Murat KAYALAR, Emin BAL, Tulgar TOROS, Tahir SÜĞÜN, Beray KELEŞOĞLU, İbrahim KAPLAN

Üçüncü bölge ekstansör tendon izole yaralanmalarında tedavi sonuçları

Amaç: Üçüncü bölgede izole ekstansör tendon kesisi olan hastalarda uygulanan cerrahi onarım ve ﬁzik tedavinin geç dönem sonuçları geriye dönük olarak incelendi. Çalışma planı: Üçüncü bölgede izole basit santral slip ekstansör tendon yaralanması nedeniyle cerrahi onarım uygulanan 16 hasta (13 erkek, 3 kadın; ort. yaş 28; dağılım 11-57) çalışmaya alındı. Yaralanan parmaklar 2. parmak (n=7), 3. parmak (n=3), 4. parmak (n=2) ve 5. parmak (n=4) idi. On dört hastada tendon onarımı primer yapıldı. İki hastada girişim sırasıyla bir hafta ve iki aylık gecikmeyle yapıldı. Dört hastada modiﬁye Kessler ve epitendinöz dikiş, 12 hastada kilitli devamlı dikiş kullanıldı. Tendon onarımı sonrasında üç hastada iki hafta süreyle ekstansiyonda K-teli ile tespit uygulanırken, 13 hastaya kısa ark hareket programı uygulandı. Hastalar son kontrolde proksimal interfalengeal (PİF) eklem hareket açıklığı ve ekstansiyon kaybı açısından değerlendirildi. Sonuçlar, Strick- land formülü kullanılarak değerlendirildi. Ortalama izlem süresi 58 ay (dağılım 8-120 ay) idi. Sonuçlar: Proksimal interfalengeal eklem hareket açıklığı 15 hastada (%93.8) tam bulundu. Ortalama PİF eklem hareket açıklığı 89 derece idi. Bir hastada (%6.3) PİF eklem hareket açıklığında 10º ﬂeksiyon kaybı görüldü. K-teli ile tespit uygulanan üç hastada hareket açıklığında kayıp gözlenmedi. Strickland ortalaması %94.8 (dağılım %74-100) bulundu. On beş hastada (%93.8) çok iyi, bir hastada (%6.3) iyi sonuç elde edildi. Hastaların tamamı sorunsuz olarak işlerine döndü. Hiçbir olguda geç dönemde düğme iliği deformitesi, yumuşak doku komplikasyonu gözlenmedi. Çıkarımlar: İzole üçüncü bölge ekstansör tendon yaralanmalarında, uygun dikiş tekniği ve kısa ark hareket programı ile iyi sonuçlar elde edilebilir.

Anahtar Kelimeler:

El parmağı yaralanmaları, Ameliyat sonrası dönem, Geriyedönük çalışma, Ateller, Tendon yaralanmaları, Hareket açıklığı, eklem

The results of treatment for isolated zone 3 extensor tendon injuries

Objectives: We evaluated late-term results of surgical repair and physical rehabilitation of isolated zone 3 extensor tendon injuries. Methods: Sixteen patients (13 males, 3 females; mean age 28 years; range 11 to 57 years) underwent surgical repair for isolated simple central slip injuries of zone 3 extensor tendon. Injuries involved the second, third, fourth, and ﬁfth ﬁngers in seven, three, two, and four patients, respectively. Primary tendon repair was performed in 14 patients. Two patients were treated after one week and two months following primary injury, respectively. Tendons were repaired by modiﬁed Kessler and epitendinous sutures in four patients, and by locking running suture in 12 patients. Following surgical repair, three patients underwent K-wire ﬁxation in extension for two weeks, while 13 patients received the short arc motion protocol. The patients were assessed with respect to proximal interphalangeal (PIP) joint motion and extension loss. Functional results were assessed using the Strickland formula. The mean follow-up was 58 months (range 8 to 120 months). Results: Full range of motion of the PIP joint was achieved in 15 patients (93.8%). The mean PIP joint motion was 98 degrees. One patient (6.3%) had an extension loss of 10 degrees in the range of motion of the PIP joint. There were no losses in the range of motion in three patients treated with K-wire ﬁxation. The mean of the Strickland formula was 94.8% (range 74% to 100%), showing an excellent result in 15 patients (98.3%) and a good result in one patient (6.3%). All the patients returned to their pre-injury work status. None had buttonhole deformity or soft tissue complication. Conclusion: A proper suture technique combined with the short arc motion protocol provides good results in the treatment of isolated zone 3 extensor tendon injuries.

Keywords:

Finger Injuries, Postoperative Period, Retrospective Studies, Splints, Tendon Injuries, Range of Motion, Articular,

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