Wang P T, Bonavita J A, DeLone F X, McClellan R M, Witham R S
Department of Plastic Surgery, Hospital of the University of Pennsylvania, USA.
Ann Plast Surg. 1999 Apr;42(4):403-7. doi: 10.1097/00000637-199904000-00009.
In contrast to routine flexor tendon injuries, flexor tendon ruptures following blunt injury or re-ruptures following repair can be difficult to diagnose. The authors investigated the efficacy of using ultrasound to assist in the diagnosis. From 1996 to 1997, 8 patients underwent evaluation of the flexor tendons using an ATL HDI-3000 ultrasound machine with a high-resolution, 5 to 9-MHz hockey stick linear probe. Dynamic evaluation was performed in real time, simulating clinical symptoms. Six patients underwent surgical exploration. Sonographic diagnosis and intraoperative findings were correlated. Ultrasound was used to diagnose 3 patients with ruptured flexor digitorum profundus tendons. Mechanisms of injury included forceful extension, penetrating injury, and delayed rupture 3 weeks after tendon repair. Subsequent surgical exploration confirmed the ruptures and location of the stumps. Five patients had intact flexor tendons by ultrasound after forceful extension, penetrating injury, phalangeal fracture, crush injury, and unknown etiology. In 3 patients who underwent surgery for tenolysis, scar release, or arthrodesis, the flexor tendons were found to be intact, as predicted by ultrasound. The authors found ultrasound to be accurate in diagnosing the integrity of flexor tendons and in localizing the ruptured ends. They conclude that ultrasound is helpful in evaluating equivocal flexor tendon injuries.
与常规的屈指肌腱损伤不同，钝性损伤后的屈指肌腱断裂或修复后的再断裂可能难以诊断。作者研究了使用超声辅助诊断的有效性。1996年至1997年，8例患者使用ATL HDI - 3000超声仪及5至9兆赫的高分辨率曲棍球棒线性探头对屈指肌腱进行评估。实时进行动态评估，模拟临床症状。6例患者接受了手术探查。将超声诊断结果与术中发现进行对比。超声诊断出3例指深屈肌腱断裂患者。损伤机制包括强力伸展、穿透伤以及肌腱修复后3周的延迟断裂。随后的手术探查证实了断裂情况及残端位置。5例患者在经历强力伸展、穿透伤、指骨骨折、挤压伤及病因不明后，超声显示屈指肌腱完整。在3例行肌腱松解术、瘢痕松解术或关节固定术的患者中，如超声所预测，屈指肌腱完好无损。作者发现超声在诊断屈指肌腱完整性及定位断裂端方面准确无误。他们得出结论，超声有助于评估不明确的屈指肌腱损伤。
