Mastroianni Michael A, Leibman Matthew, Belsky Mark, Vitale Mark A, Ruchelsman David E
NewYork Presbyterian/Columbia University Irving Medical Center, New York, NY.
Newton-Wellsley Hospital, Hand Surgery PC, Newton, MA.
J Hand Surg Glob Online. 2022 Dec 7;5(2):133-139. doi: 10.1016/j.jhsg.2022.11.003. eCollection 2023 Mar.
Extensor carpi ulnaris (ECU) subsheath injuries result in ulnar-sided wrist pain and often present concurrently with intrinsic ECU pathology and ulnocarpal compartment injuries. There is a lack of surgical outcome data despite the variety of described ECU subsheath pathologies and reconstructive strategies.
We retrospectively reviewed our hand-center experience of 33 patients who prospectively underwent radially based extensor retinacular sling ECU subsheath reconstruction by 4 hand surgery-fellowship-trained surgeons between April 2010 and April 2021. Preoperative clinical and magnetic resonance imaging findings, along with intraoperative findings, were cataloged. Statistical analysis was conducted via a 2-tailed paired test.
The median age at the time of surgery was 44 years (range, 18-63 years). Twenty (60.6%) patients underwent reconstruction on their dominant wrist. The median time between symptom onset and surgery was 6.5 months (range, 4 days-16.1 years). Eight (18%) patients were collegiate-level or professional athletes. Ten (30.3%) patients had frank ECU snapping on the preoperative examination with no recurrence or apprehension on the postoperative examination. All 33 patients underwent a preoperative magnetic resonance imaging. Fifteen (45.4%) patients had intrinsic ECU tendinopathy, 19 (57.6%) patients had ECU tenosynovitis, 18 (54.5%) patients had triangular fibrocartilage complex tears, 20 (60.6%) patients had ulnocarpal synovitis, and 2 (6.1%) patients had lunotriquetral interosseous ligament tears. The mean postoperative pain on a visual analog scale was 0.39 ± 0.55. Grip strength, wrist flexion-extension, and pronosupination arcs ( < .05) showed excellent recovery after surgery. The mean time to unrestricted return to sports was 97.3 ± 19.7 days for the athletes in this study. There were no major complications.
Radially based extensor retinacular sling ECU subsheath reconstruction resulted in satisfactory improvements in range of motion and grip strength. Although the mean improvements in these parameters were statistically significant, the clinical significance of these postoperative improvements remains to be defined.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.
尺侧腕伸肌（ECU）腱鞘下损伤会导致尺侧腕部疼痛，且常与ECU本身病变及尺腕关节间隙损伤同时出现。尽管已描述了多种ECU腱鞘下病变及重建策略，但缺乏手术疗效数据。
我们回顾性分析了2010年4月至2021年4月间4名接受过手外科专科培训的外科医生对33例患者进行的基于桡侧的伸肌支持带悬吊ECU腱鞘下重建手术的手中心经验。记录术前临床和磁共振成像结果以及术中发现。通过双尾配对检验进行统计分析。
手术时的中位年龄为44岁（范围18 - 63岁）。20例（60.6%）患者在优势腕进行了重建。症状出现至手术的中位时间为6.5个月（范围4天 - 16.1年）。8例（18%）患者为大学水平或职业运动员。10例（30.3%）患者在术前检查时有明显的ECU弹响，术后检查无复发或弹响感。所有33例患者均进行了术前磁共振成像检查。15例（45.4%）患者有ECU本身肌腱病，19例（57.6%）患者有ECU腱鞘炎，18例（54.5%）患者有三角纤维软骨复合体撕裂，20例（60.6%）患者有尺腕滑膜炎，2例（6.1%）患者有月三角骨间韧带撕裂。术后视觉模拟量表的平均疼痛评分为0.39±0.55。握力、腕关节屈伸及旋前旋后弧度（P <.05）术后恢复良好。本研究中运动员 unrestricted恢复运动的平均时间为97.3±19.7天。无重大并发症。
基于桡侧的伸肌支持带悬吊ECU腱鞘下重建术在活动范围和握力方面取得了满意的改善。虽然这些参数的平均改善在统计学上具有显著意义，但这些术后改善的临床意义仍有待确定。
研究类型/证据水平：治疗性研究，IV级。
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