改良法修复拇长伸肌腱自发性断裂的临床疗效

目的 探讨改良的示指固有伸肌腱修复拇长伸肌腱自发性断裂的手术方法及临床疗效.方法 对20例拇长伸肌腱自发性断裂且示指固有伸肌功能存在、动力正常的患者采取改良法重建拇长伸肌腱功能.结果 20例均获随访,时间8个月~3年1个月.拇指背伸抬高丢失0~1.8 cm,拇指屈曲丢失0~2.3 cm;示指背伸丢失角度0°~10°.根据SEEM评分标准评价疗效:优15例,良5例.结论 采用改良的示指固有伸肌腱重建拇长伸肌腱功能,手术操作简单,转位肌力量足够强大,疗效满意.     

拇长伸肌腱自发性断裂19例的临床治疗

目的 探讨拇长伸肌腱自发性断裂的病因及治疗方法.方法 2015年5月-2020年1月,采用示指固有伸肌腱转位及掌长肌腱游离移植对19例拇长伸肌腱自发性断裂进行修复.结果 术后19例获随访4～24个月,平均6个月.拇指指间关节背伸0°～5°,屈曲35°～45°.按SEEM评分标准,示指固有伸肌腱移位重建拇长伸肌腱12例,...     

改良法重建拇长伸肌腱功能的疗效观察

目的通过与传统示指固有伸肌腱转移术比较,探讨改良法重建拇长伸肌腱功能的疗效。方法 2009年1月-2011年12月,采用改良法重建拇长伸肌腱功能治疗11例拇长伸肌腱自发性断裂患者(改良组)。手术在传统术式基础上,增加对拇长伸肌腱近侧断端与示指固有伸肌腱加固缝合,以及示指固有伸肌腱远端环绕拇短伸肌腱反折缝合。术后采用SEEM(specific EI-EPL evaluation method)评价方法评定手术疗效,并与同期采用传统示指固有伸肌腱转移术治疗的18例患者(传统组)进行比较。两组患者性别、年龄、病程及致伤原因等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果术后两组患者切口均Ⅰ期愈合。传统组5例失访,其余患者均获随访,随访时间8个月～2年6个月,平均1年6个月。末次随访时根据SEEM评价方法,改良组拇指抬高丢失及屈曲丢失均显著小于传统组,差异有统计学意义(P<0.05);示指单独背伸丢失与传统组相似(P>0.05)。改良组获优9例,良2例,优良率100%;传统组获优5例,良6例,可2例,优良率为84.6%;两组优良率比较,差异有统计学意义(χ2=0.03,P=0.03)。结论与传统示指固有伸肌腱转移术相比,改良法重建拇长伸肌腱功能手术操作简便,增加了转移肌腱力量,近期疗效满意,但远期疗效需进一步随访。     

桡侧腕短伸肌腱移位重建拇长伸肌功能的临床应用

临床上肌腱移位重建拇长伸肌功能的方法包括示指固有伸肌腱移位、掌长肌腱移位和桡侧腕长、短伸肌腱移位术等,其中桡侧腕短伸肌腱移位可应用于拇长伸肌腱自发断裂、陈旧性断裂和旋后肌下骨间后神经损伤后等拇指末节不能背伸.2005年以来,我们在临床上应用此方法重建拇长伸肌功能7例,疗效良好. 1.一般资料:本组7例,男5例,女2例;年龄19～52岁.其中拇长伸肌腱自发断裂2例,外伤后继发断裂2例,外伤致旋后肌下骨间后神经损伤3例.临床表现为拇指末节不能主动伸直,被动活动正常,鼻烟窝处不能触及紧张的拇长伸肌腱.自发现伸拇功能丧失至手术时间为2d至18个月.     

掌长肌腱游离移植治疗拇长伸肌腱VerdanⅤ区断裂17例

目的探讨掌长肌腱游离移植治疗拇长伸肌腱(Extensor pollicis longus tendon, EPL)VerdanⅤ区断裂的临床效果。方法 2016年6月-2018年6月对收治的17例拇长伸肌腱VerdanⅤ区断裂患者,采用肌腱探查+掌长肌腱游离移植修复。结果 17例获得6～24个月随访,平均13个月。术后拇指抬高丢失0～2.5 cm,平均1.2 cm;拇指屈曲丢失0～2.0 cm,平均1.1 cm。按SEEM评分标准进行功能评定:优12例,良3例,可2例,优良率88.2%,对示指、手腕活动未构成影响。结论对拇长伸肌腱VerdanⅤ区断裂,行掌长伸肌腱游离移植修复是一种牺牲小、预后优良的治疗方法。     

食指固有伸肌腱转移治疗外伤性、自发性拇长伸肌腱断裂

报道14例伸拇长肌腱外伤性、自发性断裂,用食指固有伸肌腱转移治疗,10例获得随访,平均随访4年半,拇指伸屈功能均达到正常。     

小指固有伸肌腱转移重建拇指对掌功能

目的 探讨小指固有伸肌腱移位拇对掌功能重建术的临床疗效。方法 2004年1月至2006年1月，对7例拇指对掌功能丧失者，采用以小指固有伸肌为动力肌，实施肌腱移位术重建拇指对掌功能。结果 术后随访3～12个月，平均8．3个月。拇指对掌功能满意，优6例，良1例，优良率为100％。结论 在拇指对掌功能重建术中，将小指固有伸肌腱作为动力肌，手术方式简单，效果满意。     

桡侧腕长伸肌腱移位桥接修复拇长伸肌腱断裂缺损

拇长伸肌腱陈旧损伤的功能重建，临床常采取掌长肌腱、尺侧屈腕肌腱、食指固有伸肌腱的移位或者游离肌腱移植。本例患者拇长伸肌腱系陈旧性的闭合断裂，拇长伸肌腱断端缺损较多；使用在止点处撕裂的桡侧伸腕长肌腱移位来桥接修复拇长伸的断裂缺损，取得了良好效果。现报告如下。     

拇长伸肌腱闭合断裂原因分析及治疗

目的：从局部解剖结构,探讨拇长伸肌腱腕背部（Ⅳ区）闭合断裂的原因及治疗。方法：解剖两例前臂标本及观察４例患者手术中局部所见,分析肌腱断裂与局部解剖结构的关系。４ 例患者均经食指固有伸肌腱转移修复拇长伸肌腱。结果：随访２～５年,拇指指间关节伸直正常,食指伸直与健食指比较无异常。结论：拇长伸肌腱由于潜在的病变与局部的解剖特点,该肌肌腱位于腕背部（Ⅳ）可发生闭合断裂,修复方法以食指的固有指伸肌腱转移较肌腱移植效果好。     

拇长伸肌腱自发性断裂5例

目的探讨拇长伸肌腱自发性断裂的发生机制、临床诊断及手术方式。方法自2006年12月以来,我院共收治拇长伸肌腱自发性断裂5例,均采用肌腱转位的方法进行修复。结果本组5例术后随访7月-18月,拇指伸指功能恢复良好。结论对于拇长伸肌腱自发性断裂的治疗,临床上采用食指固有伸肌腱移位法修复,是一种比较有效的方法。     

Effects of extensor pollicis longus transposition and extensor indicis proprius transfer to extensor pollicis longus on thumb mechanics

PURPOSE: The spatial relationship of the extensor pollicis longus (EPL) to the thumb carpometacarpal (CMC) joint may be altered by its transposition from the third dorsal wrist compartment and by subcutaneous extensor indicis proprius (EIP) to EPL tendon transfer. Changes in tendon position could alter thumb function. This study examined changes in the EPL adduction moment arm after EPL tendon transposition from its extensor compartment or EIP transfer. METHODS: The EPL adduction moment arm at the thumb carpometacarpal joint was determined under 4 tendon conditions: (1) intact extensor pollicis longus, (2) transposed extensor pollicis longus, (3) extensor indicis proprius to extensor pollicis longus tendon transfer through an extensor retinacular pulley, and (4) extensor indicis proprius tendon transfer through a subcutaneous route. Each tendon condition was tested in 2 wrist positions: neutral and 40 degrees of flexion. RESULTS: The wrist neutral/flexion moment arms for the 4 tendon conditions, in millimeters, were 9.2/7.3, 3.6/1.2, 8.3/5.1, and 4.8/1.0. CONCLUSIONS: EPL transposition produces a significant decrease of its adduction moment arm at the thumb CMC joint, an effect exacerbated by wrist flexion. The moment arm mechanics of the pulley and subcutaneous EIP tendon transfer resemble those of the intact and transposed EPL, respectively. Diminution of the adduction moment arm could impair thumb function, especially adduction.     

Evaluation of restoration of extensor pollicis function by transfer of the extensor indicis

The aim of this study was to assess long-term results of extensor indicis (EI) to extensor pollicis longus (EPL) transfers and to assess donor site morbidity. A specific EI-EPL evaluation method (SEEM) was used to measure EPL function after transfer. The outcomes in 17 patients are presented. Results were assessed by the Geldmacher score, the SEEM, mobility and strength of thumb and index finger, pinch and grip strength, and a questionnaire, comparing the operated and non-operated hands. Based on the SEEM, the results were excellent to good in 11 of 17 patients. There was no marked loss of independent extension of the index finger and only a 38% loss of extension strength.     

Extensor pollicis brevis tendon can hyperextend thumb interphalangeal joint in absence of extensor pollicis longus:Case report and review of the literature

We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis(EPB) to fully hyperextend the thumb interphalangeal joint. The thumb metacarpophalangeal joint was also able to be fully actively extended by the EPB. Previous anatomical studies have demonstrated that the insertional anatomy of the EPB tendon is highly variable and sometimes inserts onto the extensor hood and distal phalanx, which is likely the mechanism by which our patient was able to fully extend the thumb interphalangeal joint. Despite the potential for the EPB to extend the IP joint of the thumb, virtually all previously reported cases of extensor pollicis longus(EPL) tendon rupture had deficits of thumb IP extension requiring tendon transfer. This case highlights the potential ability of the EPB tendon to completely substitute for the function of the EPL tendon in providing thumb IP joint extension.     

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.     

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。     

Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon

We reviewed 21 patients with 22 ruptures of the extensor pollicis longus at a mean of 5.3 years after transfer of the extensor indicis proprius tendon. Of these, 19 with 21 transfers described the result as good, and two as fair. The mean deficit of extension between the operated and unoperated thumbs was 1.4 cm, and the mean flexion deficit 0.6 cm. Pressure gauge measurements showed that the strength of the transfer was 51% of that of the uninjured extensor. The two fair results had an extensor lag of over 1.5 cm. Independent extension of the index was maintained in all patients, none having a discernible lag, but the strength of index extension was reduced to 49% of that of the normal finger. There was no evidence of functional loss. Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon is a simple and reliable procedure with few complications. It gives satisfactory long-term extension of the thumb.     

Transfer of either index finger extensor tendon to the extensor pollicis longus tendon

BACKGROUND:

Extensor pollicis longus (EPL) tendon ruptures have been treated succesfully with the transfer of the extensor indicis proprius (EIP) tendon. Situations exist in which, due to intraoperative observations, another tendon transfer may be considered preferable to the standard EIP transfer method.

OBJECTIVES:

To determine whether transfer of the extensor digitorum communis II (EDC II) tendon from the index finger to the EPL tendon, leaving the EIP tendon to the index finger intact, would serve as an equally efficient transfer and not adversely affect the function of the hand.

METHODS:

Two patients who had the EDC II tendon transferred to the ruptured EPL tendon, and two patients who had the EIP tendon transferred, were retrospectively reviewed. In each transfer type, one patient had suffered an EPL tendon rupture after a Colles’ fracture, and the other had rheumatoid arthritis. The rupture occurred on the non-dominant side in one patient in each transfer type. Each patient was examined and subjected to range of motion and power testing at least one year following surgery.

RESULTS:

All four patients showed a minimal extension lag with the lift off test, but there was no noticeable difference in range of motion, pinch grip and hand grip strength between the transfer types. Both EDC II transfer patients demonstrated an 8° to 15° loss of thumb interphalangeal joint flexion compared with the unoperated side; EIP transfer patients demonstrated less than a 5° loss. Three patients demonstrated a minor extension lag in the index finger and middle finger. Extension power of the thumb and index finger in all patients varied with wrist flexion and extension and ranged from 50% to 150% of the unoperated side.

CONCLUSIONS:

These case reports suggest that either index finger tendon may be successfully transferred in EPL tendon ruptures.     

Sequential traumatic bilateral extensor pollicis brevis rupture: a case report

We present an interesting and rare case of a sequential bilateral traumatic rupture of the extensor pollicis brevis tendons distal to the first extensor compartment in a patient with no underlying systemic condition or pathology around the wrist. Satisfactory thumb function was restored by bilateral transfer of the extensor indicis proprius.     

Rupture of the extensor pollicis longus tendon without fracture after wrist trauma: case reports.

Four cases of rupture of the tendon of the extensor pollicis longus without detectable fracture after wrist injury are reported. The clinical features of this condition did not differ materially from those of rupture occurring after a Colles fracture. All patients were rather young, the average age being 40 years. In one patient rupture occurred a day after injury. In all patients satisfactory thumb function was restored with extensor indicis proprius tendon transfer.