高频超声在手指关节部位闭合损伤的诊断价值

[目的]探讨高频超声对手指关节部位损伤的诊断价值。[方法]对12例手指关节部位闭合损伤病例进行高频超声检查;7例行手术治疗,其余5例行石膏外固定治疗。[结果]超声显示远节指骨撕脱骨折3例,骨块均有移位,远指间关节移位;侧副韧带损伤2例,超声表现损伤局部低回声,韧带增厚回声不均匀,外加应力检查可见关节间隙增大,指间关节远端止点处副韧带连续性中断;腱帽损伤3例,表现为腱帽连续性中断,结构紊乱,局部有异常暗区,动态观察可见断端分离,伸腱向尺侧滑;掌指关节掌板损伤并掌指关节绞锁4例,均发生在拇指,超声显示掌骨头向掌侧突出,掌板连续性中断,或横断扫描时掌板纵向裂开,可见桡侧籽骨嵌在掌指关节之间,屈伸手指可见与籽骨相连的肌肉收缩,但籽骨不动;12例均获得随访。3例指骨远端撕脱骨折X线片显示骨折已完全愈合,手功能按TAM评定标准评定疗效:优9例,良3例,优良率达100%。手术病例手术中所见与超声诊断完全符合。[结论]高频超声检查对手指关节损伤的检测方便,检查费用低廉,诊断符合率高,为临床诊断提供了有价值的信息。     

腱皮缝合术治疗闭合性伸指肌腱Ⅰ区断裂伤

伸指肌腱Ⅰ区的闭合性损伤，是指由中央束在中节指骨基底部的止点开始至侧束的止点区域的损伤，多由戳伤所致。如发生断裂，手指末节立即发生掌屈而不能主动伸直，则产生锤状指畸形。对于新鲜的闭合损伤大多可采用过伸固定的非手术治疗，而对于陈旧性损伤应手术治疗。自1994年1月～2003年1月，采用腱皮缝合术治疗闭合性伸指肌腱Ⅰ区断裂损伤62例，疗效满意，报告如下。     

彩色多普勒超声在手屈指肌腱损伤急诊手术中的应用

目的探讨高频彩色多普勒超声在手屈指肌腱损伤急诊手术中的应用价值。方法采用高频探头对21例急诊手屈指肌腱损伤患者行术中探查,观察肌腱损伤程度、回缩部位及血运状况。结果高频探头可以准确清晰判断肌腱损伤程度、判定断裂部位和两端肌腱的位置,完全断裂表现为连续的肌腱纤维层状高回声和腱周腱鞘薄层低回声在伤口处连续性完全中断,为低回声、无回声所替代。结论肌腱损伤术中超声对缩短手术时间、减少对周围组织的损伤、减轻局部粘连、确保术后血管再通有重要意义。     

微型骨锚在外伤性锤状指畸形中的应用

手指损伤形成的锤状指，是指伸终腱在末节指骨止点处或近止点处断裂，断端肌腱纤维往往呈抽麻样状态。如从止点处连同—小骨片撕脱，则外伤应力造成指伸肌腱或末节指骨基底背侧的连续性中断，由于指深屈肌腱的张力及掌板作用，远指间关节（DIP）往往掌屈移位，不能伸直呈锤状指畸形。锤状指的治疗主要分为保守与外科手术两类，其效果各家报道不一，特别是陈旧性锤状指的治疗，目前仍存在争论。     

指伸肌腱滑脱的原因分析与手术要点

目的　探讨指伸肌腱滑脱的损伤机制、手术方法和术后复发的关系。方法　 1987年至 1999年 ,在 17例指伸肌腱滑脱手术中 ,在修复矢状束、腱帽和关节囊损伤的同时 ,重视了腱间筋膜的修复。通过模拟实验 ,分析腱间筋膜、矢状束和腱帽在指伸肌腱滑脱中的作用。结果　术后随访 3个月～ 10年 ,17例伸指功能均恢复正常 ,未见复发者。实验结果证实 ,切断指伸肌腱桡侧矢状束和腱帽 ,仅引起指伸肌腱的部分滑脱 ,此时切断腱间筋膜则引起其向尺侧的完全滑脱。结论　矢状束和腱帽损伤的同时 ,伴有腱间筋膜损伤是该症关键的病理机制。手术修复腱间筋膜是防止复发的根本     

骨性锤状指的手术治疗进展

骨性锤状指是伸肌腱终腱自末节指骨基底部背侧止点撕脱,且伴有撕脱骨折,伸肌腱终腱与撕脱骨块的连接是完整的.当末节指骨伸直且有纵向轴性应力的情况下,远侧指间关节过度背伸就会造成骨性锤状指,反之远侧指间关节过度掌屈则会造成腱性锤状指.此外,临床上比较罕见的同时伴有末节指骨背侧的撕脱骨折块、骨折块与伸肌腱终腱连接断裂的腱性、骨...     

克氏针背侧阻挡加压骨折块法治疗骨性锤状指

末节指骨基底背侧撕脱骨折并伸肌腱止点损伤常见于青壮年.外伤致手指Ⅰ区指伸肌腱断裂伴远节指骨基底背侧撕脱骨折,表现为手指远指间关节屈曲、背伸不能的一种畸形称为骨性锤状指.X线侧位片可见末节指骨背侧撕脱骨折向背侧移位.2006年2月至2011年5月,我科采用克氏针背侧阻挡加压骨折块法治疗骨性锤状指52例,效果良好.     

伸肌腱腱帽解剖与异体腱帽移植的相关性实验研究

目的 探讨伸肌腱腱帽解剖与异体腱帽移植的相关性研究。方法 对6只新鲜尸手24指指伸肌腱腱帽的动力结构和静力结构进行观察,并测定了各指伸肌腱在腱帽处的滑动范围。结果 各指腱帽桡、尺侧的长度均是桡侧长于尺侧,各指伸肌腱腱帽的滑动范围在0．9－1．5cm间,示指最大,小指最小。结论 异体腱移植可恢复伸肌腱腱帽的原有结构,可避免自体肌腱移植后的肌腱移植后的肌腱下滑而影响伸指功能的恢复。     

肌腱与指骨的加强固定治疗Ⅰ区伸肌腱损伤

目的　探讨应用肌腱与末节指骨的加强固定治疗Ⅰ区指伸肌腱损伤的手术方法。方法　对 18例Ⅰ区指伸肌腱损伤患者 ,于手指末节指骨基底穿过 6 0尼龙线 ,用连续缝合的方法将伸肌腱近端或以“U”形的缝合方法将撕脱骨片固定于末节指骨基底 ,肌腱止点有残留则先连续缝合肌腱 ,再以适当的张力将肌腱近端固定于指骨基底。术后用小管形石膏外固定 ,患指伸直位固定 4～ 6周。结果　术后 3个月随访 ,患指功能良好 ,远侧指间关节 (DIP)活动度均数 -10°～ 51°,肌腱未出现再次断裂。结论　本手术操作简便 ,能有效加强Ⅰ区指伸肌腱与指骨的固定     

“指伸肌腱终腱-止点系统”与锤状指形成原因的探讨

目的：通过对指伸肌腱终腱止点及末节指骨的解剖学观测,以物理力学方法对锤状指的形成原因做进一步的探讨。方法在成人新鲜尸体手指标本上,通过模拟手术,对指伸肌腱终腱止点及末节指骨的结构特点进行应用解剖学观测,用物理力学原理对指伸肌腱终腱及末节指骨进行受力分析。结果指伸肌腱终腱止点呈浅帽状被覆于末节指骨基底背侧的“舌”形骨嵴顶端,远侧指间关节侧面观呈规则的圆弧形,末节指骨在屈伸肌腱的牵拉下围绕一个固定的轴心在中节指骨头表面做屈伸运动;终腱或舌形骨嵴在手指纵轴线处受力最大,在垂直于手指纵轴线处受力最小。结论“指伸肌腱终腱-止点系统”的命名利于对锤状指的形成原因作进一步解释,并为锤状指治疗方法的改进提供解剖学依据。     

A Review of Extensor Hallucis Longus Variants Featuring a Novel Extensor Primi Internodii Hallucis Muscle Merging With Extensor Hallucis Brevis

The extensor hallucis longus (EHL) muscle/tendon complex has been used in a variety of tendon transfer and tenodesis surgeries to correct iatrogenic hallux varus deformity, equinovarus foot deformity, clawed hallux associated with a cavus foot, and dynamic hyperextension of the hallux and, even, to prevent pedal imbalance after transmetatarsal amputation. Although it is usually considered a unipennate muscle inserting into the dorsum of the base of the distal phalanx of the hallux, a vast majority of EHL muscles possess ≥1 accessory tendinous slips that insert into other neighboring bones, muscles, or tendons, which can complicate these surgeries. The present report reviewed the reported data on EHL variants and describe a new variant, in which the tendons of the extensor primi internodii hallucis muscle of Wood and extensor hallucis brevis muscle merged together proximal to the tarsometatarsal (Lisfranc) joint, a site of rupture for extensor tendons of the foot. The reported variant might have contributed to the development of the clawed hallux seen in our patient and could complicate its operative management by mimicking the normal extensor digitorum longus tendon. Knowledge of the EHL variants and the particular muscular pattern described in the present review could improve the diagnosis and tendon transfer and tenodesis operative planning and outcomes.     

Verletzungen der Endgelenke

Injuries of the distal interphalangeal joints mostly involve the extensor tendon. Its superficial position on the dorsal aspect of the finger often exposes the extensor tendon to closed and open injuries. Lesions of the extensor tendons are more common than those of the flexor tendons. Furthermore, injuries of the joint often occur as fractures of the dorsal base of the distal phalanx, and, less frequently, as fractures of the head of the middle phalanx. In all cases, correct diagnosis and therapy is essential. Incorrect diagnosis and neglecting of the injury by both surgeon and patient often lead to considerable complications, e.g., delayed healing and lack of function.     

Ultrasonic assistance in the diagnosis of hand flexor tendon injuries

In contrast to routine flexor tendon injuries, flexor tendon ruptures following blunt injury or re-ruptures following repair can be difficult to diagnose. The authors investigated the efficacy of using ultrasound to assist in the diagnosis. From 1996 to 1997, 8 patients underwent evaluation of the flexor tendons using an ATL HDI-3000 ultrasound machine with a high-resolution, 5 to 9-MHz hockey stick linear probe. Dynamic evaluation was performed in real time, simulating clinical symptoms. Six patients underwent surgical exploration. Sonographic diagnosis and intraoperative findings were correlated. Ultrasound was used to diagnose 3 patients with ruptured flexor digitorum profundus tendons. Mechanisms of injury included forceful extension, penetrating injury, and delayed rupture 3 weeks after tendon repair. Subsequent surgical exploration confirmed the ruptures and location of the stumps. Five patients had intact flexor tendons by ultrasound after forceful extension, penetrating injury, phalangeal fracture, crush injury, and unknown etiology. In 3 patients who underwent surgery for tenolysis, scar release, or arthrodesis, the flexor tendons were found to be intact, as predicted by ultrasound. The authors found ultrasound to be accurate in diagnosing the integrity of flexor tendons and in localizing the ruptured ends. They conclude that ultrasound is helpful in evaluating equivocal flexor tendon injuries.     

Anatomy of the extensor pollicis brevis muscle.

52 hands have been dissected to check the anatomy and function of the extensor pollicis brevis. Various abnormalities were found: absence of the E.P.B. (two), insertion on the distal phalanx (four), absence of bony insertion on the base of the first phalanx and insertion on the extensor hood (36). In ten cases (in addition to the two with absence of E.P.B.), no function was elicited by pulling the tendon which inserted upon the extensor hood.     

Zone I flexor tendon injuries

Zone I flexor tendon injuries entail injuries to the flexor digitorum profundus (FDP) tendon. These injuries occur distal to the superficialis insertion over the middle phalanx or proximal distal phalanx, and as such are isolated injuries to the FDP. The mechanism most commonly is closed avulsion from the distal phalanx or a laceration, but other mechanisms such as open avulsion or crush injury can occur. On physical examination, the cascade of the fingers will be disrupted, and distal interphalangeal (DIP) joint flexion must be isolated to determine if the FDP tendon is continuous, as other mechanisms are present to enable finger flexion at the other joints.     

Traumatic closed index extensor tendon rupture at the musclotendinous junction: a report of two cases

This report describes two cases of traumatic closed index extensor tendon rupture at the musclotendinous junction. Both patients were injured when their work gloves were caught in the revolving parts of machines, and both were treated surgically. One of the patients completely ruptured the index extensor digitorum communis (EDC) and the extensor indicis proprius (EIP) tendons at the musclotendinous junction of dorsal forearm. In this patient, the distal stump of the index EDC tendon was sutured to the middle EDC tendon in an end-to-side juncture. The other patient completely ruptured the EIP tendon and partially ruptured the index EDC tendon at the musclotendinous junction. In this patient, tendon transfer of the extensor digiti minimi (EDM) to the EIP tendon and plication of the index EDC tendon were performed. In both cases, surgical intervention enabled the patients to extend their index fingers almost normally; however, the former complained of inability to extend his index finger independently. Tendon transfer of the EDM in cases of index extensor tendon rupture at the musclotendinous junction is a good method to restore ability to independently extend the index finger. However, consideration should be given to anatomical variation in the little finger. The EDC tendon is sometimes absent leaving the EDM tendon as the only extensor tendon to the little finger.     

Nonoperative treatment of traumatic dislocations of the extensor digitorum tendons in patients without rheumatoid disorders

Traumatic subluxation and dislocation of the extensor digitorum tendons are uncommon in patients without rheumatoid disorders. Management of the acute injury is not well defined in the orthopedic literature. Two cases of traumatic dislocations of the extensor digitorum tendon were seen acutely in young persons without rheumatoid disease. These patients were successfully managed by early closed reduction and immobilization. This treatment had yielded good hand function to date, without recurrence of the dislocation. One of these cases was particularly unusual in that the direction of the tendon dislocation was radial. This particular injury has not been previously described.     

Biomechanical evaluation of thumb opposition transfer insertion sites

The optimal location for insertion of the transferred tendon in opposition transfer is controversial. The purpose of this study was to examine 4 commonly used insertion sites into the thumb and determine which maximizes thumb opposition. The flexor digitorum superficialis of the ring finger was used as a donor tendon and was attached in random order to the abductor pollicis brevis (APB) tendon, the APB and extensor pollicis longus, the flexor pollicis brevis (FPB) and dorsal radial extensor hood, and the ulnar extensor hood at the base of the proximal phalanx. As normal opposition was simulated, the minimum distance between the thumb and little finger and the pinch force were measured. The FPB and radial dorsal extensor hood site resulted in the statistically highest pinch force. The FPB and radial dorsal extensor hood and the APB sites had statistically smaller minimum distances between the thumb and little finger than the ulnar extensor hood site. A subjective evaluation of the 3-dimensional thumb path of motion revealed that the FPB and radial dorsal extensor hood site and the APB insertion site allowed the closest approximation of normal thumb opposition. This biomechanical study supports the use of the FPB and radial dorsal extensor hood insertion site or APB insertion site for opposition transfers.     

Subkutaner Sehnenabriss des M. flexor digitorum profundus

The diagnostic and treatment of a closed avulsion of the flexor digitorum profundus muscle at its insertion of the little finger is presented. This happened as a 41-year-old woman wanted to hold a dog lead in her left hand and suddenly the dog started to run. In the literature the flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons were found to be more frequently ruptured than the flexor digitorum superficialis tendon. Closed ruptures of the FDP have been rarely reported. In the case described here there was no torn fragment at the distal end of the FDP tendon and the bone structure of the phalanx distales was intact. The operative treatment, postoperative care and clinical course are presented.     

Avulsion of the flexor digitorum tendon secondary to enchondroma of the distal phalanx

Flexor digitorum profundus (FDP) tendon avulsion is a common injury in sports. This is secondary to forced extension against flexor digitorum profundus contraction. However, avulsion injury of the FDP tendon secondary to an enchondroma of the distal phalanx is extremely rare. There have only been three previous reports of such an occurrence. This report describes a fourth case of an avulsion injury of the FDP tendon secondary to enchondroma of the distal phalanx of the fourth digit.