插秧致中环指伸肌腱自发性断裂修复后早期疗效

目的总结肌腱移植修复插秧致中、环指伸肌腱自发性断裂的早期疗效。方法 2006年4月-2009年4月,采用肌腱移植修复21例(28指)插秧后发生中、环指伸肌腱自发性断裂。男5例,女16例;年龄35～44岁,平均42岁。均因单侧中指和(或)环指不能伸直2～19 d就诊,半均5.3 d。其中中指9例,环指5例,中、环指7例。结果术后患者切口均Ⅰ期愈合。除1例2指肌腱粘连严重影响关节功能外,其余患者经积极锻炼,关节功能均恢复良好。20例患者27指获6个月随访,1例1指失访。术后6个月随访,采用总主动活动度(TAM)系统评定手指功能:获优12指,良13指,可2指,优良率达92.6%。结论采取肌腱移植修复中、环指伸肌腱自发性断裂,术后手指关节功能恢复较好。     

早期活动对指屈肌腱修复后功能恢复探讨

1998 - 2 0 0 0年我们对 2 1例 38条指屈肌腱损伤患者行急诊修复后 2d即行主动伸指被动屈曲早期功能锻炼 ,疗效满意 ,现报告如下。1　临床资料本组患者中男 17例 ,女 4例 ;年龄 16～ 5 1岁 ,平均 33岁。右手 16例 ,左手 5例。肌腱损伤部位按国际通用划分法[1] Ⅱ区 12例 ;Ⅲ区 3例 ;Ⅳ区 3例 ;Ⅴ区 3例。拇指 3例 ;食指 15例 ;中指 10例 ;环指 7例 ;小指 3例。2　治疗方法2 1　手术方法　在臂丛麻醉下 ,上气压止血带 ,常规消毒铺巾 ,用 3 0尼龙无创伤缝线缝合 ,按Kessler缝合法 ,在屈肌腱与掌背矢状面呈 30°角的两个平面上各缝合一针 ,线…     

指屈肌腱缝合早期控制下活动预防肌腱粘连54例报告

手外伤引起指屈肌腱损伤临床较多见,术后功能恢复差,主要原因是术后肌腱粘连。我院于1997～2002年应用改良津下氏法缝合指屈肌腱,早期控制下活动,取得满意效果。1资料与方法1.1临床资料本组54例82条指屈肌腱,其中男40例,女14例;年龄11～57岁;急诊修复45例,择期9例。致伤原因:切     

第二区指屈肌腱修复

第二区指屈肌腱修复李福天张俊民修玉才第二区指屈肌腱急性损伤一期修复后，如何防止肌腱粘连是肌腱外科的难题之一。作者自１９９３～１９９６年对１４例１６条第二区指屈肌腱断裂急诊一期缝合，同时修复腱鞘，术后在保护性位置下进行早期主动活动，取得了满意效果，报告...     

指伸肌腱变异一例报告

患者　男 ,2 0岁。右腕部正中神经损伤后致拇外展功能丧失 1年 ,于 2 0 0 0年 11月入院作拇对掌功能重建术 (示指固有伸肌腱移位重建拇外展功能 )。术前检查 :示指固有伸肌腱肌力为Ｍ5。术中发现 :第二掌指关节背侧仅有示指固有伸肌腱而无示指指伸肌腱 ,但在第三掌指关节背侧却有 2根粗细一样的指伸肌腱。故在伸肌腱扩张部切断示指固有伸肌腱及中指桡侧 1根指伸肌腱 ,将中指指伸肌腱近端与示指固有伸肌腱远端缝合以恢复示指的伸指功能。于尺骨小头近端切口内抽出示指固有伸肌腱 ,通过皮下隧道、绕过豌豆骨达拇短展肌止点 ,并从拇长伸肌腱下…     

卡锁环肌腱缝合法在伸指肌腱修复中的作用

目的：以改良Kessler法作为参照，研究卡锁环缝合法在修复伸指肌健中的抗拉力作用效果。方法：术中随机对50根断裂伸指肌腱平均分为两组，分别采用卡锁环（Locking loop）法和改良Kessler法进行修复，然后进行屈指活动抗拉力测试观察。结果：两组肌腱出现拉松和缝线拉脱的例数分别为：卡锁环法组2，0，改良Kessler组7，5。结论：卡销环法抗拉力作用显，适合于伸指肌腱的修复。     

指屈肌腱缝合早期主动活动预防肌腱粘连

目的 观察指屈肌腱Ⅱ区缝合后早期主动活动预防肌腱粘连的治疗效果。方法 采用核心津下套圈缝合联合周边Halsted缝合法临床治疗71例98指,术后早期主动活动,定期随访,将随访结果与其他缝合方法进行对应分析比较。结果 优良率达97．8％。在随访期各阶段本法均优于其他缝合方法。结论 津下套圈核心缝合联合Halsted周边缝合术后可早期主动活动,粘连率低,疗效显著。     

陈旧性1区指伸肌腱断裂的修复

陈阳性 1区指伸肌腱断裂修复后 ,往往因肌腱愈合不牢固 ,去除外固定后 ,肌腱缝合处受指屈肌腱持续张力的作用 ,被逐渐拉长而重新产生锤状指畸形。近 5年来 ,我们改进了对锤状指的手术方法 ,共治疗 10例 ,疗效比较满意。一、资料与方法1.一般资料 :本组共 10例 ,男 7例 ,女 3例 ;年龄 48～ 65岁 ,平均 5 7岁。伤因 :戳伤 8例 ,压砸伤 2例。伤后立即发生锤状指 8例 ,3～ 5ｄ后发生锤状指 2例。 8例均无末节撕脱骨折。急诊手术 2例 ,因失败而再次手术 ,陈旧性锤状指 8例 ,均于伤后 3～ 6个月择期手术。2 .手术方法 :在伤指远侧指间关节背侧作纵…     

Outcome of early active mobilization after extensor tendon repair

Background:

Traditionally the repaired extensor tendons have been treated postoperatively in static splints for several weeks, leading to formation of adhesions and prolonged rehabilitation. Early mobilization using dynamic splints is common, but associated with many shortcomings. We attempted to study the results of early active mobilization, using a simple static splint, and easy-to-follow rehabilitation plan.

Materials and Methods:

In a prospective study 26 cases of cut extensor tendons in Zone V to VIII were treated with primary or delayed primary repair. Following this, early active mobilization was undertaken, using an easy-to-follow rehabilitation plan. The results were assessed according to the criteria of Dargan at six weeks and one year.

Results:

All the 26 patients were followed up for one year. 20 out of 26 patients were below 30 years of age, involving the dominant hand more commonly (16 patients, 62%). Agriculture instruments were the most common mode of injury (13 patients, 50%). The common site for injury was extensor zone VI (42%, n = 11).

Conclusion:

Rehabilitation done for repaired extensor tendon injuries by active mobilization plan using a simple static splint has shown good results.     

Complications of extensor tendon repairs at the extensor retinaculum

Literature describing surgical, post-operative management and outcomes following EDC repairs in close proximity to or within the extensor retinaculum is limited. This complex injury can result in decreased wrist and digital motion as well as loss of independent motion of the digits. This paper reviews complications following such injuries observed clinically as well as experimental simulation performed on cadaveric specimens. Our observations have direct implications to hand therapy practice and outcomes used following such injuries.     

Congenital dislocation of the extensor tendon of the hand

Abstract

Congenital dislocation of the extensor tendon is extremely rare. We report a case of bilateral dislocations in an 8-year-old boy, which were treated successfully with reconstruction of the sagittal band. We describe the technique and 18 months’ result.     

Spontaneous rupture of extensor pollicis longus tendon with tophaceous gout infiltration

Introduction Spontaneous rupture of the extensor pollicis longus (EPL) tendon has been reported in the literature. Various mechanisms have been proposed to account for this problem, but gouty infiltration is a rare mechanism. Here we report a patient with a long-standing history of gout who presented with sudden loss of interphalangeal extension of the left thumb. Spontaneous rupture of the EPL tendon caused by gout was discovered.Materials and methods The successful treatment done involved surgical exploration and extensor indicis proprius tendon transfer. Postoperative thumb spica immobilization for 6 weeks was applied.Results Pathology disclosed urate crystals deposited within the ruptured EPL tendon. The functional recovery is satisfactory at the 1-year follow-up. Conclusion Spontaneous rupture of the EPL tendon caused by gout is rare. Successful treatment was done with surgical management. Life-long medical follow-up to prevent a repeated acute attack can lower the risk of a large amount of tophaceous gout infiltration in tendons and may possibly prevent acute spontaneous tendon rupture.     

Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation

Introduction The outcome of primary extensor repair in hand surgery has been widely explored, but little systematic effort has been made to investigate the influence of the anatomical zone of tendon injury. Therefore, the aim of our study was to assess the outcome of primary extensor tendon repair with a special focus on the pre-operative state and Verdan’s anatomical zones. Our hypothesis being tested was that the outcome after primary extensor repair depends on the complexity of trauma and the site of lesion. Materials and methods One hundred and seventy seven patients with 203 extensor tendon repairs were studied. After tendon repair and a 6-week protective immobilization, physiotherapy was carried out. A score proposed by Geldmacher and Schwarzbach was applied to estimate the outcome pre-operatively and to assess the results in a follow-up after a mean of 13 months. Correlations were tested between the anatomical zone of tendon injury, the pre-operative expectation and the results as considered both by the patient and the physician. Results In Verdan’s zones 1, 2, 4 and 5, excellent or good results were obtained in the vast majority of patients. Due to a higher frequency of complex injuries with concomitant soft tissue and bony injuries, the outcome was significantly worse after tendon repair in zones 3 and 6, as expected after the pre-operative estimation. In addition, a strong correlation was found for all anatomical zones between the pre-operative estimation and the outcome as judged both by the physician and the patient. Conclusion Recovery of finger function after primary extensor tendon repair depends on the complexity of trauma and the anatomical zone of tendon injury. Static splinting is an appropriate tool after primary extensor tendon repair in Verdan’s zone 1, 2, 4 and 5, whereas injuries in zones 3 and 6 may demand for a different treatment regimen.     

自发性手指伸肌腱断裂的修复重建

目的探讨不同部位手指伸肌腱自发断裂的治疗方案及其疗效。方法29例患者总结如下：伸肌腱Ⅰ区22例、中环小指伸肌腱Ⅵ区3例、拇长伸肌腱4例，修复重建后配合功能锻炼。结果Ⅰ区原位直接缝合修复，优良率100％；食指固有伸肌腱移位拇长伸肌腱，优良率85％；桡侧腕短伸肌腱修复中环小指伸肌腱Ⅵ区，优良率75％。结论伸肌腱自发断裂常伴有炎症侵蚀或骨折端磨损的病理基础，在伸肌腱Ⅰ区时首选原位直接缝合修复，无条件修复时可行远指间关节融合术；对于中环小指伸肌腱Ⅵ区及拇长伸肌腱断裂行相邻协同肌肌腱转位修复，疗效确切。     

经骨隧道加压缝合治疗手指伸肌腱止点断裂

目的探讨应用经骨隧道加压缝合治疗手指伸肌腱止点断裂的手术方法。方法对20例手指伸肌腱止点损伤所致锤状指畸形患者．用5ml注射器针头在末节指骨基底部横行钻一骨隧道,先用2／0两头带针肌腱吻合线将伸肌腱近断端按Kessler法缝合,然后将一针夹直后穿过骨隧道,如有撕脱骨折块,则将骨折块复位,对平关节面,拉紧肌腱吻合线打结,压紧骨折块,再将伸肌腱止点与指骨末节背侧软组织加强缝合1针。,术后用石膏耗外固定手指近侧指间关节屈曲45°、远侧指骨间关节轻微背伸位4~6周。结果20例木后切口愈合良好。15例患者随访6~24个月,无锤状指畸形发生。伸指0°、屈指指端过掌横纹8例;伸指受限-5°—-10°,屈指指端达掌横纹6例;伸指受限-20°,屈指指端离掌横纹1cm1例。根据Dargan功能评定法,优良率93．3％。结论本法操作简单,取材方便、便宜,能持续有效地内固定伸肌腱止点,值得临床推广应用。     

Stenosing synovitis of the extensor pollicis longus tendon

There are only a few published cases of extensor pollicis longus (EPL) tenosynovitis in patients without rheumatoid arthritis. Even less common are cases of stenosing tenosynovitis of the EPL associated with triggering. This article presents 2 cases of EPL stenosing tenosynovitis with triggering of the thumb in the area of Lister's tubercle and addresses how to treat them.     

Rupture of extensor tendon secondary to previously undiagnosed Kienböck disease

Abstract

We report three patients with an unusual pattern of rupture of the extensor tendon. All were found to have previously undiagnosed Kienböck disease. Radiographic study of the wrist is essential before treating any closed rupture of an extensor tendon. Lesions may be progressive and extend to adjacent tendons and should be treated urgently.     

Monopolar radiofrequency energy application to the dorsal extensor tendon apparatus in a canine model of tendon injury

PURPOSE: To evaluate the use of monopolar radiofrequency energy (MRFE) to shorten stretched dorsal extensor tendon apparatus (DETA) tissues in a canine model. METHODS: Eleven adult canine forelimbs were used in this in vitro investigation. The DETA tissue was isolated between the metacarpophalangeal and proximal interphalangeal joints in the third and fourth digits of each limb. Isolated tissue was stretched in all but 2 of the digits (control group). After tissue stretching, monopular radiofrequency energy (MRFE) was applied to 18 of the digits at 1 of 3 temperatures: 50 degrees C, 60 degrees C, or 70 degrees C (stretch-treatment group). Two digits were treated identically, but MRFE was not applied (stretch-only group). Tissue length was measured before and after stretching and after treatment. Percent stretch, percent shortening, and percent original length were compared among the 3 stretch-treatment groups. All DETA specimens were examined with light microscopy. RESULTS: Histologic changes were apparent in the stretch-treatment and stretch-only specimens compared with controls. Percent stretch was not significantly different between groups. Percent shortening and percent original length were significantly lower and higher, respectively, in the 50 degrees C group than in the 60 degrees C and 70 degrees C stretch-treatment groups, which were not significantly different from each other. There was a significant linear correspondence between percent shortening and treatment temperature. CONCLUSIONS: The application of MRFE at a temperature of 60 degrees C and a power of 10 W appears to shorten stretched DETA tissue to approximately the prestretched length in an in vitro canine model. Further investigation is necessary to determine the effect of treatment on the tissue's mechanical properties.