Hawi Nael, Razaeian Sam, Krettek Christian
Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Unfallchirurg. 2021 Dec;124(12):1024-1031. doi: 10.1007/s00113-021-01007-5. Epub 2021 May 22.
Transosseous reconstruction of the triceps tendon.
All tears of the triceps tendon that allow a tension-free reconstruction.
Retracted triceps tendon tears that do not allow a tension-free reconstruction after mobilization.
Two nonabsorbable sutures are threaded through two crossing transosseous canals. In addition, an anchor is placed directly in the footprint. Using the first nonabsorbable suture the tendon is sutured using the Krackow technique and subsequently shuttled transosseously distally and knotted there with its other part. Using the first suture pair of the anchor the tendon is sutured in a similar manner and knotted within the tendon. With the second pair pressure to the avulsion fragment can be increased by knotting it distally to the first knot. Alternatively, sutures of the suture anchor can be used with a Mason-Allen technique.
For the first 6 weeks a ROM brace is applied with gradual release of flexion. Free flexion after 6 weeks is allowed. Beginning of strengthening exercises after 12 weeks.
Authors have reported good results after surgical treatment of triceps tendon ruptures. Regardless of possible extension deficits described in the literature, in the case presented an excellent postoperative outcome with a free range of motion was achieved.
肱三头肌腱经骨重建。
所有可进行无张力重建的肱三头肌腱撕裂。
回缩性肱三头肌腱撕裂，经松解后仍无法进行无张力重建。
将两根不可吸收缝线穿过两条交叉的经骨隧道。此外，在肌腱附着点直接置入一枚锚钉。使用第一根不可吸收缝线，采用Krackow缝合法缝合肌腱，随后将缝线经骨向远侧穿梭并在远侧打结。使用锚钉的第一对缝线以类似方式缝合肌腱并在肌腱内打结。通过第二对缝线在第一结远侧打结，可增加对撕脱骨折块的压力。或者，可采用Mason-Allen缝合法使用缝线锚钉的缝线。
最初6周佩戴活动度支具，逐渐增加屈曲角度。6周后允许自由屈曲。12周后开始进行强化锻炼。
作者报道肱三头肌腱断裂手术治疗后效果良好。尽管文献中描述可能存在伸展受限，但在本病例中，术后获得了极佳的效果，活动范围正常。
