚在手部肌腱损伤重建的应用逐渐广泛的现状,及我科在临床应用中的经验,分别采用单、双骨锚进行止点重建。2007年7月-2009年1月随访患者8例,笔者发现采用双微型骨锚重建修复指伸肌腱终腱止点撕脱伤者疗效优于采用单微型骨锚重建修复指伸肌腱终腱止点撕脱伤者。     

应用微型骨锚重建指伸肌腱止点的临床研究

目的评估应用微型骨锚重建指伸肌腱止点的疗效。方法2004年3月～2005年12月对21例（21指）指伸肌腱止点撕脱伤所致锤状指畸形患者进行治疗，用克氏针将远侧指间关节固定于过伸位，然后将Mitekmicro微型骨锚置入远节指骨基底背侧指伸肌腱附着处，再用锚尾部的4-0 Ethibond缝合线与撕脱的指伸肌腱缝合，重建止点。术后6周拔除克氏针开始功能锻炼。结果全部患者获得18～30个月（平均20．2个月）随访。21例患者伤口均一期愈合，无感染和皮肤坏死等。患指各关节被动活动正常。术后末节主动伸直功能（欠伸度为3．5°±1．3°）较术前（欠伸度为45．6°±5．8°）明显改善，差异有统计学意义（P〈0．05），达到或接近正常。依据Patel等锤状指疗效评价体系评估：优15例，良5例，中1例，优良率为95．2％。随访期间未发现锚钉脱出、松动、断裂等并发症。结论微型骨锚用于修复与重建指伸肌腱止点，操作简便，疗效可靠。     

Reconstruction of the proximal interphalangeal joint collateral ligaments using the Mitek Micro Arc Anchor: an in vitro biomechanical assessment

Proximal interphalangeal joint (PIP) collateral ligament injuries are common and sometimes result in painful, stiff fingers. A number of techniques have been utilized in the past to reconstruct complete collateral ligament injuries. Recently, bone anchor systems have been described that allow collateral ligament reconstruction without the necessity of pull-out wires and other more cumbersome methods to reconstruct these ligaments. The Mitek bone anchor system has been used successfully in a variety of anatomic locations throughout the body to reattach soft tissues to bone. The current study was conducted to evaluate the biomechanical effects of the use of the Mitek Micro Arc Anchor in collateral ligament injuries of the PIP joint. In cadaveric PIP joints, the collateral ligament was isolated and then transsected in its mid substance. The authors compared suturing the ligament alone in standard fashion to repair of the ligament using a bone anchor inserted in the base of the middle phalanx. The joints were stressed to failure, with a lateral load applied at the distal end of the middle phalanx on a materials testing machine. The mean tensile failure loads of the two groups were the following: Mitek anchor, 16.4 +/- 3.7 N; suture repair, 19.3 +/- 7.6 N. The authors found no significant difference in the force required for failure of the repair or in the pattern of failure in the two groups. The Mitek Micro Arc Anchor appears to be adequate biomechanically to reconstruct the collateral ligaments of the finger PIP joint.     

Correction of bilateral congenital swan-neck deformity by use of Mitek mini anchor: a new technique.

Congenital swan neck deformity is a rare condition, secondary to congenital laxity of the palmar plate of the proximal interphalangeal joint. Here, we describe a new surgical method which is based on the palmar plate reinforcement using the Mitek mini anchor system (Mitek Surgical Products Inc., Norwood, MA, USA). Four fingers of a patient with congenital swan neck deformities were corrected with this technique at two stages. First, the anchor was inserted into the volar surface of the proximal phalanx. The two sutures of the anchor system were then crossed the PIP joint in a V fashion. Two holes, 5mm apart from each other, were created through the middle phalanx distal to both insertion points of superficial flexor tendon. The suture ends of the anchor were passed through these holes from the volar to the dorsal side of the middle phalanx and then turned around the edges of the bone to the volar surface. They were tied to each other as the PIP joint was stabilised at 20 degrees flexion by use of a K-wire. The K-wire was removed 21 days later and a rehabilitation program was then initiated. A second operation for the two fingers of the opposite hand was performed 2 months after the first operation. No postoperative complications were encountered. At 2 years follow-up, the active range of motion was within normal limits at PIP and DIP joints of all four fingers without any recurrence of hyperextension or hyperflexion. The final result was satisfactory regarding both the functional and cosmetic aspects. The Mitek mini anchor offers a practical, reliable and functional reconstruction of the volar plate in the management of congenital swan neck deformities. We believe that it may also be used for the acquired deformities.     

手指关节损伤的MRI检查

目的了解MRI检查对手指关节损伤的诊断作用。方法对外伤后致手指损伤的18例24个近侧指间关节或掌指关节进行X线片和MRI检查;其中对6例8个指间关节损伤进行了手术治疗,对12例16个指间关节行石膏固定。结果X线片显示24个损伤关节中发现4例(4个)指关节有损伤并伴有指骨骨折;MRI显示24个指关节均有不同程度的损伤,其中侧副韧带损伤12个关节,侧副韧带损伤伴指骨骨折4个关节,侧副韧带损伤伴掌板撕裂伤8个关节。治疗后3个月,所有病例均获得随访。手功能按TAM评定标准评定疗效:优20个,良4个,优良率达100%。结论MRI检查对手指关节损伤的阳性诊断率很高,检测方便,为临床治疗提供了可靠的依据。     

微型骨锚治疗手指近侧指间关节慢性掌板撕脱性损伤

目的介绍应用微型骨锚治疗手指近侧指间关节慢性掌板撕脱性损伤的手术治疗方法。方法对8例慢性掌板损伤病例,采用手术切开,掌板松解,Mitek微型骨锚重建撕脱掌板止点,术后早期进行屈伸功能锻炼。术后1年随访,随访内容包括手指近侧指间关节(proximal interphalangeal point,PIP)活动范围,关节疼痛,工作能力和患者主观满意度。结果本组患者术前PIP活动度为55.3°±27.8°,术后12个月为80.6°±17.6°(P<0.01)。3例优;3例良;2例一般;优良率达到75%。结论应用微型骨锚重建PIP关节撕脱掌板止点,恢复撕脱掌板正常的解剖学关系,能有效治疗慢性掌板撕脱伤;显著改善患指屈伸功能;缓解疼痛。     

Volar A1 pulley approach for fixation of avulsion fractures of the base of the proximal phalanx

Avulsion fractures of the base of the proximal phalanx associated with collateral ligament instability, excluding the thumb, are relatively rare. While the indications for surgical intervention vary, dorsal approaches have been advocated despite the volar location of the fracture fragment and orientation of the collateral ligaments. Ten patients with 11 avulsion fractures at the base of the proximal phalanx associated with collateral ligament instability were treated with open reduction and internal fixation using a volar A1 pulley approach. Anatomic restoration of the articular surface and collateral ligament stability were obtained in all patients. All fractures healed between 5 and 9 weeks (average, 6 weeks). After an average 19.4-month follow-up period all patients had full range of motion of the metacarpophalangeal joint, collateral ligament stability, and grip strength of at least 90% of the uninjured hand. No perioperative complications occurred. The average DASH score at last follow-up examination was 1.8 (range, 0-6). All patients were satisfied with the outcome of surgery. The volar A1 pulley approach is a direct and effective approach for reduction and fixation of avulsion fractures of the base of the proximal phalanx associated with collateral ligament instability.     

Palmar dislocation of the proximal interphalangeal joint

Fifteen patients with palmar dislocations of the proximal interphalangeal (PIP) joint were reviewed 6 to 49 months after treatment (average 17.8 months). Disruption of the extensor mechanism, palmar plate, and one collateral ligament was found in all patients. The loss of static and dynamic joint support caused palmar subluxation, malrotation, and a boutonnière deformity. Two dislocations were irreducible, and three were associated with dorsal avulsion fractures from the middle phalanx. The serious nature of the injuries from this dislocation was initially unrecognized, and most patients were casually treated; delay from injury to referral averaged more than 11 weeks. Twelve of the 15 required surgery for joint reduction and tendon and ligament repair; three treated earlier were managed by closed reduction and percutaneous pinning. Joint alignment, comfort, and stability were restored, and all returned to full activities including heavy labor. However, a full range of PIP motion was not recovered in any case.     

Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor

Eighteen acute grade III collateral ligament injuries were treated by using the Mitek bone suture anchor. Seven were thumb metacarpophalangeal joint injuries, and eleven were finger proximal interphalangeal joint injuries. Seventeen patients were followed more than 12 months after surgery. All patients were able to use the digits in daily living activities within 5 weeks after surgery, and return to their original work or sports activities within 12 weeks. Pain was completely relieved in 15 patients. Loss of joint motion averaged 7 degrees. In all joints the postoperative lateral stress angle was within 10 degrees of that of the contralateral digit.     

Repair of chronic mallet finger deformity using Mitek micro arc bone anchor

Surgical correction of chronic mallet finger caused by terminal tendon disruption was carried out in 22 patients. The distal stump of the tendon was fixed to the base of the distal phalanx with a Mitek micro arc bone anchor. In all patients the mallet finger deformity was corrected. There were 15 patients with excellent results, 5 with good results, and 2 with fair results. None of the patients had a poor result. No further treatment was needed. The Mitek micro arc bone anchor system is a reliable alternative for the treatment of chronic mallet finger deformity without proximal interphalangeal hyperextension.