Kim Young Jun, Baek Jong Hun, Park Jin Sung, Lee Jae Hoon
Ann Plast Surg. 2018 Mar;80(3):238-241. doi: 10.1097/SAP.0000000000001240.
We report the results of interposition tendon grafts using the ipsilateral palmaris longus tendon in 12 patients with closed flexor digitorum profundus tendon ruptures in zone III or IV of 14 digits between June 2006 and October 2015. Before surgery, 2 patients were diagnosed with closed tendon ruptures that occurred after nonunion of hamate hook fractures. The other 10 patients were diagnosed with spontaneous tendon ruptures of unknown cause. In 2 of the 10 patients with spontaneous tendon rupture, the cause of the rupture was not found. In the other 8 patients, there was rough surface with deficient overlying soft tissue on the radial side of the hamate hook. In all cases, the ruptured flexor digitorum profundus was reconstructed by applying overtension on the tendon graft, causing greater flexion than for the other normal digits. Hamate hook excision was also performed on 10 subjects with abnormalities. Postoperatively, the patients were followed for an average of 22.5 months (range, 12-64 months). At the final follow-up, the mean Disabilities of the Arm, Shoulder, and Hand questionnaire score was 5.7 (range, 3.3-8.3). There were excellent results in all 14 digits according to Strickland and Glogovac criteria. The mean total active motion was 167 degrees (range, 160-180 degrees). There were no surgical complications, including infection, adhesions, or tendon rerupture. There were excellent clinical results with the interposition tendon graft using palmaris longus for closed tendon rupture in zone III or IV of the hand. Applying overtension to the grafted tendon appears to be beneficial.
我们报告了2006年6月至2015年10月期间，12例14指手部Ⅲ区或Ⅳ区闭合性指深屈肌腱断裂患者采用同侧掌长肌腱进行肌腱移植的结果。术前，2例患者被诊断为钩骨钩骨折不愈合后发生的闭合性肌腱断裂。另外10例患者被诊断为原因不明的自发性肌腱断裂。在10例自发性肌腱断裂患者中，有2例未发现断裂原因。在另外8例患者中，钩骨钩桡侧表面粗糙，覆盖软组织不足。在所有病例中，通过对肌腱移植施加过度张力来重建断裂的指深屈肌腱，使其比其他正常手指产生更大的屈曲。10例有异常的患者还进行了钩骨钩切除术。术后，患者平均随访22.5个月（范围12 - 64个月）。在最后一次随访时，手臂、肩部和手部功能障碍问卷平均评分为5.7（范围3.3 - 8.3）。根据Strickland和Glogovac标准，所有14指均获得了优异的结果。平均总主动活动度为167度（范围160 - 180度）。没有手术并发症，包括感染、粘连或肌腱再次断裂。对于手部Ⅲ区或Ⅳ区的闭合性肌腱断裂，采用掌长肌腱进行肌腱移植取得了优异的临床效果。对移植肌腱施加过度张力似乎是有益的。
