Dagum A B, Mahoney J L
Division of Plastic Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada.
J Hand Surg Am. 1994 Jul;19(4):584-9. doi: 10.1016/0363-5023(94)90260-7.
A cadaveric study was performed on extensor tendon separation and excursion after extensor zone I (distal interphalangeal [DIP]) joint and III (proximal interphalangeal [PIP]) level lacerations and treatment. An average 1.5 mm tendon gap with 30 degrees lag following laceration at the DIP joint level and a 1.1 mm average tendon gap with 18 degrees (10 degrees-25 degrees) extension loss at the PIP level was demonstrated. Splinting zone I injuries with the DIP joints in 5 degrees hyperextension and zone III injuries with the PIP joint in 0 degrees extension eliminated tendon separation in all passive joint positions except when the wrist and metacarpophalangeal joints were placed in flexion. This position produced a 0.9 mm gap with a laceration at the DIP level and 1.0 and 2.0 mm gap at the PIP level, with a central slip and central slip and lateral band laceration, respectively. The tendon gaps were eliminated by placing the wrist in extension. This suggests that splinting of the wrist in neutral to mild extension and the joint underlying the tendon injury in full extension, while leaving the other joints free to move, would optimize treatment results.
对Ⅰ区（远侧指间关节[DIP]）和Ⅲ区（近侧指间关节[PIP]）水平伸肌腱撕裂伤及治疗后的伸肌腱分离和活动度进行了尸体研究。结果显示，DIP关节水平撕裂伤后平均肌腱间隙为1.5mm，滞后30度；PIP水平平均肌腱间隙为1.1mm，伸展损失18度（10度 - 25度）。将DIP关节处于5度过伸位固定Ⅰ区损伤，PIP关节处于0度伸展位固定Ⅲ区损伤，除手腕和掌指关节处于屈曲位外，在所有被动关节位置均消除了肌腱分离。在DIP水平撕裂伤时，该位置产生0.9mm的间隙，在PIP水平分别产生1.0mm和2.0mm的间隙，分别伴有中央束撕裂以及中央束和侧束撕裂。通过伸展手腕可消除肌腱间隙。这表明，将手腕固定于中立至轻度伸展位，将肌腱损伤下方的关节固定于完全伸展位，同时让其他关节自由活动，可优化治疗效果。
