腦中風患者偏癱側手指伸肌肌腱增粗

因手指伸肌肌腱增粗，導致中風患者偏癱側手腕背側腫脹之現象，至今尚無研究文獻提及。本文介紹11位因腦中風致單側偏癱之患者，主訴偏癱側手腕背側無痛之隆起，初步往往診斷為腱鞘囊腫，經軟組織超音波檢查後始確定為手指伸肌肌腱增粗。這些患者偏癱側上肢運動功能通常不佳，其Brunnstrom分期大多在第三期或以下。增粗之肌腱主要為第二、三、四指的伸肌肌腱，即屬於手腕背側第四伸肌隔間之肌腱。增粗最明顯之節段介於近列腕骨背側及掌骨中點背側之間，而厚度可達對側肌腱之3倍以上；肌腱周圍之腱鞘組織也往往增厚，使腫脹更形明顯。歸納初步經驗得知，此種肌腱增粗現象，最早可於中風後4週發生，而發病後兩個月至半年最明顯；其後肌腱之厚度逐漸減少，而追蹤最久之患者歷時已近一年半，其增粗之肌腱仍未完全復原。偏癱上肢手指伸肌肌腱增粗，雖未曾見載於醫學文獻，然實為極常見之臨床現象，需列為中風患者手腕及手掌背側腫脹之重要鑑別診斷。本文並對此現象形成之原因提出初步的假說。

關鍵字

手指伸肌肌腱增粗；腦中風；超音波檢查

並列摘要

Thickening of finger extensor tendons in hemiplegic hands of stroke patients has never been reported. We reported 11 patients with stroke who experienced gradual onset of a painless swelling at the dorsal aspect of the hemiplegic wrist. Soft tissue sonography revealed that the swellings were mainly composed of thickened finger extensor tendons. This thickening typically involved the tendons of the 4th dorsal extensor compartment between the proximal carpal and mid-metacarpal levels. The maximal thickness of these tendons could reach over three times that of the corresponding tendons of the contralateral hand. The synovial tissue surrounding the thickened tendon was also thicker than normal. Our preliminary data indicated that tendon thickening could become evident as early as 4 weeks post-stroke, and is usually most prominent from 2 to 6 months post-stroke. We concluded that thickening of finger extensor tendons of hemiplegic hands was a common clinical phenomenon in patients with stroke, and should be regarded as one of the major differential diagnoses of swelling at the dorsal aspects of the wrists and hands of these patients. This paper will discuss the possible causes of this phenomenon.

並列關鍵字

finger extensor tendon thickening ； stroke ； sonography

國際替代計量

腦中風患者偏癱側手指伸肌肌腱增粗

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