Arora Rohit, Lutz Martin, Gabl Markus, Pechlaner Sigurd
Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstrasse 35, Innsbruck, Austria.
Oper Orthop Traumatol. 2008 Mar;20(1):13-24. doi: 10.1007/s00064-008-1224-z.
Reconstruction of extensor functions after extensor tendon injuries of the hand.
Acute injuries of extensor mechanism with corresponding loss of function.
Complex injuries with loss of soft tissue. Limited possibility of extensor tendon reconstruction with combined injuries of the interphalangeal joints (in situations with irreparable joints: primary arthrodesis).
The treatment of extensor tendon injuries depends on the various levels of tendon laceration. Zones 1 and 2: in case of tendon disruption close to the base of the distal phalanx, refixation of tractus terminalis using a pull-out suture. In case of disruption more proximally, primary repair using mattress sutures. Temporary pinning of the distal interphalangeal joint in extension using a single transarticular Kirschner wire. Zone 3: mattress sutures of the tractus intermedius. Temporary pinning of the proximal interphalangeal joint in extension using a single transarticular Kirschner wire. Zone 4: reconstruction of the central slip and the lateral slip of extensor tendon using modified Becker sutures and mattress sutures. Temporary pinning of the proximal interphalangeal joint in extension using a single transarticular Kirschner wire. Zones 5 and 6: four-strand modified Becker sutures with additional epitendinous suture. Zones 7 and 8: core sutures using modified Kirchmayr techniques with additional epitendinous suture.
Zones 1-4: immobilization of the finger for 6 weeks with removal of the transarticular wire at 4 weeks. Zones 5-8: dynamic postoperative treatment in intrinsic-plus splint for 6 weeks.
It is postulated that dynamic postoperative treatment leads to improved functional outcome after extensor tendon injuries. While for zones 1-4 no better final clinical results are observed using the dynamic postoperative protocol, early protected motion for zones 5-8 is superior to static post operative treatment.
手部伸肌腱损伤后伸肌功能的重建。
伸肌机制急性损伤伴相应功能丧失。
伴有软组织缺失的复杂损伤。指间关节合并损伤时伸肌腱重建可能性有限（在关节无法修复的情况下：一期关节融合术）。
伸肌腱损伤的治疗取决于肌腱撕裂的不同水平。1区和2区：若肌腱在近节指骨基底附近断裂，采用抽出缝合法固定终末腱。若断裂位置更靠近近端，采用褥式缝合法进行一期修复。使用单根经关节克氏针将远侧指间关节临时固定于伸直位。3区：中间腱的褥式缝合。使用单根经关节克氏针将近侧指间关节临时固定于伸直位。4区：使用改良贝克尔缝合法和褥式缝合法重建伸肌腱的中央束和外侧束。使用单根经关节克氏针将近侧指间关节临时固定于伸直位。5区和6区：四股改良贝克尔缝合并加用腱周缝合。7区和8区：采用改良基希迈尔技术进行核心缝合并加用腱周缝合。
1 - 4区：手指固定6周，4周时取出经关节克氏针。5 - 8区：术后在内在肌加力夹板中进行动态治疗6周。
据推测，术后动态治疗可改善伸肌腱损伤后的功能结局。虽然对于1 - 4区，采用术后动态方案未观察到更好的最终临床结果，但5 - 8区的早期保护性活动优于术后静态治疗。
