- 期刊
Early Rupture of the Flexor Pollicis Longus in A Case of Colles Fracture-＂Case Report and Literature Review＂
遠端橈骨骨折後屈拇長肌肌腱斷裂－病例報告及文獻回顧
摘要
背景：屈肌肌腱斷裂在遠端橈骨骨折是很罕見的併發症，造成屈肌肌腱斷裂的主要原因可能有骨折錯位造成早期的肌腱斷裂、碎骨造成的磨損晚期肌腱斷裂或是腹側鎖定鋼板固定位置不佳所造成的併發症。目的及目標：我們報告一位遠端橈骨骨折同時合併屈拇長肌肌腱斷裂的病患，並討論造成屈拇長肌斷裂的可能病生理機轉。材料及方法：一位41歲患有小兒麻痺並造成右側肢體萎縮的男性患者因跌倒造成左側遠端橈骨骨折，在外院接受外固定手術。三個月後他來到我們門診主訴在手術後他查覺無法彎曲左手大拇指，在身體檢查後懷疑為左側屈拇長肌斷裂而進行探查手術，術中發現屈拇長肌斷裂且兩側斷端約有9公分的間距，取掌長肌肌腱作肌腱移植手術。結果：在一年後的追蹤回診病人已能彎曲其左拇指指間關節超過40度，並已回歸正常工作，病人對手術結果滿意。結論：屈拇長肌肌腱斷裂在遠端橈骨骨折中是很罕見的併發症，卻會造成手部功能很大的影響，仔細的病史詢問與完整的身體檢查是診斷此一罕見併發症很關鍵的步驟。對於高度懷疑屈拇長肌斷裂的患者進行探查手術是有必要的，通常這類患者會需要進行肌腱移植或轉位手術。
關鍵字
無資料並列摘要
Background: Flexor tendon rupture following a Colles fracture is a rare complication, with only few cases reported since the initial report in 1932. The causes of tendon rupture are related to a severe displaced fracture, bone fragments abrading the tendon, or complications after volar locking-plate fixation. Aim and Objectives: We report a case of flexor pollicis longus (FPL) tendon rupture after Colles fracture, and discuss the pathophysiology of this rare complication. Materials and Methods: A 41-year-old man has lived with the history of poliomyelitis with the sequela of right limbs weakness. He suffered from left Colles fracture and underwent external fixation. He presented to our outpatient clinic 3 months later and complained that he could not flex his left thumb following the external fixation surgery. Examination showed loss of active flexion of the interphalangeal (IP) joint of his left thumb. He underwent exploratory surgery, and a left FPL rupture was identified and repaired by tendon grafting from the left palmaris longus. Results: The patient can flex the IP joint of his left thumb with a range of motion of about 0-40°, and remains satisfied with the surgical result at a 1-year follow up. Conclusion: FPL tendon rupture after Colles fracture is a rare complication, but affects hand function significantly. Careful history taking and physical examination are the keys to diagnosis, and surgical exploration is suggested if this complication is suspected. Tendon grafting or transfer is necessary for cases with a critical tendon defect.
延伸閱讀
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