Pillukat T, Fuhrmann R, Windolf J, van Schoonhoven J
Klinik für Handchirurgie Bad Neustadt an der Saale, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland.
Klinik für Fußchirurgie Bad Neustadt an der Saale, Bad Neustadt an der Saale, Deutschland.
Orthopade. 2015 Oct;44(10):767-76. doi: 10.1007/s00132-015-3157-1.
Properly gliding flexor tendons is mandatory for the normal functioning of the finger and thumb. Any damage to tendons, tendon sheath or adjacent tissue can lead to the formation of adhesions that inhibit the normal gliding function. If adhesions limit the digital function and adequate hand therapy does not provide further progress, then surgical intervention should be considered.
The authors' strategy and treatment algorithm for flexor tenolysis are presented in the context of the current literature.
There is no absolute indication for flexor tenolysis. The decision should be made in a motivated patient who has access to adequate postoperative hand therapy. It should be based on healed fractures and osteotomies, mature soft tissue coverage, intact tendons and gliding tissues, and a full range of passive flexion, and preferably extension of the affected joints. The principle of flexor tenolysis is the consequent resection of all adhesive tissue around the tendon inside and outside the tendon sheath, with preservation of as many pulley sections as possible. Therefore, extensive approaches are frequently necessary. Arthrolysis and the resolution of unfavorable scars, the resection of scarred lumbricals, and pulley reconstruction are additional procedures that are frequently performed.
In the literature, improvement in the range of motion is between 59 and 84 %. Good and excellent functional results are reported in 60-80 % of the cases. Nevertheless, in selected cases, functional deterioration occurs. Flexor tendon ruptures after tenolysis were observed in 0-8 % of the patients.
With regard to complications such as secondary tendon ruptures, loss of pulleys, and scar formation, flexor tenolysis is part of a reconstructive ladder that includes further procedures. In the case of failure or complications, salvage procedures such as arthrodesis, amputation, and ray resection or staged flexor tendon reconstruction including tendon grafting are recommended. After successful flexor tenolysis long-term hand therapy for at least 3-6 months is mandatory to maintain the intraoperative gain of function.
手指和拇指的正常功能需要屈指肌腱正常滑动。肌腱、腱鞘或相邻组织的任何损伤都可能导致粘连形成，从而抑制正常的滑动功能。如果粘连限制了手指功能，且充分的手部治疗没有进一步改善，那么应考虑手术干预。
在当前文献背景下介绍作者的屈指肌腱松解术策略和治疗方案。
屈指肌腱松解术没有绝对的指征。应在有积极性且能接受充分术后手部治疗的患者中做出决定。该决定应基于骨折和截骨已愈合、软组织覆盖成熟、肌腱和滑动组织完整、患指关节被动屈曲范围正常且最好能被动伸直。屈指肌腱松解术的原则是彻底切除腱鞘内外肌腱周围的所有粘连组织，同时尽可能保留多个滑车节段。因此，通常需要广泛的手术入路。关节松解和不良瘢痕的处理、瘢痕化蚓状肌的切除以及滑车重建是经常进行的附加手术。
文献报道，活动度改善率在59%至84%之间。60% - 80%的病例报告了良好和优秀的功能结果。然而，在某些病例中，功能会恶化。屈指肌腱松解术后屈指肌腱断裂的发生率在0%至8%之间。
关于继发性肌腱断裂、滑车丧失和瘢痕形成等并发症，屈指肌腱松解术是重建阶梯的一部分，该阶梯还包括进一步的手术。在手术失败或出现并发症的情况下，建议采用补救手术，如关节融合术、截肢术、指骨切除或分期屈指肌腱重建术，包括肌腱移植。屈指肌腱松解术成功后，必须进行至少3至6个月的长期手部治疗，以维持术中获得的功能改善。
