| Objective:The discontinuity of the FingerⅠDistrict extensor tendon,with or without phalangette avulsion,cause mallet finger deformity.Mallet finger is a common clinical injury,if not treated properly,not only affect the appearance,but also will cause pain in the distal interphalangeal joint,extension activities are limited,seriously affecting the patient’s daily life and work.There are a variety of treatment methods for the treatment of mallet finger,conservative treatment such as: fixed support,Mick’s splint fixation,Stack splint fixation.surgical methods such as: Kirschner wire fixation,direct suture,extracting wire method,anchor repair method.In this study,we analyzed the different types of extensor digitorum tendon injury in different types of surgical procedures,to find out the best treatment of mallet finger,achieve the purpose of individualized treatment,improve the clinical effect of the treatment of mallet finger,reduce the flexion deformity and dysfunction,and provide theoretical basis for the treatment of mallet finger.Methods:We investigated 89 patients with mallet fingers in the Third Hospital of Hebei Medical University in 2014-2016,among them,there were67 males and females with an average age of 26.4 years(ranging from 1 to 65years).Sharp instrument injury : 24 cases,stab injury :30 cases,mechanical wound:26 cases;According to the classification of mallet fingers by Du Dong,34 cases of type I mallet finger type,21 cases of type II,14 cases of type type III,and 20 cases of type IV.31 cases were treated with direct suture of tendon,18 cases with steel wire extraction method,21 cases with anchor screw fixation,and 19 cases with Kirschner wire fixation.The distal end of extensor tendon was more than 2mm,the broken end was still neat,we choose the "8" or mattress suture with the 5-0 or 4-0 Prolene suture line;The method of Kirschner wire fixation was used to treat the bony mallet finger which had more than 1/3 joint surface;For the extensor tendon avulsion at the stop point,tear off the fracture block is smaller,or the fracture block involving less than1/3 joints of the hammer finger,we used the method of steel wire extraction to reconstruct the extensor tendon;The extensor tendon were removed from the dead point,or extensor tendon broken end is not neat,distal length is less than2 mm,we choose the wire anchors to reconstruct the extensor tendon.Once every 2 weeks,the patients were reexamined and the X-ray was used to find out the position and the healing of the fracture.All cases were followed up regularly after operation.The clinical efficacy was evaluated by TAM method.Results:All the patients were followed up with a time range of 6 months-5 years,an average of 2.1 years.After operation,3 cases in the direct suture group had a line knot reaction,the local skin edge necrosis,and gradually improved after treatment,and the function recovered well.There were 1 cases of tendon continuity,but the extension of the joint was poor,the tendon segment was cut,and the function of the prognosis was good;Out of the steel wire group 1 cases of nail deformity,fall off,in which there were 1 cases of infection,after dressing change,after infusion improved;There were 1 cases of anchor nail group,and there were purulent discharge,and after the operation of the second operation,the healing was better;The fracture healing of Kirschner wire group was good,1 cases had distal interphalangeal joint deformity,but the flexion and extension activities were good,and the postoperative pain was strong in the 2 cases.To evaluate the clinical efficacy of using the TAM method,direct suture group 14 cases of excellent,good in 6cases,good rate of 64.5%;taking the wire group 4 cases of excellent,good in8 cases,good rate of 66.6%;anchor repair group 8 cases of excellent,good in7 cases,good rate of 71.4%;4 cases of Kirschner wire fixation were excellent,good in 8 cases,excellent rate of 63.1%.Four groups of Kruskal-Wallis H rank sum test,still can not think of the clinical effect of the four surgical methods are different(P>0.05).Conclusions:1 Direct suture for I type closed without avulsion fracture of the tendinous mallet and open tendinous mallet finger extensor tendon and distallength of more than 2mm,for interphalangeal joint hyperextension Kirschner wire fixation,direct end-to-end suture or overlapping suture;2 The wire extraction method is suitable for the treatment of II type of mallet finger with closed fracture(1/3)which is less than the articular surface;For the open mallet finger,if the fracture is large,it is also possible to draw out the tendon of the extensor tendon;3 Anchor repair method for I type of extensor tendon from the distal phalanx base avulsion and no bone block tendinous mallet finger extensor tendon and distal length is less than 2mm,reconstruction of extensor tendon;For the type II mallet finger(the bone block is smaller than the articular surface 1/3),if the fracture block is small,it can be used to remove the avulsion small bone block4 Type III(bone mass greater than the articular surface of 1/3)mallet fingers can be selected by Kirschner wire fixation or pull out wire method,if the surrounding soft tissue injury is heavier,you can choose the Kirschner wire combined with the extraction of wire fixation.5 Open mallet finger,after the completion of the wound,skin flap covering the wound,the tendon can be selected according to the specific circumstances of a period of two or more options to repair the above approach6 According to the different types of mallet fingers,the corresponding method of individualized treatment,can effectively improve the clinical treatment of mallet finger... |
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