Nguyen Jesse T, Nguyen Jenny L, Wheatley Michael J, Nguyen Tuan A
From the *Department of General Surgery, Mayo Clinic, Rochester, MN; †Department of Plastic Surgery, Grand Rapids Medical Education Partners/Michigan State University, Grand Rapids, MI; and ‡Division of Plastic Surgery, Portland Veteran Affairs Medical Center, Portland, OR.
Ann Plast Surg. 2015 Mar;74(3):300-3. doi: 10.1097/SAP.0b013e3182996ec4.
Closed traumatic rupture of the thenar muscles is an unusual and rare injury. Traumatic musculotendinous injuries in the hand and wrist occur primarily from penetrating trauma. Only 2 such cases were identified in medical literature. We report a case of closed traumatic rupture of the thenar muscles in an otherwise healthy 33-year-old female nurse who sustained a hyperabduction injury of her right thumb and wrist during a daily occupational routine, resulting in complete avulsion of the right abductor pollicis brevis and opponens pollicis from their origins. After declining initial surgical management, the patient subsequently returned 6 months later reporting continued pain, paresthesias, and thenar deformation, and requested surgical intervention. On examination, she continued to exhibit weakness of thumb abduction and mild weakness with opposition. She was again offered an open carpal tunnel release with exploration of the thenar eminence and possible tendon transfer, although she adamantly refused any tendon transfer. An open right carpal tunnel release was performed with exploration and direct muscle repair through a lateral thenar incision. Primary muscular reattachment was accomplished by suturing the abductor pollicis brevis and opponens pollicis to the flexor retinaculum and the trapezium. Functional results 15 months after surgery were satisfactory with improvements in abduction and opposition of the thumb and restoration of the thenar contour. The chosen surgical technique for repair resulted in good functional outcome, while avoiding the need for tendon transfer.
大鱼际肌闭合性创伤性断裂是一种不常见且罕见的损伤。手部和腕部的创伤性肌腱损伤主要由穿透性创伤引起。医学文献中仅发现2例此类病例。我们报告一例33岁健康女性护士大鱼际肌闭合性创伤性断裂的病例，该患者在日常工作中右手拇指和腕部遭受过度外展损伤，导致右手拇短展肌和拇对掌肌从起点处完全撕脱。在拒绝了最初的手术治疗后，患者6个月后复诊，称仍有持续疼痛、感觉异常和大鱼际变形，并要求进行手术干预。检查发现，她仍表现出拇指外展无力和对掌轻度无力。尽管她坚决拒绝任何肌腱转移手术，但我们再次建议她进行开放性腕管松解术，同时探查大鱼际并可能进行肌腱转移。通过外侧大鱼际切口进行了开放性右侧腕管松解术，并进行了探查和直接肌肉修复。通过将拇短展肌和拇对掌肌缝合到屈肌支持带和大多角骨上完成了一期肌肉重新附着。术后15个月的功能结果令人满意，拇指的外展和对掌功能得到改善，大鱼际轮廓恢复。所选择的手术修复技术取得了良好的功能效果，同时避免了肌腱转移的需要。
