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感染性屈肌腱鞘（化脓性屈肌腱鞘炎）

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Updated Oct 2026
Illustration: 感染性屈肌腱鞘（化脓性屈肌腱鞘炎）

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的症状

屈肌腱鞘感染是指手指屈肌腱滑动穿行的那条隧道发生了感染。整个手指常常沿全长均匀肿胀，而不是只在某一个点疼痛。手指可能处于轻微弯曲的姿势，难以伸直。伸直手指，或者别人帮您轻轻把它扳直，通常最痛，尤其是在手指基部附近，那里可能看得到肿胀。

疼痛沿肌腱走行分布，从手指基部向下延伸到手掌，而不是局限在某一个关节上。疼痛往往持续存在，在手指被推直时加重。把手指稍微弯曲常常能缓解疼痛，这就是手指会蜷起来的原因。肿胀和疼痛会让日常活动变得困难：握住水壶、转动钥匙、扣纽扣、握笔或扶住扶手。

这种感染可能进展很快，是一种不能等待的感染。如果您的手指或手变得发烫、发红、肿胀和疼痛，尤其是伴有发热时，请当天前往急诊科。您无需先获得全科医生转诊。如果您的手指变得苍白、发凉、发白或发青，或者手指突然失去感觉或无法活动，也请当天前往急诊科。

实际发生了什么

每根手指的掌侧都有一条屈肌腱，这是一根把指尖拉向手掌的坚韧绳索状结构。这条肌腱在一条名为屈肌腱鞘的封闭隧道内滑动。隧道内衬有一层光滑的组织，为肌腱提供营养和润滑，使其能够自如滑动，有点像一根在涂了油的套管中穿行的缆线。

当细菌进入这个套管时（通常是通过割伤、刺伤或咬伤），这个封闭的空间就会充满脓液。由于套管是密封的，脓液带着压力紧贴在肌腱赖以滑动的那个表面上。这种压力会挤压肌腱的血供，并开始在肌腱与其内衬之间形成瘢痕。这就是为什么整个手指会均匀肿胀、为什么手指会蜷起来，以及为什么伸直时会那么痛：整条隧道的每一部分都同时发炎。

感染可能扩散。拇指的隧道与手掌中一个叫做桡侧滑囊的液体腔隙相通，小指的隧道则与一个叫做尺侧滑囊的腔隙相通。在许多人中，这些腔隙一直向上延伸到手腕附近，因此一根手指的感染可能向手掌扩散，甚至横向蔓延到拇指或小指，形成所谓的马蹄形脓肿。

关键在于时机。肌腱依赖滑动，而被困住紧贴它的脓液滞留越久，造成的损伤就越持久。如果及早治疗，大多数手指都能恢复良好。如果拖延太久，肌腱本身可能坏死，手指可能因瘢痕而僵硬，在严重情况下甚至可能失去手指。即使及时使用抗生素并手术，术后手指出现一定程度的僵硬也很常见，因为愈合中的组织往往会粘连，而不是顺畅滑动。

您的外科医生会先检查感染扩散的范围，再决定需要多紧急地进行引流。

我们如何处理

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 医生会将屈肌腱鞘感染作为急症处理，并立即开始治疗。这种感染不会等待，您也不应该等待。目标是在感染损伤让您手指得以弯曲的肌腱之前将其清除。

第一步是通过手臂上的静脉滴注给予抗生素。抗生素是与引流配合使用的，而不是替代引流。由于腱鞘是一条密封的隧道，仅靠抗生素往往无法清除感染。引流脓液可以解除对肌腱的压力，并让抗生素到达整个区域。

大多数病例需要手术对腱鞘进行引流。我们会在皮肤上做几个小切口，以便打开隧道并冲洗出脓液。及时冲洗腱鞘可以保护肌腱所需的滑动表面。手术的具体时机和类型取决于感染扩散的范围以及您就诊的早晚。

术后，您的手指可能需要用夹板固定休息。您的术后手部治疗由 Extend Rehabilitation 的 Ruby Doolan 负责。Ruby 是一名手部治疗师：她会指导您的锻炼，并制作您所需的任何夹板。她的重点是让肌腱重新滑动起来，因为肌腱与其内衬之间的瘢痕正是日后限制活动的原因。

有些感染由分枝杆菌或真菌等不常见的病菌引起，需要较长疗程的特定抗生素或抗真菌治疗。如果感染严重损伤了肌腱，重建肌腱是另一项单独的手术，可在感染完全消退后进行。

预后在很大程度上取决于时机。及早就诊是最能保护您手指的一件事，因此如果您的手指发烫、发红、肿胀和疼痛，尤其是伴有发热时，请当天前往急诊科。

预期情况

屈肌腱鞘感染的预后主要取决于治疗的及时程度。及早就诊能让您的手指最有机会重新正常弯曲。等待会让脓液带着压力紧贴肌腱滞留，而这种压力造成的损伤日后是无法逆转的。

经过及时治疗，大多数手指会在随后的数周和数月内好转并重新开始活动。即便如此，术后出现一定程度的僵硬也很常见，即使是那些原本身体健康、迅速接受了抗生素和手术治疗的人也是如此。愈合中的组织往往会粘连而不是顺畅滑动，因此手指可能无法像以前那样自如地弯曲或伸直。手部治疗会针对这一点进行训练，但这需要时间和持续的努力。

如果感染严重或拖延太久，预后就更差。肌腱周围的隧道可能被破坏，瘢痕可能使手指永久僵硬。在某些情况下，肿胀严重到挤压手指本身的血供，这种问题称为骨筋膜室综合征。在最严重的感染中，即使治疗及时且彻底，手指也可能坏死而需要截指。

还可能发生一些不太常见的情况。有时感染没有完全清除，需要进行第二次冲洗。在极少数情况下，治疗数周后手指中可能出现一种不常见的病菌，需要进一步治疗。

您能掌控的一件事就是时机。如果您的手指或手变得发烫、发红、肿胀和疼痛，尤其是伴有发热时，请当天前往急诊科。您无需先获得全科医生转诊。如果您的手指变得苍白、发凉、发白或发青，或者手指突然失去感觉或无法活动，也请当天前往急诊科。

何时就医

这种感染是急症，而且进展很快。如果您的手指或手变得发烫、发红、肿胀和疼痛，尤其是伴有发热时，请当天前往急诊科。如果您的手指变得苍白、发凉、发白或发青，或者手指突然失去感觉或无法活动，也请当天前往急诊科。您无需先获得全科医生转诊。如果您无法联系到诊所，例如在非工作时间或周末，请前往离您最近的急诊科。

警示征象与感染的特点相吻合：整个手指均匀肿胀、处于弯曲姿势、沿肌腱走行疼痛，以及伸直时非常疼痛。您不必等到所有这些征象都出现才去检查。只出现其中部分征象的手指，仍可能患有这种感染。

如果症状没有缓解、在数周内逐渐加重，或使您无法使用手部，请就诊全科医生或要求专科医生评估。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您做出自身治疗决策所需的深度。感染性屈肌腱鞘值得额外阅读，因为它是唯一一种真正属于急症的手部感染，且决定其预后的两个最关键因素在您到达医院之前就已确定——其中一个甚至在多年前就已决定。

诊断依赖于20世纪30年代提出的四个体征，这些体征从未得到过恰当的验证

Allen Kanavel 描述了感染性屈肌腱鞘炎的四个体征：手指沿其全长肿胀而非局限于某一点，保持轻度屈曲，沿整个腱鞘走行处均有压痛而非仅累及单个关节，以及四者中最具实用价值的体征——当他人轻柔地伸直手指时出现剧烈疼痛 [1]。

近一个世纪后，这四个体征仍然是确诊的依据，且其敏感性、特异性和观察者间一致性从未得到恰当的验证 [1]。对于一个延误诊断会导致手指丧失的疾病而言，这是一个显著的缺陷。

具有实际意义的要点在于：并非所有病例都会出现全部四个体征，尤其是在儿童中，且一个或多个体征的缺失并不能排除诊断 [1]。仅不符合 Kanavel 测试中一项体征的手指，并不意味着该手指已被排除诊断。

引流方式如何影响术后手指活动度

一旦确诊，就必须对腱鞘进行减压，主要有两种方法： 手术切开腱鞘，或将细导管置入其中，通过一个更小的伤口进行冲洗。

一项涵盖763例患者的系统性综述发现，导管冲洗产生的活动范围优于开放冲洗，并且将抗生素作为治疗的一部分，而非仅依赖引流，也能改善活动度 [2]。

请注意，这与指头炎（felon）的处理立场相反，后者中，引流得当的指腹脓肿完全不需要抗生素。区别在于解剖结构：指头炎是一个可以完全排空的封闭腔隙，而腱鞘是一根长管，其内壁正是肌腱必须在其上滑行的表面。如果不损伤试图保留的组织，就无法将其彻底清创干净，因此抗生素能发挥手术无法达到的作用。

失去手指的风险主要取决于患者自身的状况

这是最令人不安的结论，却也是最实用的结论。在汇总系列研究中，截指率主要由基础健康状况而非手术技术所驱动：糖尿病患者为39%，肾衰竭患者为64%，外周血管疾病患者为71%，均具有统计学显著性 [2]。

这些数据描述的是一种与健全人因木刺伤所患疾病截然不同的病症。正因如此，对于患有糖尿病或血液循环不良的患者，其感染腱鞘的处理更为紧急，且对重复清创的阈值更低；也正因为如此，对于“我能否保住手指”这一问题的诚实回答，更多取决于“您的健康状况还存在其他什么问题”，而非手术室中发生的任何事情。

为什么延误比几乎其他任何因素都更重要

腱鞘是一个封闭空间，血供较差，其内部的肌腱依赖于滑动功能。 该空间内受压的脓液会同时产生两种影响：它既会阻断肌腱的血供， 又会播散日后限制活动的粘连。这两种情况均具有时间依赖性，因此早期 治疗始终能改善预后 [2]，这也是为何针对这种特定感染，标准建议是前往急诊科而非预约全科医生门诊 [3]。

即使所有操作都正确且及时，术后僵硬也很常见。 僵硬程度在很大程度上取决于腱鞘受压的时间长短，而这正是患者可以通过尽早就诊来影响的唯一变量。

参考文献

[1] Kennedy CD, Huang JI, Hanel DP. In brief: Kanavel's signs and pyogenic flexor tenosynovitis. Clin Orthop Relat Res. 2016;474(1):280-284. https://doi.org/10.1007/s11999-015-4367-x

[2] Giladi AM, Malay S, Chung KC. A systematic review of the management of acute pyogenic flexor tenosynovitis. J Hand Surg Eur Vol. 2015;40(7):720-728. https://doi.org/10.1177/1753193415570248

[3] Goyal K, Speeckaert AL. Pyogenic flexor tenosynovitis: evaluation and management. Hand Clin. 2020;36(3):323-329. https://doi.org/10.1016/j.hcl.2020.03.005

Reviewed by AI synthesis (v2) — pending human review · 19 August 2026.

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Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Pyogenic flexor tenosynovitis is an uncommon closed-space infection of the hand [2].
  • Pyogenic flexor tenosynovitis can result in severe stiffness and other sequela [2].
  • Acute flexor tendon sheath infections are associated with significant morbidity [3].
  • 43% of patients with acute flexor tendon sheath infections have a poor result [3].
  • The consequences of pyogenic flexor tenosynovitis can include destruction of the tendon sheath [6].
  • The consequences of pyogenic flexor tenosynovitis can include scarring and inflammation causing oedema of the soft tissues of the finger [6].
  • The consequences of pyogenic flexor tenosynovitis can include resultant finger stiffness [6].
  • The consequences of pyogenic flexor tenosynovitis can occasionally include compartment syndrome [6].
  • Sonographic evidence of a swollen tendon and fluid in the flexor sheath correlates strongly with the diagnosis of acute suppurative tenosynovitis [4].
  • Sonographic evidence of a swollen tendon and fluid in the flexor sheath should prompt early surgical drainage [4].
  • Any suspicion of flexor tendon sheath phlegmon should lead to urgent surgical exploration [10].
  • Any suspicion of flexor tendon sheath phlegmon should not lead to blind antibiotic prescription [10].
  • The absence of pain on passive extension in advanced stages is a grave prognostic sign indicating tissue necrosis rather than improvement [7].

Anatomy & Pathophysiology

Flexor Tendon Anatomy and Sheath Structure

  • The extrinsic finger flexors consist of the flexor digitorum profundus and the flexor digitorum superficialis [13].
  • The flexor digitorum profundus inserts on the proximal volar aspect of the distal phalanx, flexing the distal interphalangeal joint as well as the proximal interphalangeal and metacarpophalangeal joints [13].
  • The flexor digitorum superficialis acts as a flexor of the proximal interphalangeal and metacarpophalangeal joints [13].
  • As flexor tendons pass distal to the metacarpal neck, they enter the fibroosseous tunnel, or digital flexor sheath [24].
  • The fibroosseous tunnel extends distally to the proximal aspect of the distal phalanx [24].
  • The tendinous sheath consists of annular pulleys, which provide mechanical stability, and cruciate pulleys, which provide flexibility [24].
  • The first, third, and fifth annular pulleys (A1, A3, and A5) are located over the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints, respectively [24].
  • The second and fourth pulleys (A2 and A4) are situated over the middle portion of the proximal and middle phalanges [24].
  • The A2 and A4 pulleys are the most essential in maintaining the mechanical advantage of the flexor tendons [24].
  • The tenosynovium that lines the fibroosseous tunnel supplies both nutrition and lubrication to the poorly vascularized flexor tendons [24].
  • Within the sheath, tendon vascularity is supplied via the vincula system: the vinculum longus and brevis [24].
  • The tenosynovial sheath of the flexor pollicis longus is continuous with the radial bursa [24].
  • The tenosynovial sheath to the little finger is continuous with the ulnar digital bursa [24].
  • In some patients, the radial and ulnar bursae communicate, allowing a so-called horseshoe abscess to spread between the thumb and little finger if infection occurs in the flexor tendon sheath of either one of these digits [24].

Pathophysiology of Pyogenic Flexor Tenosynovitis

  • Pyogenic flexor tenosynovitis (PFT) is an uncommon closed-space infection of the hand that can result in severe stiffness and other sequela [2].
  • Acute flexor tendon sheath infections are associated with significant morbidity, with 43% of patients having a poor result [3].
  • The consequences of pyogenic flexor tenosynovitis can be destruction of the tendon sheath, scarring and inflammation causing oedema of the soft tissues of the finger with resultant finger stiffness or, occasionally, compartment syndrome [6].
  • Sonographic evidence of a swollen tendon and fluid in the flexor sheath correlates strongly with the diagnosis of acute suppurative tenosynovitis and should prompt early surgical drainage [4].
  • Any suspicion of flexor tendon sheath phlegmon should lead to urgent surgical exploration, not blind antibiotic prescription [10].
  • Although unusual, nonsuppurative tenosynovitis secondary to foreign body migration may occasionally account for an otherwise unexplained mild but persistent tenosynovitis [11].

Classification

  • Nonsuppurative tenosynovitis secondary to foreign body migration may occasionally account for an otherwise unexplained mild but persistent tenosynovitis [11].

Investigations

  • A careful physical examination is essential to direct care and future testing if indicated [12].
  • Diagnostic tests such as imaging and serum laboratory studies are useful in the determination of pathology but can be expensive, time consuming, and often nonspecific [12].

Treatment

Operative

  • A minimally invasive, ultrasound-guided, percutaneous flexor tendon sheath lavage technique was effective in 65% of cases [1].
  • A minimally invasive, ultrasound-guided, percutaneous flexor tendon sheath lavage technique was safe in 100% of cases [1].
  • Any suspicion of flexor tendon sheath phlegmon should not be managed with blind antibiotic prescription [10].
  • Placement of irrigation catheters in ulnar or radial bursitis may be facilitated by passing an irrigation catheter over a previously placed guide wire [9].

Outcomes and Prognosis

  • No patient had a recurrence of the infection following closed tendon sheath irrigation for pyogenic flexor tenosynovitis [5].
  • Use of a protocol for the treatment of severe infections of the hand resulted in a shorter hospital stay compared with patients treated before the protocol's institution [8].
  • Use of a protocol for the treatment of severe infections of the hand resulted in faster healing compared with patients treated before the protocol's institution [8].
  • Use of a protocol for the treatment of severe infections of the hand resulted in fewer complications, including recrudescence of infection, reoperation, stiffness, arthritis, and osteomyelitis, compared with patients treated before the protocol's institution [8].

Complications

  • Pyogenic flexor tenosynovitis is an uncommon closed-space infection of the hand that can result in severe stiffness and other sequela [2].
  • Complications associated with severe hand infections include recrudescence of infection, reoperation, stiffness, arthritis, and osteomyelitis [8].

Recovery

  • The consequences of pyogenic flexor tenosynovitis can be destruction of the tendon sheath [6].
  • The consequences of pyogenic flexor tenosynovitis can be scarring and inflammation causing oedema of the soft tissues of the finger with resultant finger stiffness [6].
  • The consequences of pyogenic flexor tenosynovitis can occasionally be compartment syndrome [6].
  • Use of a treatment protocol resulted in a shorter hospital stay compared with patients treated before the protocol's institution [8].
  • Use of a treatment protocol resulted in faster healing compared with patients treated before the protocol's institution [8].
  • Use of a treatment protocol resulted in fewer complications, including recrudescence of infection, reoperation, stiffness, arthritis, and osteomyelitis, compared with patients treated before the protocol's institution [8].
  • No patient had a recurrence of the infection following closed tendon sheath irrigation [5].

Key Evidence

  • [L5] Our results have shown that this minimally invasive, ultrasound-guided, percutaneous flexor tendon sheath lavage technique was effective in 65% of cases and safe in 100% of cases. [1] (10.1016/j.hansur.2018.12.001)
  • [L5] Pyogenic flexor tenosynovitis (PFT) is an uncommon closed-space infection of the hand that can result in severe stiffness and other sequela. [2] (10.2106/jbjs.rvw.26.00015)
  • [L4] Acute flexor tendon sheath infections are associated with significant morbidity, with 43% of patients having a poor result. [3] (10.1016/0363-5023(90)90064-x)
  • [L4] Sonographic evidence of a swollen tendon and fluid in the flexor sheath correlates strongly with the diagnosis of acute suppurative tenosynovitis and should prompt early surgical drainage. [4] (10.1016/0363-5023(89)90027-0)
  • [L4] No patient had a recurrence of the infection. [5] (10.1016/s0363-5023(78)80141-5)
  • [L5] The consequences of pyogenic flexor tenosynovitis can be destruction of the tendon sheath, scarring and inflammation causing oedema of the soft tissues of the finger with resultant finger stiffness or, occasionally, compartment syndrome. [6] (10.1016/j.jhsb.2006.02.019)
  • [L3] The absence of pain on passive extension in advanced stages is a grave prognostic sign indicating tissue necrosis rather than improvement. [7] (10.1016/j.injury.2026.113631)
  • [L3] Use of the protocol resulted in a shorter hospital stay, faster healing, and fewer complications (recrudescence of infection, reoperation, stiffness, arthritis, and osteomyelitis) when compared with 107 patients who were treated before institution of the protocol. [8] (10.1016/s0363-5023(88)80060-1)
  • [L5] Placement of irrigation catheters in other closed space infections such as in ulnar or radial bursitis may also be facilitated by passing an irrigation catheter over a previously placed guide wire. [9] (10.1016/s0266-7681(97)80290-2)
  • [L4] Any suspicion of flexor tendon sheath phlegmon should lead to urgent surgical exploration, not blind antibiotic prescription. [10] (10.1016/j.main.2011.10.025)
  • [L5] Although unusual, the situation described may occasionally account for an otherwise unexplained mild but persistent tenosynovitis. [11] (10.1016/s0363-5023(83)80176-2)

References

[1] Designing a minimally-invasive, ultrasound-guided, percutaneous flexor tendon sheath lavage technique: a cadaver study. Hand Surgery and Rehabilitation. 2019. DOI: 10.1016/j.hansur.2018.12.001

[2] Management of Pyogenic Flexor Tenosynovitis. JBJS Reviews. 2026. DOI: 10.2106/jbjs.rvw.26.00015

[3] Acute flexor tendon sheath infections. The Journal of Hand Surgery. 1990. DOI: 10.1016/0363-5023(90)90064-x

[4] Use of sonography in the early detection of suppurative flexor tensosynovitis. The Journal of Hand Surgery. 1989. DOI: 10.1016/0363-5023(89)90027-0

[5] Closed tendon sheath irrigation for pyogenic flexor tenosynovitis. The Journal of Hand Surgery. 1978. DOI: 10.1016/s0363-5023(78)80141-5

[6] MRSA Pyogenic Flexor Tenosynovitis Leading to Digital Ischaemic Necrosis and Amputation. Journal of Hand Surgery. 2006. DOI: 10.1016/j.jhsb.2006.02.019

[7] Predictive Factors for Outcomes in Pyogenic Flexor Tenosynovitis: A 10-Year Analysis of 341 Patients. Injury. 2026. DOI: 10.1016/j.injury.2026.113631

[8] A protocol for the treatment of severe infections of the hand. The Journal of Hand Surgery. 1988. DOI: 10.1016/s0363-5023(88)80060-1

[9] Passage of an Irrigation Catheter with the Aid of a Guide Wire for Pyogenic Flexor Tenosynovitis. Journal of Hand Surgery. 1997. DOI: 10.1016/s0266-7681(97)80290-2

[10] Phlegmons des gaines des tendons fléchisseurs des doigts : étude de 120 cas. Chirurgie de la Main. 2011. DOI: 10.1016/j.main.2011.10.025

[11] Nonsuppurative tenosynovitis secondary to foreign body migration. The Journal of Hand Surgery. 1983. DOI: 10.1016/s0363-5023(83)80176-2

[12] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Evaluation and Clinical Examination: Current Concepts.

[13] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > Image DISORDERS OF THE MUSCULATURE OF THE HAND.

[24] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > FLEXOR TENDON INJURY.

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