Yang Xi, Fan Hua, Su Xixiong, Fang Xiang, Xu Yongqing, He Xiaoqing
Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China.
Department of Ultrasonography, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Sep 15;39(9):1149-1154. doi: 10.7507/1002-1892.202506034.
To explore effectiveness of musculoskeletal ultrasound combined with Wide-Awake technique in extensor indicis proprius tendon (EIP) transfer for repairing extensor pollicis longus tendon (EPL) rupture.
A clinical data of 20 patients with EPL spontaneous rupture, who were admitted between January 2019 and June 2024 and met the selective criteria, was retrospectively analyzed. During EIP transfer surgery, the musculoskeletal ultrasound-guided incision marking combined with Wide-Awake technique was used in combination group (=10) and the tourniquet-assisted surgery under brachial plexus block anesthesia in the control group. There was no significant difference in the baseline data between groups (>0.05), including gender, age, affected side, cause and location of tendon rupture, and time from injury to hospitalization. The accuracy of preoperative musculoskeletal ultrasound in predicting the actual tendon rupture site was evaluated in the combination group. The operation time, intraoperative blood loss, visual analogue scale (VAS) scores during operation and at 6 hours after operation, total incision length, and postoperative complications were recorded. Surgical outcomes were assessed at 12 months after operation using the specific EIP-EPL evaluation method (SEEM), which included measurements of thumb elevation loss, thumb flexion loss, index finger dorsiflexion loss, and total score.
In the combination group, the incision position marked by preoperative musculoskeletal ultrasound positioning was consistent with the actual tendon rupture position. Compared with the control group, the operation time and total incision length in the combination group were significantly shorter and the VAS score at 6 hours after operation was significantly higher (<0.05). There was no significant difference in intraoperative blood loss or intraoperative VAS score between groups (>0.05). All incisions in both groups healed by first intention. Two patients in the control group developed swelling and blisters in the tourniquet area, which subsided spontaneously without special treatment. All patients were followed up 12-14 months, with an average of 12.5 months. The thumb dorsiflexion function of all patients recovered to varying degrees. At last follow-up, the thumb elevation loss in combination group was significantly lower than that in control group, and the total score was significantly higher (<0.05); there was no significant difference in thumb flexion loss or index finger dorsiflexion loss between groups (>0.05).
Musculoskeletal ultrasound can accurately locate the site of tendon rupture, assist the Wide-Awake technique in implementing precise anesthesia, and adjust tendon tension while reducing tissue trauma, with satisfactory effectiveness.
探讨肌肉骨骼超声联合清醒技术在示指固有伸肌腱（EIP）移位修复拇长伸肌腱（EPL）断裂中的有效性。
回顾性分析2019年1月至2024年6月收治的20例符合入选标准的EPL自发性断裂患者的临床资料。在EIP移位手术中，联合组（n = 10）采用肌肉骨骼超声引导下切口标记联合清醒技术，对照组采用臂丛神经阻滞麻醉下止血带辅助手术。两组间基线资料（包括性别、年龄、患侧、肌腱断裂原因及部位、受伤至住院时间）比较，差异无统计学意义（P>0.05）。在联合组评估术前肌肉骨骼超声预测实际肌腱断裂部位的准确性。记录手术时间、术中出血量、术中及术后6小时视觉模拟评分（VAS）、总切口长度及术后并发症。术后12个月采用特定的EIP-EPL评估方法（SEEM）评估手术效果，包括测量拇指背伸丧失、拇指屈曲丧失、示指背伸丧失及总分。
联合组术前肌肉骨骼超声定位标记的切口位置与实际肌腱断裂位置一致。与对照组比较，联合组手术时间及总切口长度明显缩短，术后6小时VAS评分明显升高（P<0.05）。两组间术中出血量及术中VAS评分差异无统计学意义（P>0.05）。两组所有切口均一期愈合。对照组2例患者在止血带区域出现肿胀和水疱，未经特殊处理自行消退。所有患者随访12～14个月，平均12.5个月。所有患者拇指背伸功能均有不同程度恢复。末次随访时，联合组拇指背伸丧失明显低于对照组，总分明显高于对照组（P<0.05）；两组间拇指屈曲丧失及示指背伸丧失差异无统计学意义（P>0.05）。
肌肉骨骼超声可准确定位肌腱断裂部位，辅助清醒技术实施精准麻醉，调整肌腱张力，同时减少组织创伤，效果满意。
