自制钩刀微创治疗与开放式手术治疗手指屈肌腱狭窄性腱鞘炎的疗效比较

摘要

Objective To compare the clinical effect of minimally invasive surgery by self-made bush-hook and open surgery in the treatment of finger flexor tendon stenosing tenosynovitis (FFTST). Methods 167 FFTST patients ( 167 fingers) admitted to our hospital from March 2013 to January 2015 were involved into the study, and they were all classified as 3 to 4 according to Quinnell classification standard. According to patients' will, they were divided into minimally invasive surgery group ( 93 cases, 93 fingers) and open surgery group ( 74 cases, 74 fingers). The minimally invasive surgery group was treated with self-made bush-hook, and trochlea A1 was cut to make it loose. The open surgery group was treated with open surgery, and trochlea A1 was removed, observed the factors that influence the result. Results The operation time of minimally invasive surgery group was (3.0±0.5) min, significantly shorter than the open surgery group's 〔(19.0±3.0) min, t=51.783, P=0.000〕. The incision of both groups healed successfully to type I/A, no patient from the two groups showed swollen incision or injury of the inherent nerve and blood vessel. The healing time of minimally invasive surgery group was (6.0 ±1.3)days, significantly shorter than the open surgery group's 〔( 13.0±1.1) days, t=35.354, P=0.008〕.The clinical effect was assessed according to Quinnell classification standard: the minimally invasive surgery group: excellent ( 71 cases,71 fingers), good (17 cases, 17 fingers), medium ( 5 cases,5 fingers) , the excellent rate was 94.6 %. The open surgery group: excellent ( 61 cases ,61 fingers), good (12 cases, 12 fingers), medium (1 cases, 1 fingers), the excellent rate was 98.6 %.The clinical effect between the two groups showed no statistically significant difference (u=4.382, P=0.071). Conclusion The self-made bush-hook has advantages like minimal invasion, high curing rate and simple operation in the treatment of finger flexor tendon stenosing tenosynovitis compared with open surgery, and should be promoted in clinic.%目的 对比自制钩刀微创治疗与开放式手术治疗手指屈肌腱狭窄性腱鞘炎的疗效.方法 选择2013年3月-2015年1月门诊诊治的167例(167指)手指屈肌腱狭窄性腱鞘炎患者,依据Quinnell分级均为3,4级,根据患者意愿分为微创组93例(93指)和开放手术组74例(74指).微创组使用自制钩刀对A1滑车进行微创切割松解,开放手术组进行开放式手术,对A1滑车进行切除,并对两组术后疗效进行随访.结果 微创组手术时间为(3.0±0.5)min,开放手术组为(19.0±3.0)min,微创组手术时间少于开放手术组(t=51.783,P=0.000);两组术后切口均顺利愈合,愈合类型Ⅰ/甲,未出现切口并发症及指固有神经、血管副损伤;微创组切口愈合时间为(6.0±1.3)d,开放手术组为(13.0±1.1)d,微创组切口愈合时间短于开放手术组(t=35.354,P=0.008).参照Quinnell分级标准进行疗效评定,微创组优71例(71指),良17例(17指),中5例(5指),优良率达94.6%;开放手术组优61例(61指),良12例(12指),中1例(1指),优良率达98.6%,两组术后疗效比较,差异无统计学意义(u=4.382,P=0.071).结论 自制钩刀微创治疗相比开放式手术治疗手指屈肌腱狭窄性腱鞘炎,具有创伤小、手术时间短、操作简单、疗效可靠等优点,值得临床推广应用.