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。

Clinical evaluation of spontaneous rupture of the finger extensors

Objective]To investigate the etiology,pathological characteristic and therapeutic effect of spontaneous rupture of the finger extensors.Method]Twelve patients were included in this research group.Eight cases were diagnosed as spontaneous rupture of the extensor pollicis long(EPL) and were repaired by transfer of the extensor indicis proprius(EIP).Three cases were spontaneous double rupture of the the ring and small finger extensors.The distal stump of the ring finger extensor was woven into the middle finger extensor and the EIP was transferred to reconstruct the extensor digiti quinti.There was one case of spontaneous triple rupture of the the middle,ring finger and small finger extensors.Transplantation of frozen allogenic extensors was utilized.Result]The finger extensor rupture occurred after either rheumatic arthritis or distal radius fracture.The former pathological examination showed that the tenosynovitis and chronic inflammation of tendons accompanying with localized necrosis was dominant,while tendon fiber rupture played an important role in the latter.All patients achieved 100% of good results and no recurrent rupture occurred.Conclusion]The inflammation invasion or attrition in the fracture site was a patological basis to cause spontaneous rupture of finger extensors.The EPI transposition was a reliable option to reconstruct the EPL.It is suggested that allogenic tendon transplantation be applied in the case of multiple ruptures of the extensor tendons.