玻璃酸钠预防肌腱缝合术后粘连作用分析

陈明金

[摘要]目的 探討玻璃酸钠对肌腱缝合术后粘连的预防作用及对术后手部功能的影响。方法 选取2014年3月～2016年12月我院收治的74例手外伤伴至少有1条手指伸肌腱或屈肌腱断裂患者作为研究对象，按随机对照、自愿原则分为对照组（伸肌腱27例，屈肌腱10例）和治疗组（伸肌腱27例，屈肌腱10例），各37例。对照组采用改良Kessler缝合法，局部不使用玻璃酸钠；治疗组采用改良Kessler缝合法，加用玻璃酸钠外涂肌腱缝合接头，或修补腱鞘后用注射器将玻璃酸钠直接注入。观察并记录两组治疗1、2、3个月后的手指总主动活动度（TAM）状况，比较治疗3个月伸、屈肌腱断裂临床治疗效果，同时记录患者是否发生肌腱粘连并发症。结果 两组治疗1、2、3个月后的手指总主动活动度高于治疗前，差异有统计学意义（P<0.05）。治疗组治疗1、2、3个月后的手指总主动活动度高于对照组，差异有统计学意义（P<0.05）。治疗组治疗3个月后的伸肌腱、屈肌腱优良率高于对照组，差异有统计学意义（P<0.05）。治疗组的肌腱粘连率为5.40%，低于对照组的27.02%，差异有统计学意义（P<0.05）。结论 玻璃酸钠能有效缓解肌腱缝合术后粘连，促进术后手部功能恢复，改善患者生活质量，且无明显不良反应，值得临床推广应用。

[关键词]玻璃酸钠；肌腱缝合术；肌腱粘连；手指总主动活动度

[中图分类号] R622+.9 [文献标识码] A [文章编号] 1674-4721（2017）06（a）-0079-04

[Abstract]Objective To investigate the preventive effect of Sodium Hyaluronate on adhesion after tendon suture and the influence of hand function.Methods 74 patients with hand injuries accompanied by rupture at least 1 extensor tendons or flexor tendons from March 2014 to December 2016 in our hospital were selected as the subjects，all patients were divided into the control group （27 cases of extensor tendon，10 cases of flexor tendon） and the treatment group （27 cases of extensor tendon，10 cases of flexor tendon） according to random control and voluntary principle，37 cases in each group.The control group was treated with modified Kessler suture，and no Sodium Hyaluronate.The treatment group was treated with modified Kessler suture，and sodium hyaluronate was used to suture the tendon suture，or Sodium Hyaluronate was injected into the tendon sheath，all patients were observed and recorded in 1，2，3 months after the finger total activity （TAM），and clinical effect of the treatment of flexor tendon rupture were recorded at the same time，the complications of tendon adhesion were compared after 3 months.Results The TAM of the fingers in the two groups after 1，2 and 3 months was higher than that before the treatment，with significant difference （P<0.05）.The TAM of the fingers in the treatment group after 1，2 and 3 months was higher than that of the control group，with significant difference （P<0.05）.The excellent and good rate of extensor tendon and flexor tendon in the treatment group after 3 months was higher than that in the control group，with significant difference（P<0.05）.The adhesion rate of the treatment group was 5.40%，which was lower than 27.02% of the control group，with significant difference （P<0.05）.Conclusion Sodium Hyaluronate can effectively relieve tendon adhesion，promote postoperative recovery，improve the quality of life of patients，and no obvious adverse reaction，it is worthy of clinical promotion and application.

[Key words]Sodium Hyaluronate；Tendon suture；Tendon adhesion；Total active finger

手部手指伸肌腱或屈肌腱损伤是临床常见的手外伤之一，其相应的关节失去活动功能，给患者的正常生活造成极大影响。既往多采用手术措施来治疗本病，随着操作技术的不断完善，改良的Kessler缝合法成为常用的手术术式，其具有缝合牢固，抗拉力较好等优点，得到了广泛的应用[1]。然而此方法术后需要固定制动，严重限制了肌腱滑动，常伴随不同程度的肌腱粘连现象，影响了手部主动活动，预后效果较差。相关文献报道，肌腱缝合术后肌腱粘连现象与患侧手部主动活动功能的恢复具有密切关系[2]，因此采用有效方式来预防肌腱缝合术后粘连现象、恢复手部功能成为临床所关注的重点。……