示指固有伸肌腱移位修复自发性拇长伸肌腱断裂的临床应用(附8例报告)  

Clinical application of extensor indicis proprius tendon transfer in repairing spontaneous rupture of extensor pollicis longus tendon:A report of 8 cases

作　　者：王芊芊 吴广智[1] 张展[1] 张帆 于维[1] WANG Qianqian;WU Guangzhi;ZHANG Zhan;ZHANG Fan;YU Wei(Department of Hand Surgery,China-Japan Union Hospital,Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院手外科,吉林长春130021

出　　处：《吉林大学学报（医学版）》2022年第6期1574-1579,共6页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金项目(82001297)。

摘　　要：目的:探讨示指固有伸肌腱移位重建拇长伸肌腱功能的临床效果,为该病的治疗提供依据。方法:对2020—2021年因拇长伸肌腱自发断裂就诊的患者行术前详细查体和彩超定位,进行示指固有伸肌腱移位手术,术后收集患者的随访资料,通过测量患者的双侧示指背伸高度、拇指背伸高度、对掌距离、示指掌指(MP)关节及近指间(PIP)关节主动伸直角度,采用示指固有伸肌腱-拇长伸肌腱移位评分表(SEEM)评分对手术疗效进行评估;通过电话随访以调查问卷的形式进行密歇根手功能简表(BMHQ)评分,采用Mann-Whitney U检验对术前和术后患者的整体功能、日常生活能力、工作情况、自我满意度、疼痛和评分总分进行统计学分析,综合评价患者术后手功能、自我满意度和示指固有伸肌腱移位重建伸拇功能的疗效。结果:共随访8例患者,随访11~24个月,平均随访(14.8±4.2)个月。8例患者患手外观良好,无明显瘢痕增生。术后3周去除石膏后无肌腱断裂情况的发生,肌腱张力合适,主动屈伸拇指均可顺利完成。术后SEEM评分,患侧示指背伸高度较对侧缺失0.4~4.6 cm,平均缺失2.1 cm。拇指抬高缺失0.4~2.6 cm,平均缺失1.5 cm;对掌距离缺失1.8~3.5 cm,平均缺失2.6 cm;示指MP关节主动伸直丢失0°~14°,平均3°;示指PIP关节主动伸直丢失3°~16°,平均8.5°;评分总分60~90分,平均73.8分;SEEM评分,优2例,良5例,尚可1例,优良率为87.5%。BMHQ评分,术前和术后患者手整体功能、日常生活能力、工作学习、患者自我满意度、疼痛和评分总分比较差异均有统计学意义(P<0.01)。结论:示指固有伸肌腱移位治疗拇长伸肌腱自发断裂疗效确切,术后伸拇功能良好,患者主观满意度高,是重建拇长伸肌腱功能的可靠选择。Objective:To investigate the clinical effect of extensor indicis proprius-to-extensor pollicis longus transfer in reconstructing the function of thumb drosal extension,and to provide the basis for the treatment of the disease. Methods:The preoperative detailed physical examination and color Doppler ultrasound positioning were performed in the patients with spontaneous rupture of the extensor pollicis longus tendon from 2020 to 2021,and the transposition of the extensor indicis proprius was performed. The follow-up data of the patients were collected after the operation. The patients’ bilateral dorsiflexion heights of index fingers,dorsiflexion heights of thumb,thumb opposition distance,active extension angles of index finger metacarpophalangeal(MP)joint and proximal interphalangeal(PIP)joint were measured,and the Special EI-EPL Evaluation Method(SEEM)score was used to evaluate the surgical effect;through the telephone follow-up,the Brief Michigan Hand Questionnaire(BMHQ) score was scored in the form of questionnaire,and Mann-Whitney U test was used to evaluate the preoperative and postoperative overall function,daily living ability,work situation,degree of self-satisfaction,pain and total score of the patients before and after operation,so as to comprehensively evaluate the patients’ hand function,self satisfaction and the effect of extensor polliria tendon of the index finger transfer in reconstruction of function of extensor pollicis longus tendon. Results:A total of 8 patients were followed up for 11-24 months,with an average follow-up of(14. 8±4. 2)months. The hands of 8 patients had good appearance without obvious scarring.There was no tendon rupture after the plaster was removed 3 weeks after operation,the tendon tension was appropriate,and the active flexion and extension of the thumb could be successfully completed. The postoperative SEEM score showed that the dorsi-extended height of the index finger on the affected side was 0. 4-4. 6 cm,with an average of 2. 1 cm,which was lower than that on the op

关 键 词：拇长伸肌 自发性断裂 示指固有伸肌 肌腱移位 伸拇功能 

分 类 号：R685.4[医药卫生—骨科学]