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手部皮质类固醇注射后肌腱自发性断裂的肌腱修复临床效果:一项回顾性观察研究。

The clinical effect of tendon repair for tendon spontaneous rupture after corticosteroid injection in hands: A retrospective observational study.

作者信息

Lu Hui, Yang Hu, Shen Hui, Ye Ganmin, Lin Xiang-Jin

机构信息

Department of Hand Surgery Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou Departments of Orthopedics, Sanmen People's Hospital, Taizhou, Zhejiang Province, PR China.

出版信息

Medicine (Baltimore). 2016 Oct;95(41):e5145. doi: 10.1097/MD.0000000000005145.

Abstract

Corticosteroid injections for hand tendinitis can lead to a rare significant complication of tendon spontaneous rupture. However, only sporadic cases were reported in the literature before. This study was designed to gauge the clinical effect of tendon repair in patients of tendon spontaneous rupture after corticosteroid injection and analyze our experience.This was a retrospective observational study of 13 patients (8 women and 5 men) operated between July 2011 and December 2015 for tendon spontaneous rupture after corticosteroid injection. Demographic data, clinical features, imaging data, and surgical treatments were carefully reviewed.The average age was 52.308 ± 15.381 years (range 29-71). The average injection times were 2.538 ± 1.664 times (range 1-6). The average rupture time (after last injection) was 10.923 ± 9.500 weeks (range 3-32). Nine patients were treated by tendon suture (69% of cases), and 4 patients were treated by tendon grafting (31% of cases). All patients received follow-up in our outpatient clinic. The sites of the tendon rupture (15 tendons of 13 patients had involved) include extensor pollicis longus (6 tendons, 40% of cases), extensor digiti quinti and extensor digiti minimi (4 tendons, 27% of cases), ring finger of extensor digitorum communis (3 tendons, 20% of cases), and middle finger of extensor digitorum communis (2 tendons, 13% of cases). Two patients who had tendon adhesion (15% of cases) were treated by tendon release. One patient who had tendon rerupture (8% of cases) was treated by tendon grafting. No patient had complications of infections, vascular, or nerve injury.Tendon spontaneous rupture is a serious complication after corticosteroid injection for tendinitis. Rigid standard of corticosteroid injection is very important. Magnetic resonance imaging was contributory to preoperative assess tendon defect and can be used to monitor healing quality of tendons during the follow-up.

摘要

用于手部腱鞘炎的皮质类固醇注射可能导致肌腱自发性断裂这一罕见的严重并发症。然而,此前文献中仅报道过散发病例。本研究旨在评估皮质类固醇注射后肌腱自发性断裂患者的肌腱修复临床效果并分析我们的经验。

这是一项回顾性观察研究,对2011年7月至2015年12月间因皮质类固醇注射后肌腱自发性断裂而接受手术的13例患者(8名女性和5名男性)进行研究。仔细回顾了人口统计学数据、临床特征、影像学数据和手术治疗情况。

平均年龄为52.308±15.381岁(范围29 - 71岁)。平均注射次数为2.538±1.664次(范围1 - 6次)。平均断裂时间(最后一次注射后)为10.923±9.500周(范围3 - 32周)。9例患者接受肌腱缝合治疗(占病例的69%),4例患者接受肌腱移植治疗(占病例的31%)。所有患者均在我们的门诊接受随访。肌腱断裂部位(13例患者的15条肌腱受累)包括拇长伸肌(6条肌腱,占病例的40%)、小指伸肌和小指固有伸肌(4条肌腱,占病例的27%)、环指指总伸肌(3条肌腱,占病例的20%)以及中指指总伸肌(2条肌腱,占病例的13%)。2例发生肌腱粘连的患者(占病例的15%)接受了肌腱松解治疗。1例发生肌腱再次断裂的患者(占病例的8%)接受了肌腱移植治疗。无患者发生感染、血管或神经损伤并发症。

肌腱自发性断裂是皮质类固醇注射治疗腱鞘炎后的一种严重并发症。严格的皮质类固醇注射标准非常重要。磁共振成像有助于术前评估肌腱缺损情况,并可用于随访期间监测肌腱的愈合质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7b30/5072972/445c68319909/medi-95-e5145-g002.jpg

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