拇短伸肌腱移位重建拇对掌功能的应用解剖和临床经验

目的研究拇短伸肌腱和桡侧腕屈肌腱纤维鞘管的解剖特点,寻找拇指对掌功能重建的方法.方法对24侧新鲜成人上肢标本,建立拇短伸肌腱、桡侧腕屈肌腱纤维鞘管的解剖模型.为8例拇指对掌功能障碍者,设计以桡侧腕屈肌腱纤维鞘管为滑车,行拇短伸肌腱移位、重建拇对掌功能术.结果拇短伸肌腱止点恒定,肌腹长度为[(85.67 ± 1.67) mm, ± s,下同],肌腱长(102.41 ± 1.65) mm.桡侧腕屈肌纤维鞘管长度为(13.76 ± 0.40) mm,宽度为(6.18 ± 0.16) mm,高度为(4.11 ± 0.18) mm.8例拇对掌功能重建者,按吉林大学中日联谊医院手外科制定的评定标准优4例,良2例,可2例.结论拇短伸肌腱位置恒定,长度、肌力足够,移位后其作用方向与拇短展肌作用方向一致.以桡侧腕屈肌腱纤维鞘管作滑车,用拇短伸肌腱移位重建拇对掌功能,是一种简便有效的手术方法.     

拇短伸肌腱移位重建拇对掌功能12例报告

我科自1997年,利用拇短伸肌腱直接移位重建拇对掌功能,临床应用12例,取得了较好疗效,现报道如下。1资料与方法1.1一般资料本组12例,男10例,女2例;年龄18～45岁;左手7例,右手5例。均为腕部陈旧性切割伤及挤压伤导致正中神经损伤。1.2手术方法在拇指掌指关节背侧作一横形切口,显露拇短伸肌止点。在腕背桡侧切口中显露游离拇短伸肌腱,直至拇指基底桡背侧止点处。前臂远端“S”形切口切断掌长肌腱远端。通过腕掌侧皮下隧道,将己游离的拇短伸肌腱前移至掌侧。于腕部应用掌长肌腱远端重建滑车。此时肌腱的近、远端在大鱼际肌掌侧,成斜直形走向。…     

尺侧腕伸肌联合拇短伸肌腱转移重建拇指对掌功能

目的评价尺侧腕伸肌联合拇短伸肌腱转移重建拇指对掌功能的临床疗效。方法 2006年3月-2009年8月,采用尺侧腕伸肌联合拇短伸肌腱转移重建20例单纯腕部正中神经损伤、15例正中神经合并尺神经损伤患者的拇指对掌功能。其中男25例,女10例;年龄20～53岁,平均33.5岁。致伤原因:锐器伤24例,钝器伤9例,热压伤2例。合并尺、桡骨远端骨折6例。患者均于伤后1～3 h行神经修复术,平均2 h。受伤至该次入院时间为6～14个月,平均7.5个月。35例患者除2例单纯正中神经损伤拇外展功能不完全消失、无对掌功能外,其余拇外展及主动对掌功能完全消失。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间12～18个月,平均14个月。腕关节屈伸、拇指末节背伸活动正常。20例单纯正中神经损伤患者均恢复正常拇外展及对掌功能。15例合并尺神经损伤患者中,13例恢复正常对掌功能,2例对掌功能不全;拇外展功能均恢复良好。术后12个月,根据赵书强等拇指对掌功能评定标准,患者拇对掌功能测量值均在正常范围。结论对单纯正中神经损伤或合并尺神经损伤患者,尺侧腕伸肌联合拇短伸肌腱转移是一种操作简便且有效的手术方法。     

掌指关节关节囊掌板紧缩术治疗爪形手畸形

目的探讨掌指关节关节囊掌板紧缩术治疗爪形手畸形的疗效.方法将爪形指畸形的掌指关节的掌板舌形瓣状向近端切开掀起,用骨刀在掌骨颈处做粗糙面,将掌指关节屈曲60°位,于掌板近端U形穿过钢丝,通过注射器针头自掌骨两侧向背侧引出钢丝两端,在手背皮肤外打包拉紧钢丝,用无损伤线紧缩缝合掌板及关节囊.术后屈曲掌指关节,伸直指间关节石膏固定6周.去石膏后进行主动功能练习,10周后被动伸直掌指关节.结果用此方法治疗爪形手畸形15例,随访12例,其中优2例,良8例,差2例.结论应用此法治疗爪形手畸形,要充分了解手术适应证及影响爪形手畸形矫正的因素,以达到良好的治疗结果.     

尺侧腕伸肌-拇短仲肌腱移位重建拇指对掌功能临床疗效分析

目的评价尺侧腕伸肌及拇短伸肌移位重建拇指对掌功能的临床疗效。方法回顾分析2003年以来，接受尺侧腕伸肌及拇短伸肌移位术重建拇指对掌功能的15例腕部正中神经不可逆损伤患者和5例正中神经合并尺神经损伤患者的随访结果。结果15例单纯正中神经不可逆损伤中，优11例，良4例，优良率100％；合并尺神经损伤的5例中，优3例，良1例，可1例，优良率80％。结论对腕部正中神经不可逆损伤，特别是合并尺神经损伤患者，尺侧腕伸肌及拇短伸肌移位术是一种理想的重建拇指对掌功能的手术方法，操作简单，效果好。     

掌指关节水平分裂型复拇畸形的X线片分型

目的:通过分析掌指关节水平分裂型复拇畸形的X线表现,探讨该类型复拇畸形的X线分型。方法:自2013年1月至2019年6月我科治疗264例掌指关节水平分裂型复拇畸形,根据X线片所示桡、尺侧指的相对发育程度,可将复拇畸形分为四大类型。A型,桡、尺侧指发育基本一致;B型,桡侧指更加发育不良;C型,尺侧指更加发育不良;D型,桡...     

尺侧腕伸肌-拇短伸肌腱移位重建拇指对掌功能临床疗效分析

目的 评价尺侧腕伸肌及拇短仲肌移位重建拇指对掌功能的临床疗效.方法 回顾分析2003年以来,接受尺侧腕伸肌及拇短伸肌移位术重建拇指对掌功能的15例腕部正中神经不可逆损伤患者和5例正中神经合并尺神经损伤患者的随访结果.结果 15例单纯正中神经不可逆损伤中,优11例,良4例,优良率100%;合并尺神经损伤的5例中,优3例,良1例,可1例,优良率80%.结论 对腕部正中神经不可逆损伤,特别是合并尺神经损伤患者,尺侧腕伸肌及拇短伸肌移位术是一种理想的重建拇指对掌功能的手术方法,操作简单,效果好.     

拇短伸肌腱桡侧半转位法治疗陈旧性拇指掌指关节背侧脱位

目的 介绍拇短伸肌腱桡侧半转位法治疗陈旧性拇指掌指关节背侧脱位的临床经验。方法 回顾性分析自2018-03—2022-02采用拇短伸肌腱桡侧半转位法治疗的6例陈旧性拇指掌指关节背侧脱位,切取拇短伸肌腱桡侧半肌腱,肌腱经第1掌骨远端横行骨隧道穿过与自身呈十字形交叉,在拇收肌肌腱止点处缝合,重建掌板功能。结果 6例手术切口一期愈合,无切口感染及皮肤坏死发生。6例均获得随访,随访时间2.5～14.0个月,平均6.0个月。根据中华医学会手外科学会上肢部分功能评定试用标准评定疗效：优2例,良3例,可1例。患者均可从事原有工作或体力劳动。结论 拇短伸肌腱桡侧半转位法是治疗陈旧性拇指掌指关节背侧脱位的有效方法,掌指关节功能恢复良好,疗效满意。对于掌指关节过伸Ⅳ度患者,临床医师需谨慎采用上述方法治疗,因为侧副韧带挛缩及关节囊挛缩严重会影响掌指关节屈曲功能恢复,切口较多也会增加感染及瘢痕形成的风险。     

掌长肌腱移植与示指固有伸肌腱转位治疗拇长伸肌腱自发性断裂的疗效对比

目的 探讨并对比掌长肌腱移植与示指固有伸肌腱转位修复拇长伸肌腱自发性断裂的临床疗效。方法 对2017年2月-2020年12月收治的46例自发性拇长伸肌腱断裂患者,按手术方式分为掌长肌腱移植组与示指固有伸肌腱转位组,术后均予外展背伸位被动支具固定3周,逐步行患指主被动功能训练,定期随访。结果 两组术后均获随访4~8个月,平均5个月。根据TAM评价标准,掌长肌腱移植组与示指固有伸肌腱转位组术后均取得了较为明显的临床疗效,两组在优、良、中数量以及优良率(TAM等级优+良占总比)差异上无统计学意义(P>0.05)。结论 掌长肌腱移植与示指固有伸肌腱转位是治疗自发性拇长伸肌腱断裂的两种有效术式,临床治疗效果满意,疗效上无明显差异。     

腱球代掌骨头行掌指关节成形的应用研究

介绍腱球代掌骨头行掌指关节成形术治疗掌指关节损伤的疗效。方法：将受损的掌骨头修整成杯口状，取伤指指浅屈肌腱或掌长肌至腱腹移行处带部分肌膜，制成球状体植入掌骨头缺损处。结果：临床应用２４例２７指效果满意。术后随访２４个月，２７指均无疼痛及创伤性关节炎发生。     

Closed reduction and treatment of 2 volar thumb metacarpophalangeal dislocations: report of 2 cases

Volar dislocation of the metacarpophalangeal joint of the thumb may be irreducible by closed means. We describe 2 patients with volar dislocation of the thumb metacarpophalangeal joint treated with closed reduction and casting.     

拇指单纯掌板损伤致掌指关节交锁的诊治

目的介绍拇指单纯掌板损伤致掌指关节交锁的诊治方法。方法对11例拇指掌指关节有过伸受伤和体征的患者,结合X线片和掌指关节造影的辅助诊断,采用局部麻醉进行闭合复位,2例获得成功,9例失败而行切开复位。结果术后11例获得4～28个月的随访．平均13个月。治疗后拇指掌指关节交锁无复发,掌指关节屈曲35°～60°,平均400(少于健侧10°)。2例持重物时略有疼痛。结论根据外伤、手部体征,结合影像学检查,掌板损伤不难做出诊断。可先在局麻下手法复位。若不成功,则手术松解,可以取得满意的疗效。     

Correction of a Hyperextension Deformity at the Metacarpophalangeal Joint by Arthroplasty for Osteoarthritis of the Thumb Carpometacarpal Joint Followed by External Fixator: A Case Series: Modified Ilizarov Method for Correction of a Collapsed Thumb Deformity Due to Carpometacarpal Osteoarthritis

A hyperextension deformity in the advanced stages of carpometacarpal (CMC) arthritis of the thumb could affect the outcomes of thumb CMC joint arthroplasty. We introduce the interesting approach for treating severely collapsed thumb deformities with gradual distraction and coordinated correction of the MCP and CMC joints by means of external fixators. We divided 8 cases into 3 groups according to the angle of passive flexion of the hyperextended MCP joint: group 1, 10–20°, group 2a, 20–40°, and group 2b, >40°, retrospectively. We first performed CMC arthroplasty with trapezium excision. In group 1, we corrected the MCP hyperextension deformity by manual passive flexion and fixed the joint with an extension block Kirshner wire (K-wire) for 2 months. However, deformities recurred in 2 of 5 cases after removing the K-wire. These patients received corrective percutaneous osteotomy with external fixators at the metacarpal neck. In groups 2a and 2b, we performed CMC arthroplasty and set external fixators at the same time. All cases in groups 1 and 2a have been without recurrence for more than 2 years, while a deformity recurred in group 2b. The results of this small case series encouraged us to propose an interesting approach for collapsed zigzag thumb deformity. Good outcomes with excellent maintenance of active MCP movement and no recurrence are highly anticipated if the hyperextended thumb has no obvious degenerative changes and can be corrected by <40° of passive flexion. Our results also indicate a risk of recurrence associated with extension block by K-wire.     

Ligament replacement in palmar instability of the MP joint of the thumb

Surgical Principles In posttraumatic or habitual palmar instability of the MP joint of the thumb the deficiency of the ligaments is compensated by an increase in flexor tonus and a tenodesis to prevent hyperextension. The flexor tonus is increased by transferring the radial sesamoid bone together with the deep head of the flexor pollicis brevis to the base of the proximal phalanx. The tendinous portion of this muscle is sutured to the remaining ligaments and the abductor pollicis brevis with the MP joint in extension to form a tenodesis. Thus hyperextension is passively blocked. Revised Version from: Operat. Orthop. Traumatol. 2 (1990), 256–262 (German Edition).     

A possible new operative method for the treatment of metacarpophalangeal joint stiffness

A case is reported in which metacarpophalangeal joint capsulotomy is augmented by the use of a flap of fibrous tissue from around previously implanted silicone sheet as a form of capsular reconstruction.     

The extensor sling procedure for the unstable carpo-metacarpal joint of the thumb

Surgical Principles The sling is made by routing part of the extensor carpi radialis longus, from its insertion, through the interspace between the second and third metacarpals, encircling the base of the first metacarpal and then suturing the tendon on itself at its point of entry between the second and third metacarpal. The entire procedure is carried out from the dorsal surface of the hand and deep to the adductor pollicis. Stability of the first carpo-metacarpal joint is restored without interfering with the excursion of the first metacarpal. During pinching great lateral forces act on the first carpo-metacarpal joint and tend to dislocate it laterally. This tendency is normally kept in check by the first intermetacarpal ligament [7]. As with all joints, instability in the carpo-metacarpal joint will promote the early onset of secondary degenerative changes. Increased stability would prevent the changes, or at least delay them, until the usual age of occurrence in the general population. However, no procedure carried out at the stage where significant cartilaginous degeneration is already present, will be able to control the process of arthritis. For the first metacarpal to move laterally the intermetacarpal ligament has to stretch [1]. Re-inforcing the ligament must, therefore, control this tendency. The extensor sling procedure provides a new ligament which lies in the coronal plane of the hand between the first and second metacarpal and prevents lateral subluxation. At the same time it does not interfere with circumduction of the first metacarpal provided that the ligament is sited at the base of the metacarpal.     

小指展肌移位并跖趾关节背侧关节囊切开改善再造拇指功能

目的 探讨应用小指展肌移位并跖趾关节背侧关节囊切开改善再造拇指的外形与功能的临床效果. 方法 自2007年8月至2012年5月,对12例拇指Ⅳ°、Ⅴ°缺损患者,采用携带跖趾关节的第二足趾游离移植再造拇指,术中采用小指展肌移位重建拇对掌功能,并通过跖趾关节背侧关节囊切开,应用小指展肌、趾短伸肌调节跖趾关节张力,改善再造拇指外形与功能. 结果 12指全部成活.术后随访6-24个月,再造拇指外形及功能明显改善,按中华医学会手外科学会上肢部分功能评定试用标准评定:优9例,良3例. 结论 应用小指展肌移位能重建再造拇指的对掌功能,并结合跖趾关节背侧关节囊切开,调节关节张力,能改善再造拇指外形,手术疗效满意.     

Sagittally split fracture of trapezium associated with subluxated carpo-metacarpal joint of thumb

Trapezial fractures are uncommon, and require careful clinical and radiological assessment and treatment. Poor or inadequate treatment of displaced fractures of trapezium can lead to long-term morbidity. We report two displaced fractures of the trapezium. The clinical and radiological features are discussed. Both fractures were treated operatively and a good functional outcome was achieved.     

前臂肌腱部分移位修复桡尺远侧关节脱位的应用解剖

目的为前臂肌腱部分移位修复桡尺远侧关节脱位提供解剖学依据。方法30侧成人上肢标本,将尺侧腕屈肌腱、尺侧腕伸肌腱、桡侧腕长伸肌腱、肱桡肌腱作形态学测量,将尺侧腕屈肌腱、尺侧腕伸肌腱进行力学测试。结果尺侧腕屈肌腱长(16.7±2.7)cm;尺侧腕伸肌腱长(14.9±2.5)mm;桡侧腕长伸肌腱长(19.0±2.0)cm;肱桡肌腱长(11.7±2.4)cm。力学测试:尺侧腕屈、伸肌腱其全肌腱破坏载荷分别为(2.4±0.9)Mpa、(3.1±0.9)Mpa,半肌腱破坏载荷分别为(2.2±0.9)Mpa、(2.5±0.8)Mpa,t检验无显著性差异。结论前臂肌腱部分转位有足够的长度和强度修复桡尺远侧关节脱位。