From Niigata Hand Surgery Foundation, Niigata, Japan.
From Niigata Hand Surgery Foundation, Niigata, Japan.
J Orthop Sci. 2022 Sep;27(5):1032-1038. doi: 10.1016/j.jos.2021.06.012. Epub 2021 Jul 29.
Tendon rupture has been recognized as a complication of distal radius fracture (DRF); however, the clinical outcome of reconstructive surgery for this injury remains unclear. We examined prognostic factors for the outcomes of reconstructive surgery in patients with a tendon rupture after DRF.
This study was a retrospective review of a case series. Seventy-five consecutive patients were treated at our institution for tendon rupture after DRF. The cohort included 14 males and 61 females with a mean age of 67.7 years at the time of tendon reconstruction. Sixty-four and eighteen tendon ruptures occurred after non-operative management for DRF and palmar locking plate fixation, respectively. Seven ruptured tendons received a free tendon graft from the palmaris longus tendon, and the others underwent tendon transfers. All patients were managed postoperatively by our hand therapy unit according to a controlled active mobilization regime.
The mean follow-up period was 28 weeks (range: 12-80 weeks). Patients with extensor tendon ruptures were significantly younger than those with flexor tendon ruptures regardless of the initial DRF treatment. The mean percentage active range of motion of the injured digits relative to normal active motion (%AROM) at the final follow-up was 70% (range: 30-101%) in all patients. The %AROM after flexor tendon reconstruction for patients after non-operative management was significantly inferior to that of other patients. Multiple regression analysis revealed that aging and non-operative management of DRF are independent risk factors for poor %AROM.
This study confirmed that advanced age and non-operative management of DRF were prognostic factors for digital joint motion following surgical reconstruction for tendon rupture. Our results suggest that it may be difficult to achieve good clinical outcomes in elderly patients with tendon ruptures (particularly flexor tendon ruptures) following non-operative management of DRF.
肌腱断裂已被认为是桡骨远端骨折（DRF）的一种并发症；然而，这种损伤的重建手术后的临床结果仍不清楚。我们研究了 DRF 后肌腱断裂患者重建手术后结果的预后因素。
这是一项病例系列的回顾性研究。我们机构治疗了 75 例连续的 DRF 后肌腱断裂患者。该队列包括 14 名男性和 61 名女性，肌腱重建时的平均年龄为 67.7 岁。64 例和 18 例肌腱断裂分别发生在 DRF 的非手术治疗和掌侧锁定板固定后。7 根断裂的肌腱接受了来自掌长肌腱的游离肌腱移植物，其余的接受了肌腱转移。所有患者术后均由我们的手部治疗小组根据控制主动活动方案进行管理。
平均随访时间为 28 周（范围：12-80 周）。无论初始 DRF 治疗如何，伸肌腱断裂患者明显比屈肌腱断裂患者年轻。所有患者在最终随访时受伤手指相对于正常主动运动的主动活动范围百分比（%AROM）的平均值为 70%（范围：30-101%）。非手术治疗的 DRF 患者的屈肌腱重建后的 %AROM 明显低于其他患者。多因素回归分析显示，年龄增长和 DRF 的非手术治疗是术后手术重建后数字关节运动不良的独立危险因素。
本研究证实，年龄增长和 DRF 的非手术治疗是手术重建后肌腱断裂患者手指关节运动的预后因素。我们的结果表明，对于非手术治疗的 DRF 后肌腱断裂（特别是屈肌腱断裂）的老年患者，可能难以获得良好的临床结果。
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