可吸收防粘连膜在肌腱修复中的应用疗效观察

目的观察可吸收防粘连膜预防肌腱修复术后粘连的临床应用效果。方法将38例急性手部肌腱损伤患者随机分为两组,肌腱缝合后分别采用包绕成都迪康公司生产的聚-DL-乳酸可吸收防粘连膜和早期使用动力性支具两种方法治疗。试验组15例65腱,涉及屈肌腱10例51腱,7例伴血管神经损伤;伸肌腱5例14腱。对照组23例76腱,涉及屈肌腱11例32腱,6例伴血管神经损伤;伸肌腱12例44腱。对损伤肌腱均采用5-0肌腱缝线行改良Kessler法修复。试验组术后以石膏托固定伤手于屈腕、屈掌指关节位(屈肌腱损伤者)或伸腕、伸指位(伸肌腱损伤者),鼓励患者早期行手指活动,对照组术后第3天改用动力性支具。4周后拆除石膏托或动力性支具,行主动屈伸锻炼,辅以中药熏洗。结果试验组1例伤口延迟愈合,2例肌腱修复处皮肤出现局限性硬结,其余伤口均一期愈合。术后随访6～14个月,平均8.7个月。术后屈肌腱功能用TAM法评定,伸肌腱功能用Miller法评定。试验组综合优良率为93.85%(61/65),对照组综合优良率为90.79%(69/76)(P>0.05),两组间无显著性差异。结论可吸收防粘连膜能有效防止肌腱损伤修复术后粘连的形成,同时避免了动力性支具安装的繁琐操作,消除了医患双方在使用支具过程中对可能发生肌腱断裂的担忧,具有良好的应用前景。

Effects of the absorbable membrane on adhesion prevention in tendon repair

Objective To observe the clinical effects of the absorbable membrane on adhesion prevention in the tendon repair. Methods 38 patients with acute injury of hand tendon underwent tendon repair. They were randomized into 2 groups. There were 15 patients (65 tendons) in the test group, involving 51 flexor tendons in 10 cases, 7 of whom had neurovascular injury, and 14 extensor tendon in 5 cases. There were 23 (76 tendons) in the control group, involving 32 flexor tendons in 11 cases, 6 of whom had neurovascular injury, and 44 extensor tendons in 12 cases. All the tendons were repaired with 5-0 thread by modified Kessler method. The connected parts of the tendons were wrapped by absorbable membrane (produced by DIKANG BIOMEDICAL Co, Ltd) in the test group, and were immobilized by plaster. Postoperative exercise were encouraged. In the control group, no absorbable membrane was used, the plaster was changed into dynamic brace 3 days after operation and removed 3 weeks later, but for those with neurovascular injury it was removed 4 weeks later. And active exercises were permitted. In addition, their hands were smoked and rinsed with Chinese herbal medication. Results Postoperative follow-ups lasted 6 to 14 months, averaging 8.7 months. All the wounds were cured at one stage except for 1 case of delayed union and 2 cases of skin hardening on the limited repaired area. The function of the flexor tendon was valued by TAM system, and that of the extensor tendon by Miller Grade. The excellent rate was 93.85%(61/65) in the test group, and 90.79%(69/76) in the control group. There was no significant difference between the 2 groups. Conclusion Because the absorbable membrane can prevent the adhesion after the injured tendon is repaired, and can avoid the inconvenience or the possibility of the re-rupture of the repaired tendon in using a dynamic brace, it has a good prospect of clinical application.