类风湿关节炎致自发性手指肌腱断裂的临床分析

Clinical evaluation of spontaneous rupture of finger tendons caused by rheumatoid arthritis

目的探讨类风湿关节炎致自发性手指肌腱断裂的临床特点和治疗效果。方法对8例自发性手指肌腱断裂的患者(均有3～8年类风湿关节炎的病史),其中2例拇长伸肌腱断裂,采用示指固有伸肌腱转位修复;3例环、小指指伸肌腱断裂,采用环指指伸肌腱与中指指伸肌腱端侧编织缝合,示指固有伸肌腱移位修复小指固有伸肌腱;2例中、环、小指指伸肌腱断裂,采用冷冻异体指伸肌腱移植修复。1例拇长屈肌腱断裂,采用环指指浅屈肌腱转位修复。结果术后局部滑膜和肌腱组织送病理检查均显示为慢性炎症伴局灶性坏死。术后随访6个月～7年,未见肌腱再次断裂,优良率为100%。结论多根肌腱同时断裂是类风湿关节炎致自发性手指肌腱断裂的常见特点,手术采用肌腱转位或异体肌腱移植术,疗效确切。

Objective To investigate the clinical characteristics and treatment results of spontaneous rupture of finger tendons caused by rheumatoid arthritis （RA）. Methods Eight patients, who had a history of RA for 3 to 8 years, were included in this research group. Two cases were diagnosed as spontaneous rupture of the extensor pollicis longus （EPL） and repaired by transfer of the extensor indieis proprius （EIP）. There were spontaneous ruptures of both ring and small finger extensors in 3 eases. The distal stump of the ring finger extensor was woven into the middle finger extensor and the EIP was transferred to reeonstruet the extensor digiti quinti. Spontaneous triple raptures of the middle, ring and small finger extensors occurred in 2 eases. Frozen allogenie extensors were utilized to graft the ruptured tendons. Spontaneous rupture of flexor pollicis longus （FPL） was found in 1 ease and flexor digitorum superficialis tendon （FDS） of the ring finger was transferred. Results All patients were followed-up from 6 months to 7 years. They achieved 100% good results without recurrent rapture. The pathological examination showed that tenesynovitis and chronic inflammation of tendons was dominant accompanied with localized necrosis. Conclusion Multiple spontaneous extensor ruptures was a significant feature in RA patients. Tendon transposition was a reliable option for reconstruction of ruptured tendons. It was suggested that allogenie tendon transplantation be applied in cases of multiple ruptures of the extensor tendons.