Paniago Alexandre Firmino, Storti Thiago Medeiros, Faria Rafael Salomon Silva, Morais Dennys Carlos Aragão de, Souza Murillo Pablo de
Instituto do Ombro de Brasília, Brasília, DF, Brazil.
Clínica Videre, Brasília, DF, Brazil.
Rev Bras Ortop. 2015 Aug 29;50(5):596-600. doi: 10.1016/j.rboe.2015.08.010. eCollection 2015 Sep-Oct.
Tearing of the distal triceps is uncommon and may be difficult to diagnose, especially in situations of partial tearing. Imaging methods such as ultrasonography and magnetic resonance imaging should be used to confirm the diagnosis and define the extent of the injury. The preferred treatment for complete tearing of the triceps is surgical, unlike in cases of partial tearing, in which the treatment depends on factors such as pain, functional deficit and the patient's expectations. Here, we describe the case of a patient with partial tearing of the distal triceps after falling to the ground, which was not diagnosed at the time of first attendance and evolved with pain and great functional loss. The surgical procedure was performed nine months after the injury, with reconstruction of the triceps by means of reinforcement using the tendon of the ipsilateral semitendinosus and fixation in the olecranon using the double-row configuration. The patient remained immobilized using a sling for one week and then gains in passive range of motion (ROM) were introduced. Three weeks later, the patient was released for gains in active ROM. Muscle strengthening was started after 12 weeks. Six weeks after the surgical procedure, the patient was free from pain and presented complete ROM, grade V elbow extension force and hypertrophy of the triceps. The technique described here was shown to be useful for treating tears of the tendon of the distal triceps.
肱三头肌远端撕裂并不常见,可能难以诊断,尤其是在部分撕裂的情况下。应使用超声和磁共振成像等影像学方法来确诊并确定损伤程度。肱三头肌完全撕裂的首选治疗方法是手术治疗,这与部分撕裂的情况不同,部分撕裂的治疗取决于疼痛、功能缺陷和患者期望等因素。在此,我们描述了一名患者在摔倒后肱三头肌远端部分撕裂的病例,该病例在首次就诊时未被诊断出来,随后出现疼痛和严重功能丧失。受伤九个月后进行了手术,通过使用同侧半腱肌肌腱进行加强来重建肱三头肌,并采用双排结构固定在鹰嘴处。患者使用吊带固定一周,然后开始增加被动活动范围(ROM)。三周后,患者开始增加主动ROM。12周后开始进行肌肉强化训练。手术后六周,患者不再疼痛,ROM完全恢复,肘部伸展力为V级,肱三头肌肥大。这里描述的技术被证明对治疗肱三头肌远端肌腱撕裂有用。