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近20年后用于慢性拇长伸肌损伤的示指固有伸肌转移术：1例报告

An Extensor Indicis Proprius Transfer for Chronic Extensor Pollicis Longus Injury After Nearly 2 Decades: A Case Report.

作者信息

Shakya Amir Ratna, Chhetri Prakrit, Kayastha Nirab, Shrestha Sushil, Gaire Binod

机构信息

Department of Orthopedics, SBH, Kathmandu, Nepal.

Department of Orthopedics, NAIHS, Kathmandu, Nepal.

出版信息

JBJS Case Connect. 2025 Aug 25;15(3). doi: 10.2106/JBJS.CC.25.00273. eCollection 2025 Jul 1.

DOI:10.2106/JBJS.CC.25.00273
PMID:40854034
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12369508/
Abstract

CASE

A 36-year-old soldier presented for foreign training fitness with a history of a fall 18 years previously, that injured his nondominant left wrist. Initially, the injury was managed conservatively with a below elbow cast. Since then, he had been unable to extend the thumb at the interphalangeal joint but adapted well to daily activities. Surgical reconstruction using an extensor indicis proprius (EIP) to extensor pollicis longus (EPL) tendon transfer yielded favorable recovery.

CONCLUSION

This case highlights neglected EPL injury over 18 years and confirms that EIP transfer, when precisely performed, can restore thumb function such as pinch and grip even in very delayed cases.

摘要

病例

一名36岁的士兵前来参加国外训练体能评估，他有18年前摔倒致非优势手左手腕受伤的病史。最初，该损伤采用肘部以下石膏保守治疗。从那以后，他一直无法使拇指指间关节伸展，但能很好地适应日常活动。使用示指固有伸肌（EIP）至拇长伸肌（EPL）肌腱转位进行手术重建，取得了良好的恢复效果。

结论

本病例突出了18年以上被忽视的EPL损伤，并证实即使在非常延迟的病例中，精确实施EIP转位也能恢复拇指的捏和抓握等功能。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/e683a378fc55/jbjscc-15-e25.00273-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/ce1fec3ac4d9/jbjscc-15-e25.00273-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/78e9c3c9e6d7/jbjscc-15-e25.00273-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/90ceda8fba8d/jbjscc-15-e25.00273-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/988a13475fe8/jbjscc-15-e25.00273-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/92f73942ff7e/jbjscc-15-e25.00273-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/d164fb0733d7/jbjscc-15-e25.00273-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/a250b5eeec59/jbjscc-15-e25.00273-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/f1ec75a7e2cf/jbjscc-15-e25.00273-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/e683a378fc55/jbjscc-15-e25.00273-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/ce1fec3ac4d9/jbjscc-15-e25.00273-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/78e9c3c9e6d7/jbjscc-15-e25.00273-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/90ceda8fba8d/jbjscc-15-e25.00273-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/988a13475fe8/jbjscc-15-e25.00273-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/92f73942ff7e/jbjscc-15-e25.00273-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/d164fb0733d7/jbjscc-15-e25.00273-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/a250b5eeec59/jbjscc-15-e25.00273-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/f1ec75a7e2cf/jbjscc-15-e25.00273-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/12369508/e683a378fc55/jbjscc-15-e25.00273-g009.jpg

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本文引用的文献

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Inflammatory and degenerative changes in the extensor pollicis longus muscle and tendon following ruptures caused by distal radius fractures.桡骨远端骨折所致断裂后拇长伸肌和肌腱的炎症及退行性改变
BMC Musculoskelet Disord. 2025 Jan 3;26(1):10. doi: 10.1186/s12891-024-08212-4.
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Reconstruction strategies after rupture of the extensor pollicis longus tendon: A systematic review.伸拇长肌腱断裂后的重建策略：系统评价。
Hand Surg Rehabil. 2020 Dec;39(6):502-507. doi: 10.1016/j.hansur.2020.07.005. Epub 2020 Aug 7.
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A New Method to Control Tendon Tension in the Transfer of Extensor Indicis Proprius to Extensor Pollicis Longus Rupture.
一种在示指固有伸肌转位至拇长伸肌断裂修复中控制肌腱张力的新方法。
Ann Plast Surg. 2015 Dec;75(6):607-9. doi: 10.1097/SAP.0000000000000593.
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Transfer of either index finger extensor tendon to the extensor pollicis longus tendon.将示指伸肌腱转移至拇长伸肌腱。
Can J Plast Surg. 2004 Spring;12(1):31-4. doi: 10.1177/229255030401200108.
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Incidence of extensor pollicis longus tendon rupture after nondisplaced distal radius fractures.无移位桡骨远端骨折后拇长伸肌腱断裂的发生率
J Hand Surg Am. 2012 May;37(5):942-7. doi: 10.1016/j.jhsa.2012.02.006. Epub 2012 Mar 29.
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A possible mechanism of direct injury to the EPL tendon at Lister's tubercle during falls with the wrist fully extended.在手腕完全伸展的跌倒过程中，EPL肌腱在Lister结节处受到直接损伤的一种可能机制。
J Hand Surg Eur Vol. 2008 Apr;33(2):149-51. doi: 10.1177/1753193407087575.
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Rupture of the extensor pollicis longus tendon: a study of aetiological factors.拇长伸肌腱断裂：病因学因素研究
Scand J Plast Reconstr Surg Hand Surg. 2004;38(1):32-5. doi: 10.1080/02844310310013046.
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Effects of extensor pollicis longus transposition and extensor indicis proprius transfer to extensor pollicis longus on thumb mechanics.拇长伸肌转位及示指固有伸肌转至拇长伸肌对拇指力学的影响。
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[Narrowing of the third extensor tendon compartment in minimal displaced distal radius fractures with impending rupture of the EPL tendon].[在伴有伸指总肌腱即将断裂的轻度移位桡骨远端骨折中第三伸肌肌腱间隔变窄]
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Rupture of the extensor pollicis longus tendon after fracture of the lower end of the radius--a clinical and microangiographic study.桡骨下端骨折后拇长伸肌腱断裂——一项临床及微血管造影研究
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