Lee Joonha, Ku Ki Hyeok, Lee Jae Hoon, Baek Jong Hun
Department of Orthopedic Surgery, Yeson Hospital, Bucheon, Korea.
Department of Orthopedic Surgery, Gachon University College of Medicine, Incheon, Korea.
Clin Orthop Surg. 2025 Jun;17(3):506-513. doi: 10.4055/cios24254. Epub 2025 May 15.
Volar plate fixation for distal radial fractures is the most common cause of closed rupture of the flexor pollicis longus tendon (FPL). For treating a closed FPL rupture, transferring the fourth flexor digitorum superficialis or a tendon graft from the palmaris longus (PL) can be performed. This study reports the results of tendon grafting using the PL in closed FPL rupture and discusses the provision of optimal tendon tension.
This retrospective study included 11 out of 20 patients who underwent PL tendon graft for closed FPL rupture between 2013 and 2022, with a follow-up period of more than 12 months. There were 4 men and 7 women, with an average age of 62 years. The average period from the date of rupture to surgery was 39 days. Ruptures occurred due to volar plate fixation in 7 cases, ithout a specific cause in 2 cases, and after a steroid injection for trigger thumb in 2 cases. The rupture site was in zone 2 in 4 cases and zone 5 in 7 cases. The mean follow-up period was 59 months. Optimal tension for the grafted tendon was determined by comparing the intraoperative angles of the interphalangeal (IP) and metacarpophalangeal (MCP) joints with the angles of the same joints at the final follow-up.
At the final follow-up, the mean IP joint motion was 61.0°, which was 81.5% of the contralateral side. The average range of motion of the MCP joint was 43.6°, which was 80.0% of the contralateral side. The pinch power was 90.8% of the contralateral side. Cases with > 70° IP joint motion were those in which the IP joint angle was > 45° during surgery. Moreover, the greater the flexion of the IP and MCP joints intraoperatively, the better the range of motion of the IP joints.
Tendon grafting using the PL is recommended as an effective surgical method to achieve 81.5% of contralateral IP joint motion in cases of closed FPL tendon rupture. Over-tensioning of the tendon graft with IP Joint flexion more than 45° during surgery is recommended.
桡骨远端骨折的掌侧板固定是拇长屈肌腱（FPL）闭合性断裂最常见的原因。对于治疗闭合性FPL断裂，可采用转移示指浅屈肌或取自掌长肌（PL）的肌腱移植。本研究报告了在闭合性FPL断裂中使用PL进行肌腱移植的结果，并讨论了提供最佳肌腱张力的方法。
本回顾性研究纳入了2013年至2022年间因闭合性FPL断裂接受PL肌腱移植的20例患者中的11例，随访期超过12个月。其中男性4例，女性7例，平均年龄62岁。从断裂到手术的平均时间为39天。7例因掌侧板固定导致断裂，2例无特定原因，2例在拇指扳机指注射类固醇后发生断裂。4例断裂部位在2区，7例在5区。平均随访期为59个月。通过比较术中指间（IP）和掌指（MCP）关节角度与最终随访时相同关节的角度来确定移植肌腱的最佳张力。
在最终随访时，IP关节平均活动度为61.0°，为对侧的81.5%。MCP关节平均活动范围为43.6°，为对侧的80.0%。捏力为对侧的90.8%。IP关节活动度>70°的病例是术中IP关节角度>45°的病例。此外，术中IP和MCP关节屈曲越大，IP关节活动范围越好。
对于闭合性FPL肌腱断裂，建议采用PL肌腱移植作为一种有效的手术方法，可实现对侧IP关节活动度的81.5%。建议在手术中避免肌腱移植过度紧张，IP关节屈曲超过45°。
