- 期刊
Extensor Indicis Proprius Transfer for Extensor Pollicis Longus Tendon Rupture Following Distal Radius Fracture
伸食指肌肌腱轉位至伸拇指長肌－重建遠端橈骨骨折導致伸拇指長肌斷裂
摘要
背景：伸拇指長肌肌腱斷裂在遠端橈骨骨折是一個熟知的併發症，主要的機制有兩個：物理性的磨損，如：骨折處的不規則凸起或骨折固定器的突起；以及局部血液循環因解剖構造的改變而受損。以往以直接修補或是肌腱移植的方式重建的成效並不如預期可靠。本文以伸食指肌肌腱轉位重建在遠端橈骨骨折合併伸拇指長肌肌腱斷裂的病人，其成效可信且術後食指無明顯的功能缺損。目的及目標：以固有伸食指肌肌腱轉位重建在遠端橈骨骨折合併伸拇指長肌肌腱斷裂的病人，其供應指（食指）在術後的功能缺損極微。材料及方法：從2004年一月至2013年十二月，共有16個人接受了固有伸食指肌肌腱轉位手術，所有病人接藉由影像學診斷有遠端橈骨骨折且有不規則骨質生成或骨折固定器的突出。術後結果評估包括拇指的內收及外展手、拇指的抬升、指間關節的伸展落差、拇指開掌的長度和捏／握的肌肉強度都一一測量並與健側做比較。結果：十六個病人中有八位平均超過九個月的追蹤並測量功能的恢復，其中七位皆達良好的功能恢復，在日常生活的活動上皆可和正常側一樣的靈活使用，且供應指（食指）亦不受影響。結論：藉由固有伸食指肌肌腱轉位重建在遠端橈骨骨折合併伸拇指長肌肌腱斷裂的病人是一個可信且成效良好的方法，且術後並不會造成食指功能上明顯的缺損；其傷口小、住院期短，病人可以盡快恢復雙手的使用，唯須良好的復健來達到最佳的功能。
關鍵字
無資料並列摘要
Background: Rupture of the extensor pollicis longus (EPL) tendon after distal radius fracture is a well-known complication. Two mechanisms have been proposed in the literature: a mechanical irritation of the tendon caused by bony prominence or implant material and direct microcirculatory compromise of the poorly vascularized tendon. Attempts to restore the function of the thumb using tendon graft or tendon repair have been reported with unpredictable results. In this report, we performed extensor indicis proprius (EIP) tendon transfer for extensor pollicis longus tendon rupture in patients with distal radius fracture using two to three small incisions and showed reliable results without functional deficit of the donor finger. Aim and Objectives: To reconstruct the ruptured EPL tendon after distal radius fracture via EI tendon transfer can not only minimize the donor site morbidity but also offer a reliable method. Materials and Methods: Totally 16 patients were recruited in this study from January 2004 to December 2013. In all patients, distal radius fracture with fracture fragment, bony spur or prominent fixation devices were found in the imaging study. EPL tendon rupture was diagnosed and reconstruction was performed with EIP tendon transfer in all cases. The functional outcomes of thumb are evaluated by: range of motion of thumb abduction/adduction (angle between index and thumb), elevated angle between table and MCP joint of thumb; extension lag of IP joint of thumb; opposition distance of thumb tip to the little finger tip and comparing with non-operated hand. Each parameter was scored as zero, one, two, or three points. Results: Among the 16 patients, 8 were follow up postoperatively for longer than 6 months. The parameters for functional outcome of the thumb were monitored and the results of surgery were graded as good, fair, or poor according to the total scores of each parameter. A total score of 7 to 9 points was graded as good, 4 to 6 points as fair, 0 to 3 points as poor. Seven patients showed good results, and 1 patient had poor results. Conclusion: Restoring the EPL tendon function using tendon transfer with extensor indicis proprius tendon to extensor pollicis longus tendon is a simple and reliable method. No obvious functional deficit of the index finger was encountered. All patients were satisfied with the range of motion of thumb, compared to the normal side, but they were still dissatisfied with the muscle power of pinch and grip function. A complete post-operative rehabilitation program is essential to obtain satisfactory outcomes.