Wang Guozhong, Lu Chao, Qu Zhigang, Zhang Yuejuan, Bi Benjun, Gao Fei, Zhang Zhao, Pan Yuehai, Zhu Enxia, Huang Heng
Department of Hand and Foot Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P. R. China.
Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Mar 15;39(3):278-283. doi: 10.7507/1002-1892.202412036.
To investigate the effectiveness of free palmaris longus tendon graft reconstruction in the treatment of gouty tophus erosion lesions in flexor tendon of wrist and hand.
A retrospective analysis was conducted on 8 patients with gouty tophus erosion lesions in flexor tendon of wrist and hand who underwent free palmaris longus tendon graft reconstruction between June 2017 and December 2023. All patients were male, aged 22-65 years, with an average of 45.9 years. The duration of gout history ranged from 2 to 18 years, with an average of 8.8 years. The duration from the discovery of gouty tophus to operation ranged from 12 to 26 months, with an average of 17.6 months. The gouty tophus eroded the flexor pollicis longus tendon in 4 cases, with Verdan flexor tendon zones being Ⅰ-Ⅱ in 1 case and Ⅳ-Ⅴ in 3 cases. The flexor digitorum profundus tendons were affected in 2 cases for the index finger, 1 for the middle finger, and 1 for the ring finger, all located in zone Ⅳ-Ⅴ. The long axis of the gouty tophus ranged from 2.3 to 4.5 cm, with an average of 3.4 cm. All 8 patients presented with limited finger flexion and extension. Among them, 4 cases were accompanied by median nerve compression symptoms, and 1 case had associated bone and joint destruction in the hand. The total active motion (TAM) of the affected finger was (81.3±30.2)° before operation according to the hand function evaluation criteria for tendon repair by the Chinese Society of Hand Surgery of the Chinese Medical Association, and the functional evaluation was poor. The harvested palmaris longus tendon intraoperatively was 7-9 cm in length.
Surgical incisions in all 8 patients healed by first intention, with no infections, graft non-union, or significant adhesion complications. All patients were followed up 8-25 months, with an average of 14.8 months. Numbness symptoms resolved in all 4 patients who presented with median nerve compression symptoms. Patients did not experience wrist pain or other discomfort, and function was not compromised. At last follow-up, according to the hand function evaluation criteria for tendon repair by the Chinese Society of Hand Surgery of the Chinese Medical Association, the TAM of 8 patients was (197.5±55.8)°, which significantly improved when compared with that before operation ( =11.638, <0.001); the hand function of 1 patient with gouty tophus in zone Ⅰ-Ⅱ flexor pollicis longus tendon was good, and the other 7 patients were excellent.
Free palmaris longus tendon graft reconstruction demonstrates good effectiveness in treating gouty tophus erosion lesions in flexor tendon of wrist and hand.
探讨游离掌长肌腱移植重建术治疗腕手部屈指肌腱痛风石侵蚀性病变的疗效。
回顾性分析2017年6月至2023年12月期间接受游离掌长肌腱移植重建术治疗的8例腕手部屈指肌腱痛风石侵蚀性病变患者。所有患者均为男性，年龄22 - 65岁，平均45.9岁。痛风病史2 - 18年，平均8.8年。从发现痛风石至手术时间为12 - 26个月，平均17.6个月。4例痛风石侵蚀拇长屈肌腱，其中Verdan屈肌腱分区Ⅰ - Ⅱ区1例，Ⅳ - Ⅴ区3例。示指屈指深肌腱受累2例，中指1例，环指1例，均位于Ⅳ - Ⅴ区。痛风石长轴2.3 - 4.5 cm，平均3.4 cm。8例患者均存在手指屈伸受限。其中4例伴有正中神经受压症状，1例伴有手部骨关节破坏。参照中华医学会手外科学分会肌腱修复的手功能评价标准，术前患指总主动活动度（TAM）为（81.3±30.2）°，功能评价为差。术中切取的掌长肌腱长度为7 - 9 cm。
8例患者手术切口均一期愈合，无感染、移植肌腱不愈合或明显粘连等并发症。所有患者均获随访，随访时间8 - ২৫个月，平均14.8个月。4例伴有正中神经受压症状的患者麻木症状均消失。患者无腕部疼痛或其他不适，功能未受影响。末次随访时，参照中华医学会手外科学分会肌腱修复的手功能评价标准，8例患者TAM为（197.۵±55.8）°，与术前比较差异有统计学意义（ =11.638，<0.001）；拇长屈肌腱Ⅰ - Ⅱ区痛风石1例患者手功能为良，其余7例为优。
游离掌长肌腱移植重建术治疗腕手部屈指肌腱痛风石侵蚀性病变疗效良好。
