骨形态发生蛋白结合自体腱重建开放性指伸肌腱止点断裂的临床观察

摘要

目的 探讨骨形态发生蛋白(BMP)与自体掌长肌腱移植结合骨隧道重建开放性指伸肌腱止点断裂,为临床治疗伸肌腱止点断裂提供一种安全有效的选择.方法 取5 cm自体掌长肌腱组织,腱粗2 mm.用2.0 mm钻头于末节指骨近端钻一横孔,再用3.0 mm钻头于指骨背侧钻一单皮质垂直孔,肌腱穿过横孔并从垂直孔抽出形成3束,与伸肌腱近侧断端吻合,骨道处置入BMP 2 mg,指伸位铝板外固定制动4周后去除铝板康复锻炼.结果 术后随访6~12个月,平均8个月,23例患者中21例患者获得术后随访,按手指总主动活动度(TAM)评定法评定:优13例,良6例,可2例,优良率为90%.结论 该术式对伸肌腱止点行解剖重建,达到腱骨愈合,疗效满意,为伸肌腱止点重建提供了一种可靠的选择,值得临床推广应用.%Objective To explore the reconstruction of open extensor digitorum tendons rupture with bone morphogenetic protein(BMP) and autogenous palmaris long tendon graft combined with bone tunnel,and to provide a safe and effective choice for the treatment of exten-sor tendon rupture.Methods 5 cm autologous palmaris longus tendon tissue,tendon coarse 2 mm were selected,with the 2.0 mm bit in phalangette proximal to drill a horizontal hole,and then the 3.0 mm bit on the back side of a single vertical hole drilling and cortex,ten-don through cross hole and from vertical hole out to form the 3 beam,and the extensor tendon proximal stump anastomosis.The bone tunnel was disposed into BMP 2 mg,extensor an aluminium plate brake to aluminum rehabilitation exercise after 4 weeks.Results The patients were followed up for 6-12 months,with an average of 8 months.In 23 patients,21 patients were followed up.According to the index of total active range of motion(TAM)evaluation,there were 13 cases excellent,6 cases good,2 cases fair.The excellent and good rate was 90%. Conclusions This method can be used for anatomical reconstruction of extensor tendon insertion site and achieve satisfactory tendon healing.It provides a reliable choice for the reconstruction of extensor tendon insertion,which is worthy clinical application.