Ferlemann K, Zilch H
Klinik für Unfall-, Wiederherstellungs- und Handchirurgie, Dr.-Herbert-Nieper-Krankenhaus, Harzkliniken Goslar.
Unfallchirurgie. 1997 Dec;23(6):262-6. doi: 10.1007/BF02628923.
Closed traumatic lesions of the extensor tendon hood of a longfinger at the metacarpophalangeal joint are rare. Surgical treatment was done in 6 cases during the last 10 years in our department; in 5 cases the dorsoradial part, in one case the dorsoulnar part of the hood was injured. The tear extended longitudinal or diagonal through the transverse fibers of the hood. Respecting the accident mechanism there have been reported tangential forces at the extensor tendon hood and forced ulnar deviation in the bended metacarpophalangeal joint. A jerky dislocation of the extensor tendon to the ulnar side of the metacarpophalangeal head during increased bending of the metacarpophalangeal joint, sometimes with ulnar abduction of the longfinger, leads usually to the diagnosis. Misdiagnoses of cases sent to our department were: "trigger finger" and "recurrent dislocation of the metacarpophalangeal joint". Once the presurgical diagnosis was "rupture of the extensor tendon" because of a permanent extension deficit in 30 degree position of the metacarpophalangeal joint. Treatment is always surgical with suture of the hood and immobilization of the metacarpophalangeal joint in extension position for 4 weeks. Conservative treatment can not heal up a tear of the extensor tendon hood.
闭合性创伤性示指掌指关节伸肌腱帽损伤较为罕见。过去10年我院共收治6例，其中5例为伸肌腱帽桡背侧部分损伤，1例为尺背侧部分损伤。撕裂口沿伸肌腱帽横向纤维纵向或斜向延伸。据报道，损伤机制与伸肌腱帽受到切向力以及掌指关节屈曲时的尺侧外力有关。掌指关节过度屈曲时，伸肌腱突然向掌指骨头尺侧脱位，有时示指伴有尺侧外展，通常可据此作出诊断。转诊至我院的病例曾被误诊为“扳机指”和“掌指关节复发性脱位”。有1例因掌指关节在30°位存在永久性伸直受限，术前诊断为“伸肌腱断裂”。治疗均采用手术修复伸肌腱帽，并将掌指关节固定于伸直位4周。保守治疗无法治愈伸肌腱帽撕裂。
