Justan I, Dvořák Z, Kubek T, Hýža P, Stupka I, Veselý J
Klinika plastické a estetické chirurgie, Fakultní nemocnice u sv. Anny v Brně, Lékařská fakulta Masarykovy univerzity v Brně.
Acta Chir Orthop Traumatol Cech. 2012;79(4):367-9.
Two tendons, i.e., the extensor indicis proprius (EIP) and the extensor carpi radialis longus (ECRL), are commonly used to reconstruct the function of a ruptured extensor pollicis longus (EPL) tendon. We reviewed a group of patients with EPL ruptures treated by ECRL tendon transfer to the EPL tendon, which was the method of choice. The aim was to evaluate the results and to assess the effect of ECRL detachment on hand function.
Twenty patients were treated surgically for a subcutaneous rupture of the EPL tendon between 2003 and 2007. Each patient was examined at 2 years after surgery. The range of motion (ROM) of both the injured and the contralateral hand was recorded and evaluated with a modified Geldmacher scoring system; a response to the DASH questionnaire was obtained. The mean follow-up was 24 months (19-31 months).
For the ROM of the operated hand, the mean Total Active Motion (TAM) of 98.75 degrees (60-140, SD 22.74) was calculated. The mean extension lag at the interphalangeal (IP) joint was 5.42 degrees (0-25, SD 8.77) and the mean IP flexion was 65.8 degrees (40-80, SD 13.2). In order to evaluate body side differences, the ROM of the contralateral thumb was recorded. The values were as follows: mean TAM, 141.3 degrees (115-190, SD 20.43); mean IP extension lag, 0 degrees (0-0, SD 0); mean IP flexion, 68.8 degrees (50-80, SD 9.6).
The extension lag at the IP joint was detected in both the operated and the contralateral hands. The patients examined at a longer interval after surgery showed an increase in extension lag. This may have been caused by undesired adaptation of the donor muscle, the presence of adhesions or suture loosening.
The results showed increased adaptation of thumb motion to the extension lag at the IP joint, which had a mild effect on the patient's hand function. The difference in wrist extension between the operated and the contralateral hand corresponded to the pre-operative condition.
两条肌腱，即示指固有伸肌（EIP）和桡侧腕长伸肌（ECRL），常用于重建拇长伸肌（EPL）肌腱断裂后的功能。我们回顾了一组采用ECRL肌腱转位至EPL肌腱治疗EPL断裂的患者，这是首选的治疗方法。目的是评估治疗结果并评估ECRL离断对手部功能的影响。
2003年至2007年间，20例患者因EPL肌腱皮下断裂接受了手术治疗。每位患者在术后2年接受检查。记录并使用改良的盖尔德马赫评分系统评估患手和对侧手的活动范围（ROM）；获取患者对DASH问卷的回答。平均随访时间为24个月（19 - 31个月）。
患手的ROM方面，计算出平均总主动活动度（TAM）为98.75度（60 - 140度，标准差22.74）。指间关节（IP）的平均伸展滞后为5.42度（0 - 25度，标准差8.77），平均IP屈曲为65.8度（40 - 80度，标准差13.2）。为评估身体两侧差异，记录了对侧拇指的ROM。数值如下：平均TAM为141.3度（115 - 190度，标准差20.43）；平均IP伸展滞后为0度（0 - 0度，标准差0）；平均IP屈曲为68.8度（50 - 80度，标准差9.6）。
在患手和对侧手中均检测到IP关节的伸展滞后。术后间隔较长时间接受检查的患者，伸展滞后有所增加。这可能是由于供体肌肉的不良适应性、粘连的存在或缝线松动所致。
结果显示拇指运动对IP关节伸展滞后有增加的适应性，这对患者手部功能有轻微影响。患手和对侧手在腕关节伸展方面的差异与术前情况相符。
