| Objective: With the development of economy and culture in China,people’s demand for health is increasing day by day. Especially functionalrecovery of hand injury is highly regarded. Mallet finger which is a distalinterphalangeal joint flexion deformity and unbend limited is caused by thezone Ⅰ distal digital extensor tendon rupture, the tendon avulsion from distalphalanx bone surface or distal phalanx bone avulsion fracture. Currently, thereare a lot of methods of surgical treatment for mallet finger and various reportsvary in surgical treatment for mallet finger. In this case how to choose aappropriate surgical method to improve the efficacy and reduce complicationsin order to meet the increasing medical needs for people. The study throughbiomechanical tests and clinical efficacy of different surgical methods canhelp to guide clinical of choosing surgical treatment.Method：1Biomechanical experiment: Selected8fresh adult hand specimens whichwere intact from metacarpophalangeal joints to fingertips and index, middle,ring and little fingers were amputated from metacarpophalangeal joint.32fingers were randomly divided into4groups (A, B, C, D). The groups A,B,Cdistal digital extensor tendon were amputated form their insertion，while thegroup D extensor was amputated form the point which was distance proximalof distal interphalangeal joint5mm. Dissected nail root and measured thedistance form proximal of distal interphalangeal joint to nail root. Fingerswere undergone surgery with pull-out suture method (group A), micro boneanchor repair method (group B), drill hole suture method (group C), directtendon suture method (group D).The fingers were fasten to biomechanicaltesting machine and biomechanical testing machine pulled flexor digitorumprofundus tendon until mallet finger repair failed. The index of tension of flexor digitorum profundus tendon was recorded. Statistical analysis wasperformed by SPSS13.0.2Clinical therapeutic analysis: Patients who accepted surgical hospitalizationfrom2010to2012in the Department of Hand Surgery, Third Hospital ofHebei Medical University.36Patients were followed up,19cases of directtendon suture method,11cases of pull-out suture method,6cases of microbone anchor repair method. The clinical assessment was performed with theactive and passive activities, appearance, imaging, skin feeling, based on theDargan evaluation method. Statistical analysis was performed by SPSS13.0.Result:1Biomechanical experiment: the distance from distal phalanx base to nail rootwas3.7-4.9mm, average4.3mm. Intensity of the reconstruction insertion:group A, pull-out suture method was24.03±1.65N; group B, micro boneanchor repair method was14.70±1.01N; group C, drill hole suture methodwas12.34±0.98N; group D direct tendon suture method was11.73±1.12N.And the reason of reconstruction insertion failure: for group A, it was causedby the steel wire loose; group B was caused by suture failure with tendonavulsion at the suture; group C was caused by elasticity of the sutures, forsutures could get longer after the experiment; group D was caused by tendonavulsion at the suture. Results of analysis of variance: F=173.805, P＜0.05.The difference of overall mean of the four groups was statistically significant.Results of SNK-q test multiple comparisons showed that groups A, B, Coverall mean difference was statistically significant. Dunnett-t test group D forthe control group, C, D group overall mean difference was not statisticallysignificant, while the difference of the overall mean between A and D werestatistically significant, same with between B and D.2Medical cases follow-up：In direct tendon suture method group there are3excellent cases,11good cases,4fair cases,1poor case; in pull-out suturemethod group there are2excellent cases,6good cases,2fair cases,1poorcase; in micro bone anchor repair method group there are2excellent cases,2good cases,1fair case,1poor case. There is significant difference among three surgical methods according to the results of SPSS (P>0.05). Differentcomplications performed differently: in the group of direct suture method, partof the dorsal skin lesions is necrosis and with suture junction reaction. In thegroup of pull-out suture method, the complication is abdominal pressure sores.In the group of anchors repair method, the complications are line junctionreaction, suture rejection, nail root injury, nail malformation. Cases ofavulsion fracture distal phalanx fractures in all groups had been healed. Thedorsal feeling gradually was recovered by time. The shortest time of follow-upfor dorsal skin sensation recovered to normality is6months.Conclusion:1Pull-out suture method, micro bone anchor repair method, drill hole suturemethod were not worse than direct tendon suture method in biomechanicalexperiment at intensity of the reconstruction. Pull-out suture method, microbone anchor repair method, drill hole suture method intensity of thereconstruction insertion can meet the acquirements of mallet finger tendonhealing.2Direct tendon suture method, pull-out suture method, micro bone anchorrepair method, drill hole suture method are effective treatment method formallet finger. The surgical treatment for mallet finger should be based on thetype of injury. Functional exercises under the guidance of the doctor can beachieved to maximize efficacy. |
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