The Research Of The Ultrasonograpy In The Diagnosis And Treatment Of Mallet Finger

Objective: Hand extensor tendon injuries is common in clinic, extensortendon damage may occur at any part of the body. the extensor tendon I zonerupture lead to the flexion deformity,it is known as the mallet finger. In thepast, clinical diagnosis was mainly depended on physical examination andX-ray examination. Physical examination may easily lead to mistakes bymisdiagnosing the mallet finger symptom caused by rheumatoid arthditis andosteoarthritis. In tendinous mallet, the X-ray examination can only disclose softtissue swelling,however, without showing a clear image of the damagingseverity. Magnetic resonance imaging can describe the condition of tendoninjuries, but that may cost a great deal of money and time, which many peoplecannot afford. Besides, this kind of examination is not available for patientswho have metal planted inside. So, Magnetic resonance imaging also have greatlimitation in diagnosis. With the development of the ultrasonic technology,High-resolution sonography is very sensitive to the diagnosis of tendon injury.With a low cost, it will provide a real time observation of the tendon’s condition,and also conserve objective image materials. Although someone to useultrasound had detailed description the extensor tendon zone I but not withsurgical method combined.This article will mainly explore diagnosing malletfinger by High-resolution sonography, and making reasonable therapeuticschedule by the inspection results.Methods: there are84patients who injured during one day to sevendays.Including48males and36femals,at the average of31years old.4Indexfingers (4.8%),15middle fingers (17.9%),44ring fingers(52.4%),21littlefingeers （25.0%）.All patients underwent preoperative ultrasonographyexamination. Divide all patients into three groups according the results ofsonographic examination. Group A, there are24patients whose extensor tendon was complete tear. In these cases, the High-resolution sonography examinationshows that in discontinuity of the extensor tendon with complete teat, thedistance between two ends of extensor tendon was measurable. There arehypoechoic areas around the tendon of rupture. Through dynamic observation,we discovered that when passive motion of the phalanx distalis, the far ruptureends of the extensor tendon will move with it, but the nearer ones won’t. GroupB, there are5patents who with avulsion fracture. The ultrasound examinationshow that their continuity of extensor tendon was still exist.It can found thathematoma of hypoechoic around the base of the distal. the base of the distal shiftvolar.the ultrasound can measure size of the fracture fragment and show itwehther or not shift dorsal. Through dynamic observation, we discovered thatwhen passive motion the phalanx distalis the extensor tendon willnotgiding.Group C, there are55patients whose extensor tendon was partial tear.ultrasound examination show that ultrasonogram is disorder at the tendoninjuries place. The structure cannot be show clear, hypoechoic around theextensor tendon. Through dynamic observation, we discovered that whenpassive motion of the phalanx distalis the damaged of extensor tendon relativesliding slowly. The extensor tendon of low tension can not ability to move thephalanx distalis.Then group were divided at random into two group:There are27patients in the group C1and There are28patients in the group C2.group A、group C1accept the direct tendon suture method.group B accept the extractingwire method. Group C2accept percutaneous pinning. In the group A group Band group C1, The results of preoperative ultrasonography examination werecompared with that of the operative exploration. Evaluation standard adopt TAMsystem evalution methd.Results:In the group A、group B and group C1, operative exploration tocheck the condition of tendon.Three are24patients whose extensor tendon wascomplete tear in the group A,with0case of partial tear,with0case of avulsionfracture. Three is none patient whose extensor tendon was complete tear in thegroup B.With0case of partial tear,with5case of avulsion fracture.Group C1hasnone patient whose extensor tendon was complete tear. With27case of partial tear,with0case of avulsion fracture.Preoperative ultrasonography results of allpatients were detected with the same results of intraoperativedetection.Diagnosis rate is100%.Postoperative follow-up time is more than sixmonths, at the average time8.5months.Follow-up24cases in the group C1.there are8excellent cases,13good cases,2normal cases and1poor cases.Follow-up28cases in the group C2. there are7excellent cases,16goodcases,3normal cases and1poor cases. Group C1and group C2acceptdifferent surgieal method to treat. evaluation indicator（excellent、good、normalcases、poor）in order.Group C1and group C2isthat two independ samples becompared with.According to the characteristics, Given the Wilcoxon rank-sumtest. Z=-0.541，P=0.588>0.05. At the level ofα=0.05，it cannot considered thatthe clinical efficacies of the two surgical method have statistical significantaccording to the information in this case. When the tendon partial tear,cannotrefuse to the same assumption is that two kinds of treatment the clincal curativeeffect.Conclusion: sonographic examination as a kind of the means to diagnosethe mallet finger The benefits of ultrasonography are that minmally invasive,lowcost,repeatable,and more sensitive than physical examination.It also canidentification complete and partal the extensor tendon injuries. We can select thereasonbale treatment by the inspection results.