Langer Martin, Grünert Jörg, Ueberberg Johanna, Unglaub Frank, Spies Christian K, Oeckenpöhler Simon
Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48129, Münster, Deutschland.
Klinik für Plastische Chirurgie und Handchirurgie, Kantonsspital St. Gallen, St. Gallen, Schweiz.
Unfallchirurg. 2021 Apr;124(4):275-286. doi: 10.1007/s00113-021-00983-y. Epub 2021 Mar 16.
Due to the exposed situation of the extension side of the metacarpophalangeal joint when the fingers are bent, injuries in this region are not uncommon. The extensor apparatus lies directly below the skin and the various parts can be easily injured. Due to the complex anatomical structure, the different clinical appearances and the various forms of treatment, injuries of the extensor tendons in the region of the metacarpophalangeal joint must be examined in a very differentiated manner. The not uncommonly occurring deviation phenomenon makes all injuries in zone V suspicious and special attention must be paid to them. The alarming multitude of revision surgeries with tenolysis, arthrolysis and restoration of the balance of extensor tendons or centering show that these operations are much more demanding than the way they are appreciated in the literature and by many surgeons (beginner's operation). The article presents the surgical treatment with suture techniques and reconstruction possibilities as well as the aftercare, in addition to the special anatomy and diagnostics.
由于手指弯曲时掌指关节伸展侧处于暴露状态,该区域受伤并不罕见。伸肌装置直接位于皮肤下方,各个部分都容易受伤。由于解剖结构复杂、临床表现各异以及治疗方式多样,掌指关节区域的伸肌腱损伤必须进行非常细致的检查。常见的偏差现象使得V区的所有损伤都值得怀疑,必须予以特别关注。大量令人担忧的肌腱松解术、关节松解术以及伸肌腱平衡恢复或复位的翻修手术表明,这些手术比文献和许多外科医生(新手手术)所认为的要求更高。除了特殊的解剖结构和诊断方法外,本文还介绍了缝合技术的手术治疗、重建可能性以及术后护理。