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插秧致中環指伸肌腱自發性斷裂修復后早期療效

【摘 要】 目的 總結肌腱移植修復插秧致中、環指伸肌腱自發性斷裂的早期療效。 方法 2006 年4 月－ 2009年4 月，采用肌腱移植修復21 例（28 指）插秧后發生中、環指伸肌腱自發性斷裂。男5 例，女16 例；年齡35 ～ 44 歲，平均42 歲。均因單側中指和（或）環指不能伸直2 ～ 19 d 就診，平均5.3 d。其中中指9 例，環指5 例，中、環指7 例。 結果 術后患者切口均Ⅰ期愈合。除1 例2 指肌腱粘連嚴重影響關節功能外，其余患者經積極鍛煉，關節功能均恢復良好。20 例患者27 指獲6 個月隨訪，1 例1 指失訪。術后6 個月隨訪，采用總主動活動度（TAM）系統評定手指功能：獲優12 指，良13 指，可2 指，優良率達92.6%。 結論 采取肌腱移植修復中、環指伸肌腱自發性斷裂，術后手指關節功能恢復較好。

TRANSFER OF EXTENSOR INDICIS PROPRIUS TENDON IN THE TREATMENT OF TRAUMATIC OR SPONTANEOUS RUPTURE OF TEXENSOR POLLICIS LONGUS TENDON

In this article it was reported that there were 14 patients sufferingfrom traumatic or spontaneous rupt-ure of tendon of extensor pollicislongus at the level of the 3rd comp-artment of the dorsal aspect of thewrist where repair by direct suturecould not be used of the Listertubercle which might cause adhesionand re-rupture of the repaired tendon.It was proposed that this tendonrupture could be repaired by transferof extensor indicis proprius tendon.Of the 14 cases, 10 of them werefollowed with on average of 4.5 tears. The range of flexion and extension of the thumb all returned to normal with little disturbance of the motion of the index finger.

DYNAMIA CORRECTION OF HALLUX VALGUS DEFORMITY WITH MUSCULUS EXTENSOR HALLUCIS LONGUS SHIFTING

Objective To discuss the mechanisms and clinical effect of musculus extensor hallucis longus shifting in correcting hallux valgus (HV) deformity. Methods From April 2004 to December 2006,25 cases of HV (38 feet) were treated by musculus extensor hallucis longus shifing. There were 2 men and 23 women, aging from 22-60 years (mean 46.3 years).HV angle was 21.45° (mean 31.30°), intermetatarsal(IM) angle was 7-21° (mean 12.52°). The HV were corrected by cutting osteophyma of the first metatarsal bone, cutting transverse head of adductor pollicis, transferring musculus extensor hallucis longus and reconstructing its insertion. Results The patients were followed up 6-14 months after operation. HV angle and IM angle were 7.30°±2.62° and 6.50°±2.46° respectively, showing significantdifferences when compared with before operation (Plt;0.05). According to the American Orthopaedic Foot amp; Ankle Society (AOFAS) score system, the foot function was excellent in 25 feet, good in 7 feet and poor in 6 feet,and the excellent and good rate was 84.2%. Hallux varus occurred in 2 feet after 2 months of operation, metatarsophalangeal joint limitation of motion in 2feet after 3 months of operation, no HV recurred. ConclusionThe HV deforemity can be corrected by shifting the musculus extensor hallucis longus and reconstructing its insertion. It makes stress of metatarsophalangeal joint balance and prevent recurrance of HV deformity.

PERPENDICULAR PIN TRANSFIXION IN THE TREATMENT OF MALLET FINGERS

Since 1989, 17 cases ( 18 fingers) of mallet finger underwent surgical repair of the extensor tendons of the fingers combined with postoperative perpendicular pin transfixion. The follow-up was through 3 to 8 months. The results were 13 satisfactory, 4 improved and one failure. The method of pin transfixion was introduced in detail, and the classification of mallet fingers and the principles of treatment were discussed in detail, and the classification of mallet fingers and the principles of treatment were discussed.

ANTEROLATERAL THIGH FLAP FOR REPAIR OF TOE EXTENSOR TENDON AND DORSAL FOOT WOUND

Objective To summarize the method and the cl inical outcome of repairing both toe extensor tendon and dorsal foot wounds with anterolateral thigh flap. Methods Between February 2007 and May 2009, 11 patients with toe extensor tendon and dorsal foot defect were treated with anterolateral thigh flap. There were 8 males and 3 females with a medianage of 45 years (range, 10-60 years). The causes of injury were sharp injury in 3 cases, machine crush injury in 3 cases, and traffic accident injury in 5 cases, including 7 cases of fresh wounds with a disease duration of 2-8 hours and 4 cases of old wounds with a disease duration of 3-15 days. The size of wound ranged from 6 cm × 5 cm to 25 cm × 15 cm. All cases compl icated by toe extensor tendon defect, which were located at the 2nd-5th toes in 1 case, 3rd-5th toes in 1 case, 2nd-4th toes in 2 cases, 2nd and 3rd toes in 3 cases, 1st and 2nd toes in 1 case, and 1st toe in 3 cases. In the first stage, the anterolateral thigh flap ranged from 8 cm × 7 cm to 27 cm × 15 cm was used to repair defect and fascia lata was used to bridge two ends of digitorum longus tendon; the donor site was sutured or repaired with the skin graft. The second stage was performed after 2-3 months, tenolysis for tendon was performed, and fascia lata was spl it into tendon-l ike shape; and the toe functional exercises were done. Results All flaps survived completely after the first stage, wounds healed by first intention; the donor skin graft survived and incisions healed by first intention. At 7 days after the second stage, marginal necrosis occurred in 3 flaps (0.5-2.0 cm in width), and healed after 15-20 days of dressing change; the other flaps survived, and incisions healed by first intention. Eight patients were followed up 12-18 months (mean, 15 months). Excepts 4 sl ight bulky flaps, the other flaps had satisfactory appearance and soft texture with two points discrimination of 1-3 cm. During the follow-up, part of the dorsiflexion function recovered in 5 patients (5-40°), andflexion function was normal; 3 dorsiflexion function disappeared without effect on the function of toe flexion, and the patients could walk normally. No toe ptosis occurred. Conclusion Appl ication of the anterolateral thigh flap can repair toe extensor tendon and dorsal foot wounds with short treatment time and less damage at the donor site, so it can avoid toe ptosis after surgery and achieve excellent cl inical results.

THE EFFECT OF REPAIR OF PARATENDON IN TENDON HEALING

In order to investigate the effect of repair of paratendon in tendon healing, two different ways were performed to repair the transected extensor tendons of chick’s toe. End to end suture of the extensor tenon was performed in group 1 while the paratendon was also repaired simultaneously in addition to suture of the tendon in group 2. Gross observation and histological examination were undertaken in the 3rd and 6th week after operation. The result showed, in group 1, extensive adhesion and irregular proliferation of fibroblasts was found in the 3rd week, severe adhesion and irregular arrangement of fibroblasts with less collagen fiber was found in the 6th week; while in group 2, smooth and regular "fusiform structure" was formed, slight adhesion and regular proliferation of fibroblasts were found in the 3rd week, adhesion disappeared and the structure of paratendon and tondon recovered in the 6th week. It was concluded that repair of extensor tendon and paratendon simultaneously could promote the intrinsic tendon healing and prevent tendon adhesion.

帶食指固有伸肌腱皮瓣的臨床應用

EVALUATION OF RECONSTRUCTION OF EXTENSOR POLLICIS FUNCTION BY TRANSFER OF EXTENSOR INDICIS

Objective To assess the long-time results of reconstruction of the extensor pollicis longus (EPL) function by transfer of the extensorindicis(EI). Methods From August 1978 to March 2003, 46 cases of loss of the EPL function were treatedby transfer of the extensor indicis. Of 46 cases, there were 32 males and 14 females, aged 16-51 years with an average of 36 years; there were 24 cases of oldtraumatic rupture and 22 cases of secondary rupture. The disease course was 2 days to 5 months, averaged 74 days. A specific EIEPL evaluation method (SEEM) wasused to measure the EPL function after transfer.Results Fortyone cases were followed up 9 years and 3 months on average (7 months to 23 years). Based on the SEEM, the results were excellent and good in 39 of 41 patients. The elevation deficit and combined flexion deficit were 0-2.2 cm (1.8 cm on average) and 0-3 cm (1.6 cm on average); the independent extension deficit was 0°-8° (5° on average). Conclusion Restoration of the extensor pollicis function by transfer of the extensor indicis is an effective and safe treatment option and the SEEM is a valid method for assessing EPL function.

EFFECTIVENESS OF MODIFIED EXTENSOR INDICIS PROPRIUS TENDON TRANSFER FOR RECONSTRUCTION OF SPONTANEOUSLY RUPTURED EXTENSOR POLLICIS LONGUS TENDON

ObjectiveTo investigate the effectiveness of modified extensor indicis proprius (EIP) tendon transfer for reconstruction of spontaneously ruptured extensor pollicis longus (EPL) tendon by comparing with the traditional EIP tendon transfer. MethodsBetween January 2009 and December 2011, 11 cases of spontaneously ruptured EPL tendon were treated by modified EIP tendon transfer to reconstruct extension function (modified group). On the base of traditional procedure, the proximal end of EPL tendon was sutured with EIP tendon and the distal end of EIP tendon was crossed round extensor pollicis brevis (EPB) tendon and sutured back with EPL tendon. A specific EI-EPL evaluation method (SEEM) was used to measure the EPL tendon function after transfer. The result was compared with that of the other 18 cases undergoing traditional operation (traditional group). There was no significant difference in gender, age, disease duration, and injury causes between 2 groups (P gt; 0.05). ResultsAll incisions healed by first intention. In traditional group, 5 cases were out of follow-up, and the other 24 cases were followed up 1 year and 6 months on average (range, 8 months-2 years and 6 months). At the last follow-up, according to the evaluation of SEEM, the thumb elevation and flexion deficits of modified group were significantly less than those of traditional group (P lt; 0.05). The independent elevation deficit of the index finger of modified group was similar to that of traditional group (P gt; 0.05). The effectiveness was excellent in 9 cases and good in 2 cases with an excellent and good rate of 100% in modified group, and was excellent in 5 cases, good in 6 cases, and fair in 2 cases with an excellent and good rate of 84.6%. The effectiveness of modified group was significantly better than that of traditional group (χ2=0.03, P=0.03). ConclusionReconstruction of EPL tendon function by modified EIP tendon transfer is effective and easy. It can increase strength of the transferred tendon and obtain satisfactory results, but the long-term effectiveness needs further follow-up.

先天性伸肌腱中央束發育不全八例治療體會

目的總結先天性伸肌腱中央束發育不全的診斷要點及手術療效。方法2006 年 1 月—2017 年 1 月，收治 8 例（11 指）先天性伸肌腱中央束發育不全患兒。男 7 例，女 1 例；年齡 10 個月～4 歲，平均 24.5 個月。單側中指 2 例、環指 5 例，雙側中、環指 1 例。手指發育均正常，患指主動屈曲正常，主動伸直至 0° 位欠缺 20～50°，平均 37.5°。2 例（2 指）行伸肌腱部分切除緊縮術，6 例（9 指）行倒 Y-V 肌腱成形術。結果術后切口均Ⅰ期愈合，無感染、皮膚壞死及肌腱外露等并發癥發生。6 例（9 指）獲隨訪，隨訪時間 9 個月～8 年，平均 4.3 年。屈指畸形均糾正，手指主動伸直功能基本恢復正常，主動屈曲功能正常。末次隨訪時，參照中華醫學會手外科學會上肢部分功能評定試用標準：獲優 5 例（8 指）、良 1 例（1 指）。結論先天性伸肌腱中央束發育不全通過查體結合彩超檢查可明確診斷，手術治療效果確切。