Bonatz E, Kramer T D, Masear V R
Division of Orthopaedic Surgery, University of Alabama at Birmingham, USA.
Am J Orthop (Belle Mead NJ). 1996 Feb;25(2):118-22.
Rupture of the extensor pollicis longus (EPL) tendon after nondisplaced fracture of the distal radius is a known complication, but can also occur in nonrheumatoid patients without a history of fracture. This study is a retrospective analysis of seven patients treated between 1985 and 1992. Five EPL ruptures occurred with nondisplaced Colles' fractures. Two involved a chronic tenosynovitis of the second dorsal extensor compartment of the wrist. The age of the patients ranged from 29 years to 68 years (mean, 42 years). Length of follow-up ranged from 6 weeks to 62 months (mean, 30 months). Rupture occurred at a median of 7 weeks (range, 2 weeks to 11 months) from the time of the distal radius fracture. Three extensor indicis proprius tendons and four free palmaris longus tendon grafts were performed. At final follow-up, six patients had an extensor lag < 10 degrees or normal thumb interphalangeal joint motion. One patient had a 25 degrees extensor lag. The causes of EPL rupture include mechanical irritation, attrition, and vascular impairment leading to delayed rupture. Synovitis of the extensor carpi radialis due to repetitive use may invade the EPL tendon and lead to rupture. Extensor indicis proprius transfer or free palmaris longus grafts yield good results after EPL rupture.
桡骨远端无移位骨折后拇长伸肌腱（EPL）断裂是一种已知的并发症，但也可发生于无骨折病史的非类风湿患者。本研究对1985年至1992年间治疗的7例患者进行了回顾性分析。5例EPL断裂发生于无移位的Colles骨折。2例涉及腕背侧第二伸肌间隔的慢性腱鞘炎。患者年龄从29岁至68岁（平均42岁）。随访时间从6周至62个月（平均30个月）。EPL断裂发生于桡骨远端骨折后中位时间7周（范围2周至11个月）。进行了3次示指固有伸肌腱转位和4次游离掌长肌腱移植。末次随访时，6例患者伸肌滞后<10°或拇指指间关节活动正常。1例患者伸肌滞后25°。EPL断裂的原因包括机械刺激、磨损以及导致延迟断裂的血管损伤。由于反复使用导致的桡侧腕伸肌滑膜炎可能侵犯EPL肌腱并导致断裂。EPL断裂后，示指固有伸肌腱转位或游离掌长肌腱移植效果良好。
