Rupture ntawm extensor tendon tom qab volar phaj fixation tseem yog ib qho teeb meem loj nyob rau hauv kev kho ntawm distal radius fractures. Qhov feem ntau cuam tshuam cov leeg yog extensor pollicis longus (EPL) cov leeg, raws li nws nyob hauv EPL groove. Qhov tshwm sim ntawm EPL tendon rupture tom qab volar plating yog 0.29% -5.7%.
Qhov kev pheej hmoo ntawm qeeb EPL tendon rupture yog nce nyob rau hauv lub xub ntiag ntawm dorsal ntsia hlau protrusion, raug mob los ntawm intraoperative direct drilling, thiab dorsal ru fragments, tshwj xeeb tshaj yog nyob rau hauv cov kob tawg ntawm Lister lub tubercle. Radiographic kev soj ntsuam ntawm cov ntsia hlau protrusion nyob rau hauv distal radius fractures yog nyuaj vim lub complex geometry ntawm lub distal radius thiab lub peev xwm rau comminuted dorsal fractures. Lub dorsal tangential saib yog tib qhov ua tau intravital saib ntawm dorsal radial cortex kom tau txais kev ntsuam xyuas txhim khu kev qha ntawm qhov kev ncua deb ntawm cov ntsia hlau taub thiab dorsal cortex.
Cov txheej txheem kom tsis txhob raug mob extensor tendon suav nrog kev siv cov ntsia hlau monocortical thiab zam kev nkag mus rau hauv qhov chaw dorsal; Txawm li cas los xij, cov txheej txheem no tuaj yeem txo qhov kev ruaj ntseg ntawm kev kho pob txha. Yog li ntawd, tej zaum yuav tsum tau kho bicortical fixation. Txhawm rau txo qhov kev pheej hmoo ntawm extensor tendon raug mob, lub hom phiaj tseem ceeb ntawm kev txhim kho pob txha thiab kev ruaj ntseg yuav tsum tsis txhob cuam tshuam.
Cov txheej txheem phais tshiab
Peb piav qhia txog cov txheej txheem tshiab los txo qhov kev pheej hmoo ntawm EPL tendon rupture tom qab volar phaj fixation ntawm distal radius fractures tsis shortening lub ntsia hlau ntev los yog tshem tawm dorsal ru tsev fragments. Luv luv, cov txheej txheem yuav qhib qhov thib peb compartment los ntawm ib tug me me dorsal incision.
Yog hais tias tus ntsia hlau tau nkag mus rau lub dorsal cortex thiab protruded nyob rau hauv lub thib peb compartment: peb tshem tawm cov EPL tendon los ntawm nws zawj thiab kaw lub compartment los ntawm sutured lub retinaculum tawm hauv EPL leeg ntawm lub kho retinaculum.
Yog tias cov ntsia hlau tsis txuas mus rau hauv qhov thib peb: peb tawm ntawm EPL cov leeg hauv qhov thib peb. Qhov taw qhia rau peb cov txheej txheem yog nyob rau hauv cov neeg mob uas muaj lub vojvoog ntawm cov pob qij txha kho nrog cov volar locking daim hlau, tawg nrog dorso-parietal fragments los yog screws uas yuav nkag mus rau lub dorsal cortex los yog puas EPL tendon nyob ib ncig ntawm Lister lub tubercle. Hauv cov neeg mob uas muaj qhov tawg ntawm qhov tawg nrog dorsomedial fragments, peb tho qhov kom nkag mus rau hauv dorsal cortex thiab xaiv cov ntsia hlau ntev txaus los kho qhov tsis ruaj khov dorsomedial fragments.
Kev sib koom
Peb qhia txog ib rooj plaub uas EPL cov leeg raug tshem tawm los ntawm qhov thib peb qhov chaw vim yog protrusion ntawm cov ntsia hlau nyob rau hauv lub thib peb compartment thaum lub phaj fixation ntawm ib tug comminuted distal radius tawg nrog dorsomedial fragments. Peb tau lees paub tias EPL cov leeg tsis zoo 7 xyoo tom qab ua haujlwm, txawm hais tias cov ntsia hlau tseem ceeb hauv qhov thib peb.
Cov ntaub ntawv no yog ib tug poj niam muaj hnub nyoog 67 xyoo uas tau kuaj pom ntawm ib qho intra-articular unstable distal radius tawg nrog txoj cai dorsal medial fracture (Daim duab 1A-E). Tsis muaj keeb kwm ntawm kev haus luam yeeb, ntshav qab zib lossis haus cawv. Tau taug kev yam tsis muaj tus neeg taug kev.
![distal radius tawg]()
Daim duab 1. Preoperative imaging pom ib tug comminuted intra-articular puas ntawm lub distal radius.
A thiab B: Preoperative X-rays,
C thiab D: sagittal thiab axial views ntawm cov duab tomography,
E: 3D xam tomography duab. Dorsal medial lunate facet fragments thiab dorsal apical fragments (dawb asterisks) yog pom.
Cov txheej txheem phais
Peb kho qhov kev puas tsuaj no nrog lub voj voog xauv phaj. Intraoperatively, peb drilled los ntawm dorsal cortex thiab xaiv ib tug ntsia hlau ntev txaus kom ruaj ntseg dorsal cortex vim hais tias cov dorsal cortex tsis ruaj khov (Daim duab 2).
Kev phais tau ua los qhib lub qhov thib peb tom qab ntsia hlau kho.
Txij li thaum cov ntsia hlau tau nkag mus rau qhov thib peb qhov chaw thiab tawm mus (Daim duab 3A), qhib tag nrho lub qhov thib peb thiab txav EPL cov leeg tawm ntawm nws qhov zawj (Daim duab 3B).
Qhov thib peb compartment raug kaw los ntawm suturing lub retinaculum (Fig. 3C, D), thiab EPL tendon tau muab tso rau ntawm lub kho retinaculum (Fig. 3 E).
Tom qab kev phais, tus neeg mob tau mus rau qhov chaw kho mob sab nraud ntawm peb lub tsev kho mob kom txog thaum cov pob txha zoo. Tus neeg mob tsis xav tshem tawm cov khoom siv.
Postoperative rov qab
Xya xyoo tom qab kev ua haujlwm, tus neeg mob rov qab mus rau lub tsev kho mob kom rov kuaj xyuas dua vim yog mob pob txha. Sab tes xis tsis yog neeg xiam oob qhab. X-ray duab qhia txog kev kho mob pob txha nrog dorsal protrusion ntawm distal locking ntsia hlau. Tus neeg mob tus ntiv tes xoo tau txuas ntxiv, thiab EPL cov leeg tsis muaj qhov pom tseeb bowstring.
Ntawm peb qhov kev pom zoo, tus neeg mob tau pom zoo tshem tawm cov cuab yeej kho vajtse thiab tshuaj xyuas cov leeg extensor. Intraoperatively, peb tshuaj xyuas EPL tendon los ntawm dorsal incision thiab ib nrab qhib qhov thib peb thiab plaub compartments.
EPL leeg tau nyob sab nraum qhov thib peb qhov chaw nyob rau hauv tib txoj hauj lwm zoo li hauv kev ua haujlwm dhau los, thiab cov leeg tsis khaus.
Peb paub tseeb tias cov ntsia hlau nkag mus rau hauv qhov thib peb qhov chaw thaum lub extensor tendons ntawm cov ntiv tes tau thim rov qab.
Thaum kawg, peb kho cov hlua txhawb nqa thiab tshem tawm cov khoom siv. Ntawm qhov kev ntsuam xyuas zaum kawg 2 lub hlis tom qab tshem tawm cov khoom kho mob, tus neeg mob tsis mob thiab muaj tus ntiv tes xoo txuas ntxiv.
Sib tham
Nyob rau hauv peb txoj kev, tom qab volar phaj fixation ntawm distal radius tawg, peb ib nrab qhib lub thib peb compartment los ntawm ib tug incision li 2 cm ntev ulnar mus rau lub tubercle ntawm Lister. Peb ncaj qha txheeb xyuas EPL cov leeg thiab hauv pem teb ntawm qhov thib peb extensor compartment los ntawm maj mam rub lub EPL tendon.
Yog hais tias cov ntsia hlau nkag mus rau hauv lub dorsal cortex mus rau hauv lub thib peb compartment los yog muaj dorso-parietal khib nyiab, peb tsis tau ua intraoperative ntsia hlau hloov los yog fragmentectomy, tab sis kiag li qhib lub thib peb compartment thiab tshem tawm cov EPL leeg ntawm nws zawj. Tom qab ntawd peb kaw lub compartment los ntawm suturing lub retinaculum thaum repositioning lub EPL tendon nyob rau hauv peb compartment.
Yog tias cov ntsia hlau tsis txuas mus rau hauv qhov thib peb, peb tawm ntawm EPL cov leeg nyob rau hauv ib feem qhib qhov thib peb.
Peb cov txheej txheem phais tso cai yooj yim tshuaj xyuas ntawm EPL tendon raug mob nrog kev pom ncaj qha hauv tsawg li 10 feeb ntxiv. Yog tias EPL leeg raug mob, nws tuaj yeem kho ncaj qha. Cov txheej txheem no pab tiv thaiv EPL cov leeg nqaij ntuag tom qab distal radial phaj fixation. EPL tendon bowstring tej zaum yuav tshwm sim, tab sis nws tsis tshwm sim nyob rau hauv peb rooj plaub.
Hauv kev xaus
Peb tau ntsib ib rooj plaub uas EPL cov leeg tsis zoo li 7 xyoo tom qab ua haujlwm, txawm hais tias cov ntsia hlau siv los kho cov volar phaj yog qhov tseem ceeb hauv qhov thib peb. Peb cov txheej txheem phais kom txo qis qhov kev pheej hmoo ntawm EPL cov leeg pob txha tawg tom qab volar phaj fixation rau distal radius fractures.
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