评估双骨隧道重建止点治疗手指近指间关节掌板撕脱性损伤的临床效果。

回顾性分析2021年6月至2024年1月苏州瑞华骨科医院手外科收治的7例近指间关节掌板撕脱性损伤患者的临床资料，其中男5例，女2例，年龄22~63（46.0±15.7）岁。损伤位于左手1例，右手6例；具体分布为示指1例、中指2例、环指1例、小指3例。致伤原因包括摔伤2例、机器绞伤3例、车祸伤1例及重物砸伤1例。患者掌板撕脱性损伤均伴有近指间关节背侧脱位，脱位伴中节指骨基底撕脱骨折3例，不伴骨折4例。骨折类型均为Ⅱ型骨折。7例患者均为急诊手术。手术采用掌侧入路，摘除部分碎骨后保留少许骨皮质，撕脱掌板止点采用双骨隧道联合肌腱线重建。

患者术后切口均一期愈合，随访时间4~10个月（平均6个月）。末次随访时，近指间关节屈曲活动度为70 °~100 °，关节稳定性良好，活动时无明显疼痛不适。参照中华医学会手外科学会上肢部分功能评定试用标准进行评估，疗效评定结果为优3例、良4例。

采用双骨隧道重建止点治疗手指近指间关节掌板撕脱性损伤，具有操作简便、临床疗效满意等优势，是一种有效的治疗方法。

This study evaluates the clinical efficacy of dual bone tunnel reconstruction for treating volar plate avulsion injuries in proximal interphalangeal （PIP） joints of the finger.

A retrospective analysis was conducted on 7 patients with the proximal interphalangeal joint volar plate avulsion injuries，who were treated at the Department of Hand Surgery，Suzhou Ruihua Orthopaedic Hospital between June 2021 and January 2024. The cohort included 5 males and 2 females，aged 22–63 （46.0±15.7） years. Injury distribution： 1 left hand，6 right hands； 1 index finger，2 middle fingers，1 ring finger，and 3 little fingers. Mechanisms of injury comprised falls （n=2），machinery entanglement （n=3），vehicular accidents （n=1），and crush injuries （n=1）. All cases of avulsion injuries involved dorsal dislocation of the proximal interphalangeal joints，including 3 cases with Type Ⅱ avulsion fractures of the middle phalanx base and 4 non-fracture cases. Emergency surgical intervention via volar approach was performed： fragmented bone was debrided with cortical preservation，followed by anatomic reattachment of the avulsed volar plate using dual bone tunnels with nonabsorbable sutures.

Primary wound healing was achieved in all cases. Mean follow-up duration was 6 months （range： 4–10 months）. At final assessment，active PIP joint flexion ranged from 70 ° to 100 ° with stable joints and absence of pain during motion. According to the upper limb function assessment of the Chinese Medical Association Hand Surgery Society，outcomes were graded as excellent in 3 cases and good in 4 cases.

Dual bone tunnel reconstruction provides a technically feasible and clinically effective solution for PIP joint volar plate avulsion injuries，demonstrating satisfactory functional restoration.