Suganuma Seigo, Tada Kaoru, Takagawa Shingo, Yasutake Hidetoshi, Shimanuki Keito, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-higashi,Kanazawa, Ishikawa 920-8530, Japan.
Department of Orthopaedic Surgery, Kanazawa University Hospital, Kanazawa, Japan.
JPRAS Open. 2021 Mar 5;28:66-71. doi: 10.1016/j.jpra.2021.02.006. eCollection 2021 Jun.
Spontaneous attritional extensor tendon ruptures of the index finger due to carpal bone lesions are uncommon. Here, we report the case of a patient with a spontaneous rupture of the extensor indicis proprius (EIP) and index extensor digitorum communis (EDC2) tendons due to a previously symptomatic dorsal scaphoid osteophyte. A healthy 60-year-old man with right-hand dominance experienced mild pain over the dorsum of his left hand for no particular cause. He was a maker of tatami mats. Nine months later, he noted a sudden snap on the dorsum of his right hand while he was making tatami mats and he became unable to extend his index finger. Plain radiography revealed an osteophyte on the dorsal side of the scaphoid. Computed tomography revealed a bone fragment on the dorsal side between the scaphoid and lunate, which seemed to be derived from the scaphoid osteophyte. He underwent surgery 24 days after the incident. First, the fragment was excised; then tendon transfer was performed. EIP and EDC2 tendons were bundled using a side-to-side suture and connected to the middle extensor digitorum communis tendon using interlacing sutures. Histopathological findings of the resected bone were compatible with osteoarthritic change. Tatami mat making requires repeated radioulnar deviation, which could be a risk factor for scaphoid osteophytes. To our knowledge, the present case is the first to report extensor tendon rupture due to a scaphoid osteophyte in a healthy person. Although there is no consensus on the appropriate management of symptomatic scaphoid osteophytes, early intervention at the first sign of tenosynovitis might be necessary to prevent extensor tendon ruptures.
因腕骨病变导致的示指自发性磨损性伸肌腱断裂并不常见。在此，我们报告一例因先前有症状的舟骨背侧骨赘导致示指固有伸肌（EIP）和示指伸指总肌（EDC2）肌腱自发性断裂的病例。一名惯用右手的60岁健康男性无特殊原因出现左手背轻度疼痛。他是一名榻榻米编织工。九个月后，他在编织榻榻米时右手背突然发出啪的一声，随后示指无法伸直。X线平片显示舟骨背侧有骨赘。计算机断层扫描显示舟骨和月骨之间背侧有一骨块，似乎源自舟骨骨赘。事件发生24天后他接受了手术。首先切除骨块；然后进行肌腱转位。EIP和EDC2肌腱采用侧对侧缝合捆绑，并使用交织缝合与中指伸指总肌肌腱相连。切除骨的组织病理学检查结果与骨关节炎改变相符。编织榻榻米需要反复进行桡尺侧偏斜，这可能是舟骨骨赘形成的危险因素。据我们所知，本病例是首例报告健康人因舟骨骨赘导致伸肌腱断裂。尽管对于有症状的舟骨骨赘的恰当处理尚无共识，但在腱鞘炎的首个迹象出现时尽早干预可能是预防伸肌腱断裂所必需的。
