Uzel K, Aydin F, Asfuroğlu Z M, Gümüşoğlu E, Eskandari M M
Medipol Mega University Hospital, Department of Orthopaedics and Traumatology, Division of Hand Surgery, Bağcılar/İstanbul, Turkey.
Gölköy State Hospital, Department of Orthopaedics and Traumatology, Ordu, Turkey.
Acta Chir Orthop Traumatol Cech. 2024;91(6):364-368. doi: 10.55095/ACHOT2024/039.
The aim of this study to evaluate the subjective and objective results of Extensor indicis proprius (EIP) to extensor pollicis longus (EPL) transfer with an emphasis on donor site morbidity.
17 patients (59% men, 41% women) who underwent EIP-EPL transfer were retrospectively analyzed. The mean age was 43 (9-64) years, and the mean follow-up was 72 (19-124) months. The extensor strengths were measured according to the Medical Research Council (MRC) scoring system. Nail tip-table surface distance (NTD) was measured to evaluate extension loss, and pulp-palm distance (PPD) to evaluate thumb flexion-adduction limitation. Grip and key pinch strengths were measured and corrected regarding the dominance and compared with those of the non-operated side. Quick Disability of Arm, Shoulder, and Hand (QDASH) and satisfaction scores of the patients were evaluated.
Donor site morbidity was detected in 6 patients (35%). The extension strength of the index finger was found to be significantly lower than the non-operative side (p<0.05). Thumb mean NTD and PPD values were 6.8 (0-50) and 2.9 (0-20) mm, respectively. The index finger mean NTD was 0.6 (0-10) mm. The grip strength was 86% (43%-100%) and the pinch strength was 82% (31-100%) of the expected strengths. Compared to the preoperative period, there was a significant decrease in the QDASH score (p <0.05). Postoperative QDASH scores of patients with donor site morbidity were significantly higher than those without (p <0.05).
Although patients are generally satisfied with the EIP-EPL transfer results, the permanent morbidity rate in the index finger is high. Therefore, alternatives other than EIP should be considered for transfer to EPL in individuals whose occupation requires complete and strong index finger extension.
extensor pollicis longus, neglected tendon laceration, extensor indicis proprius, tendon transfer, donor site morbidity.
本研究旨在评估示指固有伸肌（EIP）转位至拇长伸肌（EPL）的主观和客观结果，重点关注供区并发症。
对17例行EIP-EPL转位的患者（59%为男性，41%为女性）进行回顾性分析。平均年龄43（9 - 64）岁，平均随访72（19 - 124）个月。根据医学研究委员会（MRC）评分系统测量伸肌力量。测量指尖 - 桌面距离（NTD）以评估伸展丧失，测量指腹 - 手掌距离（PPD）以评估拇指屈曲 - 内收受限情况。测量握力和捏力，并根据优势手进行校正，与未手术侧进行比较。评估患者的手臂、肩部和手部快速残疾（QDASH）评分及满意度评分。
6例患者（35%）出现供区并发症。发现示指的伸展力量明显低于未手术侧（p<0.05）。拇指平均NTD和PPD值分别为6.8（0 - 50）mm和2.9（0 - 20）mm。示指平均NTD为0.6（0 - 10）mm。握力为预期力量的86%（43% - 100%），捏力为预期力量的82%（31 - 100%）。与术前相比，QDASH评分显著降低（p <0.05）。有供区并发症患者的术后QDASH评分显著高于无并发症患者（p <0.05）。
尽管患者总体上对EIP-EPL转位结果满意，但示指的永久性并发症发生率较高。因此，对于职业需要示指完全且有力伸展的个体，应考虑使用EIP以外的替代方法转位至EPL。
拇长伸肌；陈旧性肌腱撕裂；示指固有伸肌；肌腱转位；供区并发症
