Sukop A, Tichá P, Molitor M
Klinika plastické chirurgie 3. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha.
Acta Chir Orthop Traumatol Cech. 2018;85(5):370-372.
Injuries of the flexor finger apparatus are very common. Primarily, it is routinely treated by suture of the tendon. Isolated deep flexor injuries, when the flexion restriction only reaches the DIP joint, are sometimes overlooked by the surgeon or by the patients themselves, especially if the deep flexor is injured, after a closed rupture or cutaneous injury with a small skin wound. The patient is then sent to a department specializing in hand surgery after a few weeks. Subsequent shortening of the tendon apparatus makes flexor suture more difficult or sometimes even impossible. Many ways of suturing the tendons and subsequent treatment are described. The treatment results vary immensely. It depends on the mechanism of injury, injury zone, the suture suture technique used, time that has elapsed since primary treatment, surgeon experience and subsequent postoperative and rehabilitative care. One of them is reconstruction of the flexor apparatus by primary transplantation of an autologous tendon graft. Most commonly, the tendon graft is taken from the palmaris longusfrom the same hand. The tendon graft can subsitute the entire area of zones I and II. The tendon suture is made in the palm proximal to the A1 pulley outside the tendon sheath in the area where the muscular belly of thelumbricalis is located on the tendon of the deep flexor. The distal end is reinserted to the base of the distal phalanx. The primary use of the autologous tendon graft can be used in the reconstruction of obsolete deep-flexor injuries in Zone II, but also in primary treatments. This type of treatment has a number of advantages. Performing the reinforcement of the tendon at the base of the distal phalanxand the suture in the palm of the hand completely eliminates the complications caused by the tendon suture in zone II. There is no injury to the tendon sheath, or the need for intersection of the tendons. The transplanted tendon is smaller in diameter than the deep flexor, so it can also be used for older injuries when the tendon sheath is in partially missing. It removes painful palmar resistance by restoring the right position and a tension of tendon of lumbricalis and the tendon of the deep flexor. This type of reconstruction allows immediate active or semi-rehabilitation of the hand and fingers. Key words:tendon, injury, hand, transplantation, surgery, flexor, reconstruction, rupture, treatment.
屈指装置损伤非常常见。主要通过肌腱缝合进行常规治疗。孤立的指深屈肌损伤，当屈曲受限仅累及远侧指间关节时，有时会被外科医生或患者本人忽视，特别是在指深屈肌因闭合性断裂或伴有小皮肤伤口的皮肤损伤而受伤后。几周后患者才被送往手外科专科。随后肌腱装置的缩短会使屈肌腱缝合更加困难，有时甚至无法进行。文中描述了多种肌腱缝合及后续治疗方法。治疗结果差异极大。这取决于损伤机制、损伤区域、所采用的缝合技术、初次治疗后经过的时间、外科医生的经验以及后续的术后和康复护理。其中一种方法是通过自体肌腱移植进行屈指装置重建。最常用的是取自同手的掌长肌腱。肌腱移植可替代Ⅰ区和Ⅱ区的整个区域。肌腱缝合在掌部，于A1滑车近端、腱鞘外、指深屈肌腱上蚓状肌肌腹所在区域进行。远端重新附着于远节指骨基部。自体肌腱移植的主要用途可用于Ⅱ区陈旧性指深屈肌损伤的重建，也可用于初次治疗。这种治疗方法有许多优点。在远节指骨基部进行肌腱加强以及在手掌部进行缝合，完全消除了Ⅱ区肌腱缝合引起的并发症。不会损伤腱鞘，也无需肌腱交叉。移植的肌腱直径比指深屈肌小，因此也可用于肌腱部分缺失的陈旧性损伤。通过恢复蚓状肌肌腱和指深屈肌肌腱的正确位置和张力，消除了掌部的疼痛性阻力。这种重建方式可使手部和手指立即进行主动或半康复训练。关键词：肌腱、损伤、手、移植、手术、屈肌、重建、断裂、治疗
