Krishnan Kartik G, Schackert Gabriele
Department of Neurological Surgery, Carl Gustav Carus University Hospital, Dresden, Germany.
J Hand Surg Am. 2008 Feb;33(2):223-31. doi: 10.1016/j.jhsa.2007.10.015.
We present the results of a modified tendon transfer for the restoration of wrist and finger extension in irreparable radial nerve lesions.
Restoration of wrist extension, finger extension, thumb extension, and thumb abduction was done in 29 patients (20 males and 9 females; age range: 10-58 years) with isolated, irreparable radial nerve palsy. We used a modified tendon transfer technique using the flexor digitorum superficialis (FDS) 3 (to extensor indicis proprius [EIP] and extensor pollicis longus [EPL]) and FDS 4 (to extensor digitorum communis 2-4 [EDC]) as donors for the reconstruction of selective finger and thumb extension (all patients) and pronator teres (PT) for wrist extension (25 patients). Thumb abduction was achieved by transferring the palmaris longus (PL) tendon to the abductor pollicis longus (APL) (all patients).
Results show that near-normal wrist extension was achieved in 22 of 25 patients with extension strength of M4+. In the other 3 patients, wrist extension strength did not exceed M3 (1 patient) or M4 (2 patients). Extension of long fingers with a completely extended wrist joint was achieved in 12 of 29 patients. In the remaining 17 patients, full-range finger extension was possible only with the wrist in neutral. The advantage of the selective tendon transfer (FDS 3 to EIP and EPL and FDS 4 to EDC 2-4) resulted in selective extension of the index finger and thumb, as well as other digits, in all patients. Thumb abduction and rotation was achieved in all.
Tendon transfers are indicated in longstanding, irreparable, isolated radial nerve lesions. Selective tendon transfer of FDS 3 to EIP and EPL and FDS 4 to EDC through the interosseous membrane results in reliable selective extension of these digits. The sacrifice of FDS 3 and 4 to reconstruct finger extension results in bowing of the donor digits.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
我们展示了一种改良肌腱转移术治疗不可修复性桡神经损伤以恢复腕关节和手指伸展功能的结果。
对29例（男20例，女9例；年龄范围：10 - 58岁）孤立性、不可修复性桡神经麻痹患者进行腕关节伸展、手指伸展、拇指伸展和拇指外展功能的恢复。我们采用改良肌腱转移技术，使用指浅屈肌（FDS）3（转移至示指固有伸肌[EIP]和拇长伸肌[EPL]）和FDS 4（转移至指总伸肌2 - 4[EDC]）作为供体来重建选择性手指和拇指伸展功能（所有患者），并使用旋前圆肌（PT）来恢复腕关节伸展功能（25例患者）。通过将掌长肌（PL）肌腱转移至拇长展肌（APL）来实现拇指外展功能（所有患者）。
结果显示，25例患者中有22例实现了接近正常的腕关节伸展，伸展力量为M4 + 。另外3例患者中，腕关节伸展力量未超过M3（1例患者）或M4（2例患者）。29例患者中有12例在腕关节完全伸展时实现了长手指伸展。其余17例患者仅在腕关节处于中立位时才能实现全范围手指伸展。选择性肌腱转移（FDS 3转移至EIP和EPL，FDS 4转移至EDC 2 - 4）的优势在于所有患者的示指、拇指以及其他手指均实现了选择性伸展。所有患者均实现了拇指外展和旋转。
肌腱转移术适用于长期、不可修复的孤立性桡神经损伤。通过骨间膜将FDS 3选择性转移至EIP和EPL以及FDS 4转移至EDC可实现这些手指可靠的选择性伸展。牺牲FDS 3和4来重建手指伸展功能会导致供体手指出现弓形畸形。
研究类型/证据水平：治疗性III级。
