應用PDS可吸收縫合線的改良Kessler縫合法修復手部屈指肌腱斷裂

[摘要]目的：探究應用PDS可吸收縫合線的改良Kessler縫合法修復手部屈指肌腱斷裂的臨床療效。方法：回顧性分析筆者醫院手外科于2020年3月-2023年3月收治的45例手部屈指肌腱斷裂患者，根據治療方法將其分為常規組和加強組，各45例。常規組實施改良Kessler縫合法治療；加強組實施改良Kessler縫合法+PDS加強縫合治療。比較兩組患者圍手術期指標（手術時間、術后恢復鍛煉時間及基本康復時間）、并發癥、抗拉力測試結果，術前及術后6 h、24 h、48 h的視覺疼痛評分（VAS），術后8周手功能及美學效果滿意度。結果：兩組患者手術時間比較差異無統計學意義（P＞0.05），加強組患者術后恢復鍛煉時間及基本康復時間均低于常規組（P＜0.05）；加強組并發癥發生率、拉力測試失敗率均低于常規組（P＜0.05）；加強組治療后6 h、24 h及48 h的VAS評分低于常規組（P＜0.05）；術后8周，加強組患者各患指關節活動度均大于常規組（P＜0.05）；加強組美學效果滿意度為93.33%，高于常規組的73.33%（P＜0.05）。結論：改良Kessler縫合法+PDS加強縫合可有效修復患者手部屈指肌腱，恢復手功能，減輕疼痛感，減少并發癥，美學效果滿意度高，值得推廣。

[關鍵詞]Kessler縫合法；PDS縫合線；手部；屈指肌腱損傷

[中圖分類號]R622" " [文獻標志碼]A" " [文章編號]1008-6455（2025）02-0048-05

Modified Kessler Suture Method Using PDS Absorbable Suture to Repair Flexor Tendon Rupture in the Hand

LI Ajing， CHEN Mingzhi

（ Department of Burns and Plastic Surgery， Affiliated Hospital of GanSu Medical College， Pingliang 744300， Gansu， China ）

Abstract： Objective" To explore the the clinical efficacy of modified kessler suture method using PDS absorbable suture to repair flexor tendon rupture in the hand. Methods" The patients with hand flexor tendon rupture admitted to department of hand surgery of the author's hospital from March 2020 to March 2023 were retrospectively analyzed. According to the treatment methods， they were divided into conventional group and enhanced group， with 45 cases in each group. The conventional group was treated with modified Kessler suture， and the enhanced group was given modified Kessler+PDS enhanced suture treatment. Perioperative indicators （surgical time， postoperative recovery exercise time and basic rehabilitation time）， complications， tensile resistance test result， visual analogue scale （VAS） before and at 6， 24 and 48 hours after surgery and hand function at 8 weeks after surgery and cosmetic satisfaction were compared between the two groups of patients. Results" There was no statistical significance in the surgical time between the two groups （P＞0.05）， and the postoperative recovery exercise time and basic rehabilitation time in enhanced group were shorter than those in conventional group （P＜0.05）. The complication rate and failure rate of tensile test in the reinforcement group were lower than those in the conventional group（P＜0.05）. The VAS scores in enhanced group at 6， 24 and 48 hours after treatment were lower than those in conventional group （P＜0.05）. At 8 weeks after surgery， the ranges of motions of hand joints in enhanced group were larger than those in conventional group （P＜0.05）. The aesthetic satisfaction of the enhanced group was 93.33%， which was higher than 73.33% of the conventional group （P＜0.05）. Conclusion" Modified Kessler+PDS enhanced suture can effectively repair the flexor tendon of the affected hand， restore the hand function， relieve the pain and reduce the complications， and it has high cosmetic satisfaction.

Key words： kessler suture; PDS suture; hand; flexor tendon injury

手部屈指肌腱斷裂是手外科常見疾病，通常由切割傷所致，肌腱損傷斷裂情況普遍較為嚴重，若不及時修復，易導致患者手指畸形或壞死，嚴重影響手外觀與功能[1]。手屈指肌腱斷裂后功能恢復始終是臨床難以攻克的問題，其關鍵點在于縫合術后易發生肌腱粘連，導致手術效果降低，嚴重影響患者手功能預后恢復[2]?！?br>