指伸肌腱滑脱的原因分析与手术要点

Etiology of extensor tendon dislocation and the key points of surgical treatment

目的 探讨指伸肌腱滑脱的损伤机制、手术方法和术后复发的关系。方法 1987年至 1999年 ,在 17例指伸肌腱滑脱手术中 ,在修复矢状束、腱帽和关节囊损伤的同时 ,重视了腱间筋膜的修复。通过模拟实验 ,分析腱间筋膜、矢状束和腱帽在指伸肌腱滑脱中的作用。结果 术后随访 3个月～ 10年 ,17例伸指功能均恢复正常 ,未见复发者。实验结果证实 ,切断指伸肌腱桡侧矢状束和腱帽 ,仅引起指伸肌腱的部分滑脱 ,此时切断腱间筋膜则引起其向尺侧的完全滑脱。结论 矢状束和腱帽损伤的同时 ,伴有腱间筋膜损伤是该症关键的病理机制。

Objective To explore the anatomical characteristics and injury mechanisms of extensor tendon dislocation, and the relationship between operative methods and postoperative recurrence. Methods 17 cases of extensor tendon dislocation treated from 1987 to 1999 were involved. In the operation, in addition to the sagittal band, the extensor tendon hood and the joint capsule, the intertendinous fascia was also repaired. Simulating experiments were carried out to analyze the role of the intertendinous fascia , the sagittal band and the extensor tendon hood in the extensor tendon dislocation. Results Normal function of finger extension was recovered in all cases without recurrence after 3 months to 10 years follow up. The results of the experiment showed that resection of the sagittal band and the extensor tendon hood only resulted in partial dislocation of the extensor tendon, while additional resection of the intertendinous fascia led to total dislocation of the tendon. Conclusions The mechanism of extensor tendon dislocation lies in the injury of the intertendinous fascia combined with the injury of the sagittal band and extensor tendon hood. To avoid recurrence, the intertendinous fascia should be repaired