异体肌腱移植术后粘连原由分析.pdfVIP

346 Chinese Journal of Reparative and Reconstructive Surgery, March 2008, Vol. 22, No.3 · · 异体肌腱移植术后粘连原因分析 孙燕琨 张友乐 李祥 邓玖征 【摘 要】 目的 通过对异体肌腱移植术后粘连的回顾性分析，探讨影响肌腱粘连的因素。 方法 1990年5 月－ 2000 年6 月，行异体肌腱移植手术85 例因肌腱粘连行二期肌腱松解术。男76 例，女9 例；年龄8 ～46 岁，平均24.5 岁。 机器绞伤、碾压伤38 例，电烧伤32 例，切割伤4 例，爆炸伤4 例，肢体离断伤7 例。屈肌腱缺损66 例，伸肌腱缺损 19 例。 单指肌腱缺损6 例，两指以上79 例。缺损范围为Ⅰ～Ⅴ区。术前关节总活动度 220° 者73 例。合并皮肤缺损者以皮瓣 修复创面，骨折行内固定，骨缺损行髂骨移植，血管、神经及肌肉损伤行一期修复。　结果　85 例异体肌腱移植术后主动 活动度小于被动活动度50% 以上，于移植术后4 ～15 个月行二期肌腱松解术，平均8.8 个月。松解后第2 天开始主动手 指屈伸活动，并配合支具牵引进行功能锻炼。松解术后患者均获7 ～17 年随访，平均12.7 年。患者关节主动活动度与被 动活动度一致，平均关节总活动度为200° 。 结论 患者受伤的严重程度是影响肌腱愈合和粘连的主要因素，改进异体 肌腱的选材和处理方法，以及制订安全有效的早期功能锻炼方案可减轻术后粘连。 【关键词】 肌腱损伤 异体肌腱移植 粘连 松解术 分析 中图分类号：R274. 31 R685. 4 文献标志码：A ANALYSIS OF REASONS OF TENDON ADHESION POST TENDON ALLOGRAFT / SUN Yankun, ZHANG Youle, LI Xiang, DENG Jiuzheng. Department of Hand Surgery, Beijing Jishuitan Hospital, the Forth Clinical Hospital of Beijing University, Beijing, 100035, P. R. China. Corresponding author: SUN Yankun, E-mail: sunyankun01@ 【Abstract 】 Objective To explore the reasons of tendon adhesions post tendon allograft. Methods From May 1990 to June 2000, 85 cases receiving tendon allograft were given tenolysis because of tendon adhesions. There were 76 males and 9 females, with an average age of 24.5 years (8-46 years). Injury was caused by machine in 38 cases, electric in 32 cases, cut in 4 cases, explosion in 4 cases and extremity mutilation in 7 cases; including 66 cases of flexor tendon deficit and 19 cases of extensor tendon deficit. Six cases had 1 tendon deficit, 79 cases had tendon deficit of more than 2. The defect region ranged from I to V. The total mobility of the joint was less than 220° in 73 cases. The impairment of skin, bone, nerve and vascular