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1.
Three cases are presented, in which an anomalous tendon slip between the extensor carpi ulnaris tendon and the extensor apparatus of the fifth finger was found. One of the patients was a violinist, who had serious impairment of the left wrist joint and the small finger due to the anomaly. The symptoms disappeared after excision. 相似文献
2.
Loss of the extensor mechanism at the distal interphalangeal (DIP) joint leads to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of a rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between the proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger leads to a swan neck deformity from PIP joint hyper extension and DIP joint flexion. Most mallet finger injuries can be managed non-surgically, but occasionally surgery is recommended for either an acute or a chronic mallet finger or for salvage of failed prior treatment. 相似文献
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Shinohara T Nakamura R Suzuki M Maeda N 《The Journal of hand surgery, European volume》2005,30(1):79-82
A tendon subluxation test was performed on the unaffected side in 13 patients with traumatic extensor tendon dislocation of the middle finger and on both middle fingers in 800 healthy controls to identify extensor mechanism laxity at the metacarpophalangeal joint. Ten of the 13 patients with dislocation had laxity of middle finger extensor tendon, compared with 174 of the 800 (22%) controls. The difference in these rates of extensor tendon laxity is significant (P<0.0001), and suggests that extensor mechanism laxity at the metacarpophalangeal joint may predispose to traumatic extensor tendon dislocation. 相似文献
5.
Y Hirai K Yoshida K Yamanaka A Inoue K Yamaki M Yoshizuka 《The Journal of hand surgery》2001,26(6):1009-1015
A total of 548 upper limbs (276 right and 272 left hands) from Japanese cadavers were dissected. The arrangements of extensor indicis proprius, extensor digitorum communis (EDC), and extensor digiti minimi tendons and the intertendinous connections were studied. The most common pattern of extensor tendons was as follows: the index finger had a single EDC tendon, the middle finger had a single EDC tendon, the ring finger had a single EDC tendon, and the small finger had a single EDC tendon or a single common EDC tendon distributed to the ring and small finger. A single extensor indicis proprius tendon ran along the ulnar side of the EDC, and the extensor digiti minimi tendon consisted of 2 slips. Intertendinous connections were classified into 3 types: type 1 with a filamentous band, type 2 with a fibrous band, and type 3 with a tendinous band subdivided to r-shaped and y-shaped. The most common patterns were type 1 in the second intermetacarpal space (IMCS), type 3r in the third IMCS, and type 3y in the fourth IMCS. 相似文献
6.
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. 相似文献
7.
自发性手指伸肌腱断裂的修复重建 总被引:1,自引:0,他引:1
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。 相似文献
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经骨隧道加压缝合治疗手指伸肌腱止点断裂 总被引:1,自引:0,他引:1
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。 相似文献
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自发性伸指肌腱断裂临床分析 总被引:7,自引:0,他引:7
[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。 相似文献
11.
Permanent abduction of the little finger is a bothersome deformity which usually occurs in the context of sequelae of ulnar nerve palsy (Wartenberg's sign), but also in rheumatoid arthritis. The authors report an original technique for correction of this deformity. The extensor digiti minimi tendon is sectioned at its distal insertion and transferred in the wrist through the extensor retinaculum. The "rerouted" tendon is finally resutured distally on the radial aspect of the interosseous muscle. Side-to-side suture of the transferred tendon to the extensor digitorum tendon of the little finger further reinforces the solidity of the procedure. The distal insertion of the extensor digiti minimi tendon is consequently radialized. Its new direction eliminates the abduction component, and the tendon then behaves as an active adductor of the little finger. Five cases (2 cases of ulnar nerve palsy, 3 cases of rheumatoid arthritis) are reported with a mean follow-up of 19 months. All patients have complete active adduction of the little finger in extension, with a persistent capacity for abduction. The other correction techniques published in the literature are discussed. 相似文献
12.
Extensor tendons ruptured in 12 patients as a result of osteoarthritis of the distal radio-ulnar joint. Rupture occurred without warning in ten cases and was sequential in five. Perforation of the dorsal capsule of the distal radio-ulnar joint, allowing contact between the roughened ulnar head and extensor tendons, was present in every case. The capsular performation was demonstrated by arthrography, which may be used to identify patients who are at risk of extensor tendon rupture. Loss of independent extension of the little finger is a valuable clinical sign because rupture of extensor digiti minimi may be masked by a powerful contribution from the extensor tendon of the ring finger. 相似文献
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PURPOSE: To report a congenital anomaly of the middle finger. METHOD: Nine patients (16 digits) are reported with congenital flexion deformity of the metacarpophalangeal (MCP) joint of the middle finger. Three patients (4 digits) had isolated deformities to the middle finger and in 6 the deformity was part of congenital ulnar drift (CUD) of the hand. Three patients had Freeman-Sheldon syndrome, 2 had nonsyndromic CUD, and 1 had arthrogryposis multiplex congenita. In CUD patients the middle finger had substantially greater flexion deformity of the MCP joint in comparison with other digits. Seven patients were treated surgically and 2 were treated nonsurgically. Five of the surgical patients had bilateral middle finger involvement. RESULTS: During surgery on 12 digits sagittal band hypoplasia of varying degrees was encountered in all patients and in all patients the extensor tendon of the middle finger was underdeveloped and often ulnarly displaced. Longitudinal imbrication of the remnants of the extensor tendon and centralizing the tendon if necessary by radial sagittal band reefing improved MCP joint flexion deformity. CONCLUSIONS: Congenital middle finger-in-palm deformity in our patients was caused by sagittal band and extensor tendon hypoplasia. 相似文献
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小指固有伸肌腱移位术后小指伸直障碍的防治 总被引:2,自引:0,他引:2
目的 探讨小指固有伸肌腱移位术后小指伸直障碍的应用解剖学依据及其防治方法。方法 针对小指伸肌腱行解剖学观察158例标本,并将伸向小指的指总伸肌腱束按生物力学分类为四型:即标准型、力线偏离度小型、力线偏离度大型及缺如型;针对术后小指伸直障碍,用腱间纤维联系切断术治疗3例,术中预防性治疗55例。结果 经1年以上随访,1989年8月-1996年间的54例病例中,3例术后发生小指伸直不全,经腱间纤维联系切断术后均治愈,此后,采用术中预防性治疗后未再发生小指伸直障碍。结论 小指固有伸肌腱移位术后小指伸直障碍与伸向小指的指总伸肌腱束的力线有关,按其类型分别采用腱间纤维联系切断术、腱短缩术及腱重建术,能够有效地防治小指伸直障碍的发生。 相似文献
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Chao JD Sarwahi V Da Silva YS Rosenwasser MP Strauch RJ 《The Journal of hand surgery》2004,29(2):216-219
PURPOSE: Tenotomy of the central slip, described by Fowler, can clinically improve chronic distal interphalangeal joint (DIP) extensor lag secondary to mallet finger (terminal tendon disruption). The goal of this study is to evaluate the potential of central slip tenotomy to restore DIP joint extension. METHODS: A mallet deformity was reproduced in 15 fresh-frozen cadaver fingers after the extensor tendon insertion was sectioned over the DIP joint. A suture anchor inserted at the terminal insertion was then secured to the extensor tendon over the middle phalanx to reconstruct the extensor mechanism. A 500-g weight attached to the proximal extensor tendon applied extensor tension. Central slip tenotomy was then performed. DIP extensor lags before and after tenotomy were recorded. RESULTS: After sectioning of the terminal tendon over the DIP joint the average amount of extensor tendon lag produced was 45 degrees. After central slip tenotomy was performed the average amount of extensor lag correction was 36 degrees (range, 30 degrees-46 degrees). CONCLUSIONS: Several clinical studies have shown that central slip tenotomy is an effective treatment for chronic mallet finger but may not fully restore DIP joint extension. Our data suggest that patients with a pre-existing extensor lag of greater than 36 degrees may not achieve full extension from central slip tenotomy, although extensor lags of up to 46 degrees may be corrected. 相似文献
16.
第二掌背动脉肌腱皮瓣的临床应用 总被引:7,自引:2,他引:5
目的 介绍第二掌背动脉肌腱皮瓣修复手指皮肤伴肌腱缺损的应用价值。方法 在解剖学研究的基础上 ,采用第二掌背动脉肌腱皮瓣修复手指皮肤伴肌腱缺损 11例。其中 ,伴屈肌腱缺损 3例 ,伸肌腱缺损 8例。皮瓣顺行移位 3例 ,逆行移位 4例 ,游离移植 4例。结果 10例肌腱皮瓣移植后完全成活 ,1例部分坏死 ,经换药后伤口愈合。 8例术后随访 12~ 5 7个月 ,3例失访。两点辨别觉 :手指背侧 8~11m m,指腹 5~ 7mm。手指伸屈功能均恢复至健侧的 60 %~ 70 %。结论 第二掌背动脉肌腱皮瓣是修复手指或手部小范围皮肤伴肌腱缺损的理想皮瓣。 相似文献
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Leiv M. Hove 《Acta orthopaedica》1994,65(2):199-203
18 consecutive cases of delayed rupture of the extensor pollicis iongus tendon were recorded during 5 years; 4 were spontaneous, and 14 after distal radius fracture, most of which were undisplaced or only slightly displaced. 15 cases were operated upon with tendon transfers: 13 had extensor indicis pro-prius transfer, 1 transfer of the extensor carpi radialis Iongus, and 1 reoperated with the extensor communis to the little finger as a motor unit. Subjectively, nearly complete satisfaction was reported; all patients were able to elevate the thumb to the level of the palm and full independent index finger movements were noted.
In this 5-year-period 4,400 patients with distal radius fractures were treated, giving an incidence of delayed tendon rupture after distal radius fracture of 0.3 percent 相似文献
In this 5-year-period 4,400 patients with distal radius fractures were treated, giving an incidence of delayed tendon rupture after distal radius fracture of 0.3 percent 相似文献
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M Ishizuki 《The Journal of hand surgery》1990,15(6):967-972
Extensor tendon dislocation is an unusual problem in patients unaffected by rheumatoid arthritis. Sixteen cases of ulnar dislocation of the long extensor tendon of the long finger are reported. Five of these cases were classified as traumatic dislocation and 11 as spontaneous dislocation. All cases were treated by surgery. Differences in anatomic and clinical features between traumatic and spontaneous dislocation of the long extensor tendon are described. 相似文献
20.
This study correlates the excursion of the extrinsic finger extensors in zones V, VI, and VII and the extensor pollicis longus tendon in zones T IV and T V ("T" is used to designate thumb zones) with joint motion. Excursion was estimated by review of the literature, biomechanic calculations, and intraoperative observations. A simple equation determines extrinsic extensor tendon excursion in zone V, VI, and VII. This equation is substantiated by Brand's work on radians and by intraoperative studies. Guidelines are suggested for controlled motion for extrinsic finger extensors and the extensor pollicis longus tendon on the basis of our 6 years experience of treating extensor tendon injury with early passive motion. 相似文献