Immediate Reconstruction of 4^(th) and 5^(th) Toe Extension Functions after Rupture of the Musculotendinous Junction of the Extensor Digitorum Longus Tendon by Transferring Distal Ruptured End to Proximal 2^(th) and 3^(rd) Extensor Digitorum Longus Tendon in End to Side Fashion-＂Case Report＂

立即性轉移撕脫斷裂的第四及第五身趾長肌肌腱遠端側縫合至第二、第三伸趾長肌肌腱來重建伸趾功能－病例報告

趙崧筌(Sung-Chuan Chao) ； 簡雄飛(Hsiung-Fei Chien) ； 湯月碧(Yueh-Bih Tang) ； 謝榮賢(Jung-Hsien Hsieh)

《臺灣整形外科醫學會雜誌》 23卷3期 (2014/09) Pp. 254-258

摘要

背景：手部肌腱的撕脫斷裂發生在肌肉肌腱相接處，無論是手指撕裂截肢或閉鎖性撕脫傷的機制，都是手外傷的棘手問題。若是屈肌肌腱的閉鎖性撕脫斷裂，常以重新附著縫合或肌腱轉移來治療。而伸肌肌腱的閉鎖性撕脫斷裂，則以肌腱轉移或側側端縫合。然而發生在下肢的伸趾長肌撕脫斷裂傷，所導致的垂趾畸形，並不常見。目的及目標：我們報告一個病例，應用立即性轉移撕脫斷裂的第四及第五伸趾長肌肌腱遠端側縫合至第二、第三伸趾長肌肌腱來重建伸趾功能。材料及方法：我們施以緊急清創及將斷裂的第四、第五伸趾長肌肌腱以魚口式肌腱編織縫合法（Pulvertaft weave fashion）纏繞在未受損的第二、第三伸趾長肌肌腱，同時令第四、第五趾伸直並以鋼絲（Kirschner-wires）固定近端及遠端趾間關節。肌腱轉移術後數月，經過幾次小範圍清創、負壓傷口照護及植皮，傷口癒合良好。固定鋼絲則在肌腱轉移術後三週移除。結果：伸趾長肌肌腱受損之第四、第五趾則恢復伸直功能，同時保留屈趾能力。並且不需要皮瓣手術來重建傷口及功能。雖然足背因植皮後疤痕攣縮較明顯，但病人對於功能恢復及傷口癒合程度感到相當滿意。結論：對於伸趾長肌肌腱在肌肉肌腱相接處撕脫斷裂的傷害，尤其是第五足趾缺少伸趾短肌的情況下，運用轉移撕脫斷裂的第四及第五伸趾長肌肌腱遠端側縫合至第二、第三伸趾長肌肌腱可重建伸趾功能。

並列摘要

Background: Tendon avulsion at the musculotendinous junction caused by digit avulsion amputation or closed injury is a challenging problem of hand trauma. For closed avulsion injuries, flexor tendons were preferentially treated with reattachment or transfer, while extensor tendons were reconstructed with transfer or side-to-side repair. However, extensor digitorum longus avulsion (EDL) at the musculotendinous junction leading to dropped toes is rare in lower extremity trauma. Aim and Objectives: We presented one case of a right foot dorsum avulsion injury and dropped toes with fourth and fifth EDL tendon ruptures at the musculotendinous junction. The patient regained toe extension functions after immediate transferring distal ruptured end to proximal 2^(nd) and 3^(rd) extensor digitorum longus tendon in end to side fashion. Materials and Methods: We performed emergent debridement with attaching severed 4^(th) EDL to 2^(nd) EDL and 5^(th) EDL to 3^(rd) EDL tendons in a Pulvertaft weave fashion. The distal and proximal interphalangeal joints of the 4^(th) and 5^(th) toes were fixed in extension by Kirschner-wires. After subsequent minor debridements, negative pressure wound therapy and skin grafting in the following months, the wound healed well. The Kirschner-wires were also removed 3 weeks after the emergent operation. Results: Both the extension function of the patient's 4^(th) and 5^(th) toes on the right foot recovered well while plantar flexion function of the 4^(th) and 5^(th) toes were also preserved. No flap surgery was needed for further reconstruction. Despite scar contraction of the skin grafting, the patient was very satisfied with the results of toes function recovery and wound resurfacing. Conclusion: We concluded that immediate transfer of distal ruptured end to proximal tendons in end to side fashion for EDL avulsion injury at the musculotendinous junction of the foot is straightforward and effective in restoring toe extension functions, especially for the 5^(th) toe injury.

並列關鍵字

dropped toes ； extensor digitorum longus/brevis ； foot avulsion injury ； tendon transfers ； tendon avulsion injury