桡骨远端骨折非手术治疗后拇长伸肌腱自发性断裂的原因分析与对策
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摘要
目的:提高对桡骨远端骨折非手术治疗后拇长伸肌腱(extensor pollicis longus,EPL)自发性断裂的诊治水平。方法:通过对既往有桡骨远端骨折、无新发创伤而确诊EPL自发断裂病例进行原因分析和规范手术治疗。结果:桡骨远端骨折后,存在"摩擦机制"和"压力机制"两种原因诱发EPL迟发性损伤,如未引起重视,则有可能发生EPL自发性断裂,早期可行端对端原位修复,晚期因肌腱近断端动力不足,多采取肌腱转位重建伸拇功能,示指固有伸肌腱是较好的动力肌选择。结论:需要充分认识桡骨远端骨折发生后,无论骨折移位与否,均有可能发生EPL自发性断裂。如果早期发现"摩擦机制"和"压力机制"存在的高危因素,并尽早干预处理,就可能降低EPL发生自发性断裂的概率。
Objective:To improve the diagnosis and treatment of spontaneously ruptured extensor pollicis longus(EPL)after non-operative treatment of distal radius fractures. Methods:Causal analysis and standard operative treatment were conducted on 30 cases of spontaneously ruptured EPL with old distal radius fractures but without new wrist trauma. Results:Friction theory and Pressure theory would lead to EPL spontaneous rupture after distal radius fractures with or without displaced fracture. Once ruptured tendons were found,at early stage,the end to end in-situ remediation could be performed;at late stage,the reconstruction of EPL function by transferring extensor indicis proprius(EIP)was more appropriate. Conclusion:Friction theory and Pressure theory need to be fully understood,and only the high risk factors for EPL spontaneous rupture were early found and properly treated,the lower incidence of EPL spontaneous rupture would become a reality.
Objective:To improve the diagnosis and treatment of spontaneously ruptured extensor pollicis longus(EPL)after non-operative treatment of distal radius fractures. Methods:Causal analysis and standard operative treatment were conducted on 30 cases of spontaneously ruptured EPL with old distal radius fractures but without new wrist trauma. Results:Friction theory and Pressure theory would lead to EPL spontaneous rupture after distal radius fractures with or without displaced fracture. Once ruptured tendons were found,at early stage,the end to end in-situ remediation could be performed;at late stage,the reconstruction of EPL function by transferring extensor indicis proprius(EIP)was more appropriate. Conclusion:Friction theory and Pressure theory need to be fully understood,and only the high risk factors for EPL spontaneous rupture were early found and properly treated,the lower incidence of EPL spontaneous rupture would become a reality.
引文
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[10]张金喜,李敏皋,李坚.示指固有伸肌腱转位修复重建V区拇长伸肌腱自发性断裂临床研究[J].浙江创伤外科,2014,19(1):89-90.
[11]魏壮,尹维田,刘飙,等.桡侧腕长伸肌腱移位重建伸拇功能九例[J].中华显微外科杂志,2004,27(4):291.
[12]曹能力.桡侧腕短伸肌腱转位治疗拇长伸肌腱自发性断裂的临床疗效[J].医药论坛杂志,2015,36(4):110-111.
[13]谭俊峰,刘洋,李明辉,等.腕背伸肌支持带筋膜瓣在桡骨远端骨折背侧入路中的应用[J].骨科,2017,8(1):48-51.
[14] Lourie GM,Putman A,Cates T,et al. Extensor pollicis longus ruptures in distal radius fractures:clinical and cadaveric studies with a new therapeutic intervention[J]. Am J Orthop(Belle Mead NJ),2015,44(4):183-187.
[15] Kuriyama K,Murase T,Moritomo H,et al. Attritional rupture of the extensor pollicis longus tendon by an osseous spur more than 30years after wrist injury:a case report[J]. J Plast Surg Hand Surg,2014,48(6):452-454.
[16]王振军.桡骨下端骨折并发肌腱断裂1例分析[J].中国社区医师·医学专业,2011,13(33):210.
[2]詹海华,阚世廉,费起礼,等.食指固有伸肌腱移位重建拇长伸肌功能及评价[J].中国修复重建外科杂志,2004,18(4):301-303.
[3]李茂萍.超声诊断拇长伸肌腱完全性断裂1例[J].临床超声医学杂志,2009,11(11):774-784.
[4]李宝克,王用凯,王学华,等. Colles骨折伴拇长伸肌腱迟发性断裂[J].骨与关节损伤杂志,2001,16(4):310-311.
[5]王月秋,张华,陈伟. Colles骨折并发拇长伸肌腱断裂1例[J].中医正骨,2004,16(3):62.
[6] Loos A,Kalb K,Van Schoonhoven J,et al. Reconstruction of the extensor pollicis longus tendon by transposition of the extensor indicis tendon[J]. Handchir Mikrochir Plast Chir,2003,35(6):368-372.
[7]孙世山,王丽芬.闭合性拇长伸肌腱损伤的诊治体会[J].中国现代药物应用,2014,8(23):21.
[8] Figl M,Mayer M,Lederer S,et al. Extensor pollicis longus rupture after distal radius fracture:results of reconstruction by transposition of the extensor indicis tendon and postoperative dynamic splinting[J]. Wien Klin Wochenschr,2011,123(15-16):485-487.
[9]魏壮,崔树森,刘飙,等.拇长伸肌腱自发性断裂的临床分析及治疗[J].中国修复重建外科杂志,2006,20(2):200-201.
[10]张金喜,李敏皋,李坚.示指固有伸肌腱转位修复重建V区拇长伸肌腱自发性断裂临床研究[J].浙江创伤外科,2014,19(1):89-90.
[11]魏壮,尹维田,刘飙,等.桡侧腕长伸肌腱移位重建伸拇功能九例[J].中华显微外科杂志,2004,27(4):291.
[12]曹能力.桡侧腕短伸肌腱转位治疗拇长伸肌腱自发性断裂的临床疗效[J].医药论坛杂志,2015,36(4):110-111.
[13]谭俊峰,刘洋,李明辉,等.腕背伸肌支持带筋膜瓣在桡骨远端骨折背侧入路中的应用[J].骨科,2017,8(1):48-51.
[14] Lourie GM,Putman A,Cates T,et al. Extensor pollicis longus ruptures in distal radius fractures:clinical and cadaveric studies with a new therapeutic intervention[J]. Am J Orthop(Belle Mead NJ),2015,44(4):183-187.
[15] Kuriyama K,Murase T,Moritomo H,et al. Attritional rupture of the extensor pollicis longus tendon by an osseous spur more than 30years after wrist injury:a case report[J]. J Plast Surg Hand Surg,2014,48(6):452-454.
[16]王振军.桡骨下端骨折并发肌腱断裂1例分析[J].中国社区医师·医学专业,2011,13(33):210.