کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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4070424 | 1604422 | 2010 | 6 صفحه PDF | دانلود رایگان |
PurposeThis retrospective study documents the results of primary enlargement of tendon sheath pulleys by incision and extensor retinaculum graft repair during flexor tendon repairs in zone 2 in 9 fingers.MethodsThe entire A2 or A4 pulley was enlarged by complete incision and repaired with an interposed extensor retinaculum graft at the time of primary flexor tendon repair in a total of 9 fingers in 7 patients, ages 15 to 54 years. The indication for primary pulley enlargement was failure of the tendon repair to glide smoothly and without snagging through the normally tight-fitting pulley system. In no case was more than one major pulley enlarged, and the entire A1 pulley was never enlarged. The zone 2 tendon repairs were done using a 2-strand modified Kessler 3-0 core suture and a 6-0 nylon running circumferential suture. The follow-up averaged 3.6 years. Interphalangeal total active motion and Strickland-Glogovac grade in patients with adequate follow-up of more than 6 months or obtaining full range of motion were obtained from a retrospective chart review.ResultsInterphalangeal total active motion averaged 127° and the scores according to the Strickland-Glogovac system were excellent for 3, good for 2, fair for 2, and poor for 2. There were no tendon ruptures. Two fingers in one patient required a tenolysis and a third finger had secondary skin scar lengthening. Two fingers had visible and palpable bowstringing when seen at long-term follow-up and there was an average flexion contracture of 21°.ConclusionsPrimary pulley enlargement using a free graft in zone 2 tendon injuries may achieve the 3 goals of providing a good gliding environment, avoiding triggering, and minimizing bowstringing. These initial clinical outcomes are average for zone 2 tendon repair, but encouraging. Further research and refinement in surgical technique and rehabilitation method are needed to minimize flexion contractures.Type of study/level of evidenceTherapeutic IV.
Journal: The Journal of Hand Surgery - Volume 35, Issue 5, May 2010, Pages 785–790