Department of Orthopedics and Traumatology, Hand and Upper Extremity Surgery Division, Ankara University Medical Faculty, Ankara-Türkiye.
Department of Orthopedics and Traumatology, Hand and Upper Extremity Surgery Division, Ankara City Hospital, Ankara - Türkiye.
Ulus Travma Acil Cerrahi Derg. 2023 Apr;29(4):530-537. doi: 10.14744/tjtes.2023.78622.
Patients with hand tendon injuries may present to the hand surgery clinic in the late stage after being examined in emergency departments. Even if an approximate idea has been obtained in physical examination of these patients, diagnostic imaging is usually requested for reconstructive approach, correct planning of surgical incisions and medicolegal reasons. The primary purpose of this study was to determine the overall accuracy of Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) in patients with late presentation of a tendon injury.
The surgical findings and imaging reports of 60 patients (32 females, 28 males) who underwent surgical exploration, late secondary tendon repair or reconstruction with a diagnosis of late-presenting tendon injury in our clinic were evaluated. Comparisons were made of 47 preoperative USG images (18-874 days) and 28 MRI (19-717 days) results for 39 extensor and 21 flexor tendon injuries. The imaging reports were interpreted as partial rupture, complete rupture, healed tendon and adhesion formation and these were compared with the surgical reports in terms of accuracy.
In extensor tendon injuries, the sensitivity and accuracy values were both 84% for USG and 44% and 47% for MRI, respec-tively. In flexor tendon injuries, the sensitivity and accuracy values were 100% for MRI and 50% and 53%, respectively, for USG. Of the 4 sensory nerve injuries, 4 were missed on USG and 1 on MRI. The results obtained with USG and MRI in the late-presenting patients in this study were lower than those reported in previous USG and MRI studies in the literature.
Scar formation with tendon healing causes a change in anatomy, which could prevent accurate evaluation. There-fore, it would be beneficial for surgeons to start evaluating their patients with easily accessible ultrasonography; thus, surgical morbid-ity should be reduced.
手部肌腱损伤患者在急诊科检查后可能会在晚期到手外科就诊。即使在对这些患者进行体格检查时已经获得了大致的认识，通常仍需要进行诊断影像学检查以确定重建方法、正确规划手术切口以及出于法医学原因。本研究的主要目的是确定超声（USG）和磁共振成像（MRI）在晚期出现肌腱损伤患者中的总体准确性。
对在我院就诊并接受手术探查、晚期二次肌腱修复或重建的 60 例（32 例女性，28 例男性）手部肌腱损伤患者的手术发现和影像学报告进行了评估。比较了 39 例伸肌腱和 21 例屈肌腱损伤的 47 例术前 USG 图像（18-874 天）和 28 例 MRI（19-717 天）结果。将影像学报告解读为部分撕裂、完全撕裂、愈合肌腱和粘连形成，并与手术报告进行比较，以评估准确性。
在伸肌腱损伤中，USG 的敏感性和准确性均为 84%，MRI 分别为 44%和 47%。在屈肌腱损伤中，MRI 的敏感性和准确性均为 100%，USG 分别为 50%和 53%。4 例感觉神经损伤中，USG 漏诊 4 例，MRI 漏诊 1 例。与文献中先前的 USG 和 MRI 研究相比，本研究中晚期患者的 USG 和 MRI 结果较低。
随着肌腱愈合的瘢痕形成，解剖结构发生改变，这可能会妨碍准确评估。因此，让外科医生开始使用易于获得的超声进行评估将是有益的，从而降低手术的发病率。
