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儿童先天性拇长屈肌腱鞘肥厚性狭窄,系拇长屈肌腱纤维鞘增原形成环状狭窄所致。主要表现为指间关节固定屈曲不能伸直,是一种较少见的畸形。我院外科于1986年8月至1993年4月期间施治15例18只指。现报道如下。 临床资料 15例中最小者7月,最大者5岁,平均1.8岁。男性7例,女性8例,两者之比约1:1。左侧8例,右侧4例,双侧3例,共18只指。 临床表现:病者拇指末节呈持续性屈曲畸形,多呈90度,主动伸直障碍。在拇指的掌指关节处可触及米粒大硬性小结节,该结节与拇指长屈肌腱紧密相连,无明显触痛。被动伸屈拇指关节活动范围仅10度左右,并有弹跳感和/或弹响声。 治疗:本组15例中,其中有2例曾行夹板固定及激素鞘内注射治疗,效果不满意,末节指仍屈曲畸形。手术治疗主要作屈指腱鞘增厚的纤维组织切除与腱鞘带切开。术中拇指末节即可被动伸直180度,屈90度,伸屈范围90度。全部病例切口一期愈合,15例中有1例7天伤口拆线后,发现拇指末节伸屈不满意,观察3个月后,拇指末节又呈持续屈曲畸形,遂经第二次手术治疗(术中所见腱鞘增厚部切除不完全,腱鞘带松解不够)而获治愈。切除物送活检2例,1例病理诊断为纤维结缔组织,另1例活检诊断为胶原纤维,排列不整齐,组成紊乱。
Children with congenital thumb flexor tendon sheath hypertrophic stenosis, the Department of thumb flexor tendon fibrosis sheath formation of annular stenosis. The main performance of the inter-finger joint flexion can not be straight, is a less common deformity. Surgery in our hospital from August 1986 to April 1993 during the treatment of 15 cases 18 fingers. Report as follows now. The smallest clinical data in 15 cases in July, the largest of 5 years old, an average of 1.8 years old. 7 males and 8 females, the ratio of the two is about 1: 1. Left in 8 cases, right in 4 cases, bilateral in 3 cases, a total of 18 fingers. Clinical manifestations: The patient’s thumb was persistent flexion deformity, mostly 90 degrees, active straightening disorders. In the thumb of the metacarpophalangeal joints can reach a large hard nodules, the nodules and thumb flexor tendon closely linked, no obvious tenderness. Passive flexion and flexion of the thumb joint activity range is only about 10 degrees, and there is a sense of bounce and / or sounded sound. Treatment: The group of 15 cases, of which 2 cases had line splint fixation and hormone intrathecal injection, the effect is not satisfied, the distal refers to the still flexion deformity. Surgical treatment mainly for flexor tendon sheath thickening of the fibrous tissue resection and incision with the sheath. The thumb during surgery can be passive straight 180 degrees, 90 degrees flexion, flexion and extension of the range of 90 degrees. All cases of incision healed, 15 cases in 1 case 7 days after the stitches were stitched, found that the thumb distal flexion is not satisfied, after 3 months of observation, the thumb distal continued buckling deformity, and then by the second surgery ( Surgery see thickening of the tendon sheath resection is not complete, not loose with the tendon sheath) and was cured. The biopsy was performed in 2 cases, 1 case was diagnosed as fibrous connective tissue, and the other 1 case was diagnosed as collagen fibers by biopsy.