拇长伸肌腱自发性断裂桡侧腕短伸肌腱替代术的临床应用

Clinical application of ECRB transfer for repair of spontaneously ruptured EPL

目的探讨腕部拇长伸肌腱自发性断裂，采用桡侧腕短伸肌腱替代术的临床疗效。方法1996年2月-2005年7月，对12例拇长伸肌腱自发性断裂的患者采用桡侧腕短伸肌腱移位替代术。其中桡骨远端骨折愈合后肌腱断裂6例，类风湿骨关节炎4例，不明原因2例。术后均不用石膏固定，术后2d开始练习伸手、伸腕、伸拇动作，2～3次／d；术后7d停止练习；术后4-5周可缓慢伸手持物。结果12例术后随访均在1年以上，12个月后平均伸拇肌力已达4～5级，腕背肌腱滑动时无障碍。术后无肌腱再断裂者，伸腕、伸指时拇指末节过伸2°～5°，平均3°，拇对掌、对指功能正常。根据中华医学会手外科学会手部肌腱修复后功能评定标准评价，优良率达100％。全部患者对术后功能满意。结论拇长伸肌腱自发性断裂，应用桡侧腕短伸肌腱移位替代术，对供区损伤小，操作方便，肌腱缝合牢固，有利早期功能恢复。

Objection To assess the long-term results of extensor carpi radialis brevis （ECRB） transfer for reconstruction of spontaneously ruptured extensor pollicis longus （EPL） function. Methods From February 1996 to July 2005, 12 cases of spontaneous EPL rupture were treated using transfer of the ECRB. The underlying etiologies were rheumatoid arthritis for 4 cases, distal radius fracture for 6 cases, and idiopathic for 2 cases. Under local anesthesia, ECRB tendon was woven into distal stump of the ruptured EPL with tension adjusted so that the distal phalanx of the thumb was hyperextended 0 to 3° while wrist and hand in neutral position. Wrist and finger extension exercise started 2 days postoperatively, 2 to 3 times a day. This exercise was terminated at 7 days postoperatively and resumed at postoperative 4 to 5 weeks when patients were encouraged to extend the wrist and hand to hold objects. Results All the patients were followed for over 1 year. Strength of thumb extension reached MRC 4 to 5. Smooth tendon excursion over the dorsum of the wrist was observed. No recurrent rupture occurred. Extension of interphalangeal joint of the thumb could be 2°to 5° of hyperextension while the wrist was in extended position. The overall excellent and good result rate was 100%. All the patients were satisfied with the treatment. Conclusion ECRB transfer is an effective procedure to treat EPL spontaneous rupture. It is an easy and straightforward procedure that causes mininmal donor site morbidity. The interwoven tendons are strong enough to facilitate early postoperative rehabilitation.