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

Causes and countermeasures for spontaneously ruptured extensor pollicis longus after non-operative treatment of distal radius fractures

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-oper-ative 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 trans-ferring extensor indicis proprius（EIP） was more appropriate. Conclusion：Friction theory and Pressure theory need to be fully under-stood,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.