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[1]金少楓,蘇坤陽,陳畢能,等.超聲引導(dǎo)下經(jīng)皮松解術(shù)治療老年橈骨遠(yuǎn)端骨折非手術(shù)治療后腕部指屈肌腱粘連[J].中醫(yī)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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超聲引導(dǎo)下經(jīng)皮松解術(shù)治療老年橈骨遠(yuǎn)端骨折非手術(shù)治療后腕部指屈肌腱粘連()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年08期
頁碼:
12-19,24
欄目:
臨床研究
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:
金少楓; 蘇坤陽; 陳畢能; 林友聰; 呂輝照
(中國人民解放軍聯(lián)勤保障部隊第九一〇醫(yī)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
關(guān)鍵詞:
橈骨骨折;  老年人;  指淺屈肌腱;  指深屈肌腱;  肌腱粘連;  肌腱粘連松解;  超聲引導(dǎo);  臨床試驗
Keywords:
radius fractures;  aged;  tendon of flexor digitorum superficialis;  flexor digitorum profundus tendon;  tendon adhesion;  tenolysis;  ultrasound-guided;  clinical trial
摘要:
目的:探討超聲引導(dǎo)下經(jīng)皮松解術(shù)治療老年橈骨遠(yuǎn)端骨折非手術(shù)治療后腕部指屈肌腱粘連的臨床療效和安全性。方法:將58例老年橈骨遠(yuǎn)端骨折非手術(shù)治療后腕部指淺、深屈肌腱粘連患者隨機分為2組,其中經(jīng)皮松解組(33例)采用超聲引導(dǎo)下經(jīng)皮肌腱粘連松解術(shù)治療,切開松解組(25例)采用切開肌腱粘連松解術(shù)治療。分別于術(shù)前和術(shù)后1周,采用視覺模擬量表(visual analogue scale,VAS)評分評價手指疼痛程度; 分別于術(shù)前和術(shù)后3個月,采用手指關(guān)節(jié)總主動活動度(total active movement,TAM)評價手指活動能力,采用手部功能獨立性量表(functional independence measure,FIM)評價手指日常生活活動能力,采用明尼蘇達(dá)手靈巧度測驗(Minnesota manual dexterity test,MMDT)評價手指靈巧度,通過超聲測量肌腱移動度和粘連帶厚度以評價肌腱粘連程度; 并觀察并發(fā)癥發(fā)生情況。結(jié)果:①手指疼痛VAS評分。術(shù)前,2組患者的手指疼痛VAS評分比較,差異無統(tǒng)計學(xué)意義[(1.9±1.0)分,(2.0±0.9)分,t=-0.323,P=0.748]; 術(shù)后1周,經(jīng)皮松解組的VAS評分低于切開松解組[(1.6±0.9)分,(3.4±1.4)分,t=-6.191,P=0.001],經(jīng)皮松解組的VAS評分與術(shù)前的差異無統(tǒng)計學(xué)意義(t=0.964,P=0.339),切開松解組的VAS評分高于術(shù)前(t=-5.309,P=0.001)。②手指關(guān)節(jié)TAM。術(shù)前和術(shù)后3個月,2組患者的手指關(guān)節(jié)TAM比較,組間差異均無統(tǒng)計學(xué)意義[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]; 術(shù)后3個月,2組患者的手指關(guān)節(jié)TAM均高于術(shù)前(t=-4.597,P=0.001; t=-6.211,P=0.001)。③手部FIM評分。術(shù)前和術(shù)后3個月,2組患者的手部FIM評分比較,組間差異均無統(tǒng)計學(xué)意義[(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]; 術(shù)后3個月,2組患者的手部FIM評分均高于術(shù)前(t=-3.000,P=0.004; t=-5.214,P=0.001)。④MMDT結(jié)果。術(shù)前和術(shù)后3個月,2組患者的放置測驗所需時間比較,組間差異均無統(tǒng)計學(xué)意義[(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]; 術(shù)后3個月,2組患者的放置測驗所需時間均短于術(shù)前(t=5.691,P=0.001; t=4.929,P=0.001)。術(shù)前和術(shù)后3個月,2組患者的翻轉(zhuǎn)測驗所需時間比較,組間差異均無統(tǒng)計學(xué)意義[(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]; 術(shù)后3個月,2組患者的翻轉(zhuǎn)測驗所需時間均短于術(shù)前(t=2.539,P=0.014; t=2.799,P=0.009)。⑤肌腱移動度和粘連帶厚度。術(shù)前和術(shù)后3個月,2組患者的肌腱移動度比較,組間差異均無統(tǒng)計學(xué)意義[(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]; 術(shù)后3個月,2組患者的肌腱移動度均大于術(shù)前(t=-25.132,P=0.001; t=-31.986,P=0.001)。術(shù)前和術(shù)后3個月,2組患者的肌腱粘連帶厚度比較,組間差異均無統(tǒng)計學(xué)意義[(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]; 術(shù)后3個月,2組患者的肌腱粘連帶厚度均小于術(shù)前(t=13.349,P=0.001; t=18.573,P=0.001)。⑥并發(fā)癥發(fā)生情況。經(jīng)皮松解組出現(xiàn)切口淺表感染、切口延遲愈合、切口血腫、正中神經(jīng)損傷、腕部肌腱再粘連各1例,切開松解組出現(xiàn)切口淺表感染2例、切口血腫1例、切口延遲愈合3例、正中神經(jīng)損傷1例、腕部肌腱再粘連5例。經(jīng)皮松解組患者的并發(fā)癥發(fā)生率低于切開松解組(χ2=7.408,P=0.006)。結(jié)論:超聲引導(dǎo)下經(jīng)皮松解術(shù)與切開松解術(shù)治療老年橈骨遠(yuǎn)端骨折非手術(shù)治療后腕部指屈肌腱粘連的療效相當(dāng),但前者較后者創(chuàng)傷更小、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 本文編輯:時紅磊)

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通訊作者:林友聰 E-mail:[email protected]
更新日期/Last Update: 1900-01-01