自发性拇长屈肌腱断裂1例报道

目的 探讨自发性拇长屈肌腱断裂的病因及治疗.方法 环指浅肌腱移位修复拇指屈肌腱.结果术后拇指功能恢复正常.结论自发性拇长屈肌腱断裂后行环指浅肌腱移位修复,对环指功能无影响,可早期行功能练习,拇指愈后佳.     

自发性伸指肌腱断裂临床分析

[目的]探讨自发性伸指肌腱断裂的病因，病理特点和治疗效果。[方法]本组病例12例，自发性拇长伸肌腱断裂8例，均采用食指固有伸肌腱转位修复。自发性环小指伸肌腱断裂3例，环指指伸肌腱远侧断端与中指伸指肌腱端侧编织缝合，食指固有伸肌腱移位修复小指固有伸肌腱。自发性中环小指肌腱断裂1例，冷冻异体伸指肌腱移植修复。[结果]所有病例术前均有类风湿关节炎史或桡骨远端骨折史，前者组织学检查显示以滑膜和肌腱慢性炎症伴局灶性坏死为主，后者以肌腱纤维断裂为主。所有病例治疗优良率达100％，未发生再次肌腱断裂。[结论]炎症侵蚀或骨折端磨损，是伸指肌腱自发性断裂的病理基础。食指固有伸肌腱转位重建拇长伸肌腱疗效确切，对多根伸指肌腱断裂可考虑行异体肌腱移植术。     

保留腱鞘修复Ⅱ区拇长屈肌腱损伤的疗效分析

目的 探讨急诊保留腱鞘修复Ⅱ区拇长屈肌腱损伤的临床疗效。方法 2016年9月-2020年6月,对35例Ⅱ区拇长屈肌腱损伤患者采用改良Kessler法修复同时完整地保留屈肌腱鞘,所有患者均行急诊手术修复,观察术后临床效果以及并发症。结果 术后患者伤口愈合良好,无肌腱断裂发生,肌腱粘连1例。术后对35例进行3～9个月随访,平均5.5个月。根据屈肌腱修复术后Kleinert评定标准,治疗的优良率为91.4%。结论 保留腱鞘急诊修复Ⅱ区拇长屈肌腱损伤的手术方法安全有效,能有效地恢复拇指屈曲功能。     

经腕横韧带近侧切口显露拇长屈肌腱腕远侧断裂

拇长屈肌腱断裂后近端均有不同程度回缩,有时寻找极其困难.我们于1997年至今以经腕横韧带近侧切口肌腱向远侧递推法显露拇长屈肌腱近侧断端13例,效果满意,介绍如下.     

Ⅱ、Ⅲ区陈旧性拇长屈肌腱损伤的重建

目的探讨重建Ⅱ、Ⅲ区陈旧性拇长屈肌腱损伤的手术疗效。方法对20例Ⅱ、Ⅲ区陈旧性拇长屈肌腱损伤的患者，根据手术方式分成两组：A组10例，采用环指指浅屈肌腱移位修复拇长屈肌腱；B组10例，采用掌长肌腱移植修复。结果术后随访10～18个月，平均12个月。按照屈肌腱术后评定标准(Kleinert)评定，A组优良率为90％，B组优良率30％。A组明显优于B组。结论对伤后时间超过8周的Ⅱ、Ⅲ区拇长屈肌腱损伤首选修复方法是行环指指浅屈肌腱移位术。     

晚期拇长屈肌腱损伤的修复

近年来处理晚期拇长屈肌屈腱损伤４８例，随访４０例，其中ＩＩ区、ＩＩＩ区、ＩＶ区分别为１８例、１１例、１１例，指间关节主动活动度分别为平均３８°、３６°、３１°。采用肌腱断端直接缝合８例，肌腱移植７例，指浅层肌腱转移２５例，其指间关节主动活动度分别为平均３６°、２７°、４３°。对晚期拇长屈肌腱损伤修复方法的选择．应根据不同损伤部位选用合适的手术方法。指浅层肌腱转移代拇长屈肌是重建ＩＩ、ＩＩＩ区晚期损伤屈拇功能的有效方法。     

环指浅屈肌腱转移修复拇长屈肌腱缺损伤

拇指在手的功能中占有非常重要的位置，而拇长屈肌腱是拇指的主要肌腱之一，一旦缺损将对拇指及手的功能产生极大的影响。我科从2003年至今用环指浅屈肌腱转移修复拇长屈肌腱缺损15例取得较好的效果。     

拇长屈肌腱移位修复陈旧性跟腱断裂

对于各种原因造成的陈旧性跟腱断裂只有采取手术治疗，其手术方法报道较多，但对拇长屈肌腱移位修复陈旧性跟腱断裂的手术方法，国内报道甚少。2001年11月至2005年5月，我科采用拇长屈肌腱移位修复陈旧性跟腱断裂8例，获得较好的治疗效果，现报告如下。     

屈指浅肌腱移位修复拇长屈肌腱损伤

目的：介绍一种修复拇指屈曲功能的手术方法。方法：利用屈指浅肌腱移位治疗屈拇长肌腱损伤。结果：经美国手外科学会T－A－M法评定,术后1．5年随访,优良率90％。结论：屈指浅肌腱移位治疗屈拇长肌腱Ⅱ、Ⅲ区陈旧损伤和肌腱损伤缺损患应首选。     

拇长伸肌腱腱鞘炎合并肌腱嵌顿一例报告

腱鞘炎是手外科临床中最为常见的一种疾病，而这类疾病中，又以指屈肌腱腱鞘炎广为人知。拇长伸肌腱腱鞘炎虽然没有受到广泛关注，但临床并不少见，因为它是引起拇长伸肌腱自发性断裂的一个重要原因。然而，拇长伸肌腱腱鞘炎合并肌腱嵌顿却较为少见，由于其症状和体征与拇长伸肌腱断裂非常相似，在诊断与治疗中如对这一情况没有认识，则很容易误诊、误治。近期，我们遇到1例，希望能够提高对此病的认识。     

Rupture of the flexor pollicis longus tendon after volar fixed-angle plating of a distal radius fracture: a case report

We report a case of complete rupture of the flexor pollicis longus tendon 13 months after volar fixed-angle plating of a distal radius fracture. Tendon disruption was associated with a prominent distal volar lip of the plate. The plate was placed at the volar distal lip of the radius, at the location recommended by the manufacturer. Most previous reports of flexor tendon ruptures after volar plating of distal radius fractures have been in improperly placed plates, custom-made plates that were later taken off the market, or in physiologically abnormal tendons. This may be a unique case of flexor pollicis longus rupture with a currently commercially available volar fixed-angle plate, placed at the site recommended by the manufacturer, in a patient without other predisposition to tendon rupture.     

Flexor carpi radialis tendon rupture as a complication of a closed distal radius fracture: a case report

Although extensor pollicis longus tendon ruptures have been noted as a complication of distal radius fractures, flexor tendon ruptures in association with acute fractures of the distal radius are rare. We report a rupture of the flexor carpi radialis tendon as a complication of an acute distal radius fracture that was discovered during operative management of the fracture.     

A method of restoration of the abduction of the thumb in traumatic tetraplegic patients

A method of restoring extension and abduction of the thumb in traumatic tetraplegia is described. This method includes tenodesis of the abductor pollicis longus, transfer of the distal stump of the extensor pollicis brevis tendon to the flexor carpi radialis tendon, and transfer of the distal stump of the extensor pollicis longus tendon to the brachioradialis tendon. I performed this procedure on 6 hands in 5 patients and monitored each patient for 6 to 12 months. A significant increase in radial abduction of the thumb (0.5 +/- 0.2 cm to 2.8 +/- 0.2 cm) occurred in all hands.     

Scaphoid nonunion and flexor pollicis longus tendon rupture

Four patients presented with a rupture of the flexor pollicis longus tendon that was associated with a longstanding scaphoid nonunion. A radiocarpal arthrosis was present in 3 of the 4 patients and a dorsiflexed intercalated segment instability deformity was also seen in 3 of the 4 patients. Three patients underwent surgery consisting of an osteosynthesis with an iliac bone graft for the scaphoid nonunion and a palmaris longus tendon graft for the ruptured flexor pollicis longus tendon. An osseous union of the scaphoid and a functional active range of motion of the thumb interphalangeal joint (33 degrees on average) was attained in all 3 of the patients treated surgically. Preoperative radiologic examinations and intraoperative findings suggest that the volarly protruding distal scaphoid segment is the cause of the rupture.     

Flexor tendon ruptures in the rheumatoid patient

In patients with rheumatoid arthritis, flexor tendon ruptures are much less common than extensor tendon ruptures. The most common cause of flexor tendon rupture is direct abrasion on a bony prominence. The most common flexor tendon rupture is the flexor pollicis longus (FPL) attritional rupture within the carpal canal. The best treatment for flexor tendon rupture is prevention. Flexor tenosynovectomy is indicated when medical management does not control wrist tenosynovitis. A variety of techniques are available for reconstruction of flexor tendon ruptures. Irrespective of the reconstructive method, the results of reconstruction for rheumatoid flexor tendon rupture are poor.     

趾长屈肌腱和长屈肌腱移位修复陈旧性跟腱断裂

目的：探讨趾长屈肌腱、[足母]长屈肌腱移位修复陈旧性跟腱断裂的手术方法和疗效。方法：13例陈旧性跟腱断裂患者,男9例,女4例;年龄32～69岁,平均41岁;左侧8例,右5例;受伤至手术时间3～8个月,平均4.5个月。13例患者均有明确外伤史,均为闭合性损伤跟腱断裂。采用趾长屈肌腱移位修复陈旧性跟腱断裂5例,行[足母]长屈肌腱移位修复陈旧性跟腱断裂8例。结果：13例随访时间11个月～4.5年,平均2年,伤口无感染,跟腱无再断裂,踝关节活动基本正常,足背屈跖屈功能良好,未发生锤状趾畸形。按Arner-Lindholm疗效评定标准评定,优9例（[足母]长屈肌腱移位修复6例,趾长屈肌腱移位修复3例）,良3例（[足母]长屈肌腱移位修复2例,趾长屈肌腱移位修复1例）,差1例（趾长屈肌腱移位修复）。结论：采用趾长屈肌腱、[足母]长屈肌腱移位修复陈旧性跟腱断裂的手术方法,可获得良好的疗效,是较理想的治疗方法。而采用长屈肌腱移位修复陈旧性跟腱断裂更趋近于合理。     

Delayed Rupture of the Flexor Pollicis Longus Tendon After Inappropriate Placement of the π Plate on the Volar Surface of the Distal Radius

The π plate (Synthes Ltd, Paoli, PA) was designed to fit the unique contour of the dorsal aspect of the distal radius. Complications of π plate fixation of the dorsal distal radius have been previously reported to include both extensor tenosynovitis and delayed extensor tendon rupture. We report a case of rupture of the flexor pollicis longus tendon associated with inappropriate placement of the π plate on the volar surface of the distal radius. (J Hand Surg 1999; 24A:1279–1280.     

Flexor Tendon Problems after Volar Plate Fixation of Distal Radius Fractures

Four cases of flexor tendon problems which developed after volar plate fixation of distal radius fractures are presented. All cases were associated with close contact of the screws or distal edge of the plate with the flexor tendons. Poor bone stock or multiple bone fragments allowing loosening of the plate or non-locking screws cause the hardware to irritate the flexor tendons and ultimately lead to rupture. The flexor tendons involved include the flexor carpi radialis, flexor pollicis longus and flexor digitorum superficialis, and flexor digitorum profundus to the index and long fingers.     

Rupture of Flexor Pollicis Longus Tendon: A Complication of Volar Locking Plating of the Distal Radius

We report an unusual case of complete rupture of the flexor pollicis longus tendon following volar locking plating for a distal radius fracture. We believe that the prominence of a distal locking screw head predisposed to the rupture of the tendon. We highlight that correctly attaching the distal locking screws to the plate is essential for obtaining the correct biomechanics of the device and preventing flexor tendon rupture.     

Results of pronator quadratus repair in distal radius fractures to prevent tendon ruptures

Background:

Distal radius fractures are one of the the most common adult fractures encountered during the clinical practice of an orthopedic surgeon.^1,2 Although several methods of treatment are suggested for these fractures, there are still controversies about the best treatment approach in the literature. Volar plating of distal radius fracture is a method of treatment which has become increasingly popular. One of the complications of this technique is flexor tendon rupture. The purpose of this study was to evaluate the protectiveness of complete repair of pronator quadratus muscle against flexor tendon rupture.

Materials and Methods:

From September 2010 to September 2012, a consecutive series of 157 patients who were younger than 60 years with unstable distal radius fractures were included in the study. A standard volar approach to the distal radius was carried out. The radial and distal ends of pronator quadratus muscle were meticulously elevated from the radius and after volar plate fixation of the fracture, pronator quadratus muscle was restored to its normal insertion. We achieved full coverage of the plate with this muscle and followed the patients postoperatively.

Results:

A total of 135 patients were studied. The mean age of patients was 34 ± 10 years (range 20-60 years). One 55-year-old diabetic female patient with flexor tendon rupture was identified. The flexor pollicis longus tendon had ruptured 16 months after surgery.

Conclusions:

Pronator quadratus repair should be done in distal radius fracture to protect flexor tendons.