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[拇指伸肌腱损伤]

[Extensor tendon injuries of the thumb].

作者信息

Lenz M, Spiegel C, Langer M, Hofmann G O

机构信息

Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.

Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48129, Münster, Deutschland.

出版信息

Unfallchirurg. 2021 Apr;124(4):287-293. doi: 10.1007/s00113-021-00982-z. Epub 2021 Mar 3.

Abstract

Extensor tendon injuries of the thumb include lesions of the tendons of the extensor pollicis longus, extensor pollicis brevis and abductor pollicis longus muscles. The latter is practically only affected in open injuries. Open injuries require a tendon reconstruction by suture followed by immobilization in the distal and an adequate aftercare depending on the zone of injury. In distal injuries static splinting is applied, whereas proximal injuries from T4 on require a dynamic after-treatment. Different courses of the tendon of the extensor pollicis brevis muscle exist distal to the metacarpophalangeal joint and must be considered. The rare ruptures of the extensor hood at the metacarpophalangeal joint provoke an ulnar displacement of the extensor pollicis longus or both extensor tendons with concomitant lack of active extension in the metacarpophalangeal and interphalangeal joints. This injury is often misdiagnosed as a rupture of the ulnar collateral ligament of the metacarpophalangeal joint. It should be treated by refixation of the ruptured structures. Closed chronic ruptures of the extensor pollicis longus tendon go along with a defect that requires a tendon transfer or a tendon autograft.

摘要

拇指伸肌腱损伤包括拇长伸肌、拇短伸肌和拇长展肌肌腱的损伤。后者实际上仅在开放性损伤中受到影响。开放性损伤需要通过缝合进行肌腱重建,随后进行远端固定,并根据损伤区域进行适当的后续护理。对于远端损伤,采用静态夹板固定,而从T4开始的近端损伤则需要进行动态后续治疗。在掌指关节远端,拇短伸肌肌腱存在不同走行,必须予以考虑。掌指关节处伸肌帽的罕见断裂会导致拇长伸肌或两根伸肌腱向尺侧移位,同时掌指关节和指间关节主动伸展功能丧失。这种损伤常被误诊为掌指关节尺侧副韧带断裂。应通过修复断裂结构进行治疗。拇长伸肌腱的闭合性慢性断裂伴有缺损,需要进行肌腱转移或自体肌腱移植。

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