Anatomical Study On Stepped Repair Of Flexor Tendon In Ⅱ Zone To Prevent Tendon Adhesion

Objectives The feasibility of repairing the flexor tendon of the finger to prevent adhesion was proved by the use of the anatomical specimen of the upper limb.It provides an anatomical basis for the clinical treatment of flexor tendon injury and finger position fixation in area II.The effect of the clinical treatment of flexor tendon dislocation suture in the second area was discussed.Methods 1 The anatomical specimen was used to repair the flexor tendon with the misplacement of the tendon,which proved that the prevention of tendon adhesion was feasible.Combined with the data obtained from the anatomy,the conclusion is drawn to further guide the clinical work.The selection of normal adult hand specimens of 15,including the index finger,middle finger,ring finger and little finger,15 fingers,divided into 3 groups,20 of each group,a total of 60 fingers.The flexor tendons of 2 areas were revealed.The metacarpophalangeal joints,the proximal interphalangeal joints,and the distal interphalangeal joints were fixed in three different groups.The flexor tendon in the II C area was severed laterally by the anatomical knife,and the model of flexor tendon rupture was made.Group A: When the flexion of the MP joints,PIP joints and DIP joints of the fingers were at 0 degree,The deep and superficial flexor tendons of the flexor tendon were severed with the anatomical knife.Group B: When the MP joint of the finger was 60 degrees,the PIP joint and the DIP joint were flexed at 0 degrees.The deep and superficial flexor tendons were severed with the anatomical knife.Group C: When the finger MP joint flexion was 80 degrees,PIP joint flexion was 90 degrees and DIP joint flexion was 10 degrees,The deep and superficial flexor tendons were severed with the anatomical knife.The three groups were marked with the pen at the broken end of the flexor tendon.Excision of the distal flexor tendons of the finger or the tendon of the superficial flexor digitorum.After suturing,it was fixed on the flexion of the MP joint 60°,PIP joint and DIP joint flexion 0°.Measure and record the dislocation of the deep and shallow flexor tendons.2 Clinical practice application: From October 2015 to January 2017,In our department,we treated 41 fingers with 33 cases of fresh ruptured emergency patients in the flexor tendon area II.All the patients were treated with the buried modified Tang suture to repair the flexor tendon.The resection of the distal FDS or FDP is 0.6cm to 1.0cm.The sheath,the broken end of FDS and FDP were dislocated in a stepped manner to reduce postoperative adhesion.After the operation,the flexion of the wrist was fixed at 20 to 30 degrees with plaster,and the flexion of the MP joint was 60 degrees.The PIP and DIP joints are all extended 0°.Under the guidance of the surgeon,4th to 5th days after the operation,the active flexion and passive extension of the hand were carried out in plaster.Every morning and evening,2 groups of exercise were required,each group flexed 3 times,and the passive extension was 3 times.After 3 weeks of reexamination,removal of plaster gradually increased the exercise rate until the full active flexion of the fingers.The curative effect was evaluated according to the total active system..Results 1 anatomic experiment:The results of 60 fingers experiment.By removing the distal 0.6~1.0 cm finger deep flexor tendon or superficial flexor tendon,In the plaster fixed finger MP joint flexion 60 °,PIP joint and DIP joint flexion 0 °,The staggered anastomotic stoma is staggered by 1cm,which can achieve the purpose of preventing adhesions after tendon surgery.2 clinical practice application: The wound healing situation in this group was: 31 cases of 39 fingers in phase Ⅰ healing and 2 fingers of 2 cases inPhase II healing.A total of 41 fingers of 33 patients were followed up for 5 to 17 months with an average of 8.3 months.The effect of the treatment was evaluated according to the system assessment of the total active activity of the hand.The assessment status was as follows: Excellent 22,Good 17 and Can 2.The rate of excellence was 95.1%.Conclusion 1 The flexor tendon rupture in the second region of the different finger position,shortening 0.6cm to 1.0cm FDS or FDP,M-Tang suture was used to repair flexor tendons.The hand was fixed in MP joint flexion 60°,PIP joint and DIP joint flexion 0°by plaster,the broken end of two tendons were kept 1 cm.It can provide the anatomical basis for the stepped repair II region of flexor tendon in the clinical.2 in the application of clinical practice,The II region of flexor tendon with stepped suture has strong strength.Less exposed threads,Early functional exercise.The two flexor tendons are staggered,Which could prevent tendon adhesions.It is a good way to repair the flexor tendon rupture in the II region.