Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
Hand Surg Rehabil. 2021 Jun;40(3):314-318. doi: 10.1016/j.hansur.2020.12.018. Epub 2021 Mar 16.
Triple finger flexor tendon pulley injuries (A2-A3-A4) are generally reconstructed due to the considerable extent of bowstringing and resulting loss of range of motion (ROM). We present a series of 11 patients (12 cases) with triple pulley lesions. Six cases were diagnosed acutely (<2 weeks after injury), one subacutely (4 weeks), 3 late (>2 months) and 2 incidentally (asymptomatic). All patients but one were climbers. All acute and subacute patients were initially treated with two-pulley protection splint at the centre of the middle and proximal phalanx, proximal interphalangeal (PIP) joint extension splints for 2 months and had occupational therapy to prevent extension deficit. At 6 months' follow-up, the 6 patients with acutely and the 1 subacutely diagnosed injuries were back climbing at the same level. Almost no pain or restriction in daily activities remained; they had full flexion but a slight extension deficit (0-25°). Two of the three patients who were seen and diagnosed late had secondary pulley reconstruction because of persistent pain and increased extension deficit in the PIP joint. Both patients gained almost full range of motion without remaining pain. The third patient was asymptomatic with an extension deficit of 30°. Our case series suggests that early conservative treatment in acute and subacute triple pulley ruptures holds promise to decrease bowstringing, regain full flexion and return to pre-injury climbing level. Delayed diagnosis with delayed treatment is associated with less favorable results. Secondary pulley reconstruction of these chronic injuries yields good results even when performed months after the injury occurred.
三联指屈肌腱滑车损伤（A2-A3-A4）通常由于弓弦效应和由此导致的活动范围（ROM）丧失而进行重建。我们报告了一组 11 例（12 例）三联滑车损伤患者。6 例为急性损伤（伤后<2 周），1 例亚急性（4 周），3 例为慢性（>2 个月），2 例为偶然发现（无症状）。除 1 例患者外，所有患者均为攀岩者。所有急性和亚急性患者最初均在中指和近节指骨的中央、近节指间关节（PIP）伸展夹板上使用双滑车保护夹板治疗 2 个月，并接受职业治疗以预防伸展不足。在 6 个月的随访中，6 例急性损伤和 1 例亚急性损伤患者均能够恢复到受伤前的攀岩水平。几乎没有疼痛或日常活动受限；他们有完全的屈曲但存在轻微的伸展不足（0-25°）。3 例慢性损伤患者中，有 2 例因持续疼痛和 PIP 关节伸展不足而接受了二次滑车重建。这 2 例患者均获得了几乎完全的活动范围，没有残留疼痛。第 3 例患者无症状，但存在 30°的伸展不足。我们的病例系列表明，急性和亚急性三联滑车断裂的早期保守治疗有望减少弓弦效应，恢复完全屈曲，并恢复到受伤前的攀岩水平。延迟诊断和治疗与不太理想的结果相关。即使在受伤后数月进行，这些慢性损伤的二次滑车重建也能取得良好的效果。
