Reparación del tendón extensor pollicis longus, mediante la técnica del lazo con el extensor pollicis brevis

Resumen

Introducción Se presenta una alternativa quirúrgica a las técnicas convencionales para reparación de lesiones por herida o por mecanismo cerrado del tendón EPL, denominada lazo transfixiante y contínuo; el cual emplea el tendón de anclaje motor procedente del músculo EPB (Extensor Pollicis Brevis). El objetivo fundamental del estudio fue explicar el desarrollo de esa técnica y los resultados satisfactorios que muestra en la reparación de las lesiones completas del EPL.

Material y método  Se describe un nuevo nudo, conocido como lazo transfixiante y continuo, el cual emplea el tendón de anclaje motor procedente del músculo EPB (Extensor Pollicis Brevis), uniendo el tendón EPL lesionado con el tendón EPB, envolviendo a éste, sin desinsertar la unidad motora del EPB, recuperando con ello la función extensora del primer dedo de la mano. Se seleccionó una serie de 10 casos de rotura del EPL reparados con esa técnica, en contexto de accidente laboral. Se tomaron como variables; edad, profesión, sexo, lateralidad, dominancia, mecanismo lesional, momento de la intervención y presencia de lesiones asociadas. Seis de los casos se produjeron por mecanismo lesional cerrado (60%), y los 4 casos restantes mediante herida (40%).

Resultados. Al finalizar el proceso, 9 pacientes presentaron como resultado curado (90%), mientras que sólo 1 de ellos resultado baremo (10%). No se observaron diferencias entre la extremidad sana y la extremidad operada en movilidad y en cuanto a resultados funcionales mediante tres mediciones; prensión, pinza terminoterminal y pinza lateral.

Discusión el lazo continuo transfixiante para la reparación de lesiones del tendón EPL empleando el tendón EPB es un procedimiento que genera un rango funcional efectivo. Aporta unos resultados satisfactorios, en cuanto a la funcionalidad objetivada a través de test biomecánicos, alcanzando adecuada tasa de reincorporación laboral.

Abstract

Introduction There are many conventional techniques for repairing the EPL tendon (extensor pollicis longus). A surgical alternative is presented to these techniques for repair of open or closed mechanism of injury of EPL tendon, called transfixiant continuous loop; which uses the EPB (extensor pollicis brevis) as a motor unit. The main objective of the study, was to explain the development of this technique and the good results shown in the repair of the complete injuries of EPL.

Material and Methods A new knot is described, known as a transfixiant and continuous loop, which uses the motor anchorage tendon from the EPB muscle, uniting the tendon injured with the EPB tendon, wrapping it without uninsert the motor unit of EPB, thus recovering the function. We selected a serie of 10 cases of rupture of EPL repaired with this technique, in context of work accident. Were taken as variables: age, profession, sex, laterality, dominance, lesion mechanism, moment of intervention and presence of associated injuries. 6 of the cases were produced by closed mechanism (60%) and the 4 remaining cases by wound (40%).

Results At the end of the process, 9 patients presented as a cure result (90%), while only 1 of them result scale (10%). No difference was observed between the healthy limb and the extremity operated in the functional results by means of three measurements; grip, clamp and side caliper.

Discussion The transfixiant continuous loop for repairing the injuries of EPL tendon using the EPB tendon is a procedure that generates an effective functional range. It provides satisfactory results, in terms of objective functionality through biomechanical testing, reaching the right rate of labour reincorporation.

Palabras Clave

reparación del tendón extensor pollicis longus - transferencias tendinosas en la mano - extensor pollicis longus

Keywords

extensor pollicis longus repair - hand tendon transfers - extensor pollicis longus

• Bibliografía

• 1 Kim CH. Spontaneous rupture of the extensor pollicis longus tendon. Arch Plast Surg 2012; 39 (06) 680-682
• 2 Figl M, Mayer M, Lederer S, Bogner R, Leixnering M. Extensor pollicis longus rupture after distal radius fracture: results of reconstruction by transposition of the extensor indicis tendon and postoperative dynamic splinting. Wien Klin Wochenschr 2011; 123 (15-16): 485-487
• 3 Naito K, Sugiyama Y, Dilokhuttakarn T. , y col . A survey of extensor pollicis longus tendon injury at the time of distal radius fractures. Injury 2017; 48 (04) 925-929
• 4 Pal JN, Bera AK, Roy AN, Bari W. Palmaris longus tendon grafting for extensor pollicis longus tendon rupture by screw tip after 20 years. J Orthop Case Rep 2016; 6 (03) 25-27
• 5 Pillukat T, Prommersberger KJ, van Schoonhoven J. [Comparison of the results between reconstruction of the extensor pollicis longus tendon using a free interposition tendon graft and extensor indicis transposition]. Handchir Mikrochir Plast Chir 2008; 40 (03) 160-164
• 6 Magnussen PA, Harvey FJ, Tonkin MA. Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon. J Bone Joint Surg Br 1990; 72 (05) 881-883
• 7 Evans RB. Therapeutic management of extensor tendon injuries. Hand Clin 1986; 2 (01) 157-169
• 8 Gelb RI. Tendon transfer for rupture of the extensor pollicis longus. Hand Clin 1995; 11 (03) 411-422
• 9 Chitnis SL, Evans DM. Tendon transfer to restore extension of the thumb using abductor pollicis longus. J Hand Surg [Br] 1993; 18 (02) 234-238
• 10 Bullón A, Bravo E, Zarbahsh S, Barco R. Reconstruction after chronic extensor pollicis longus ruptures: a new technique. Clin Orthop Relat Res 2007; 462 (462) 93-98
• 11 Justan I, Dvořák Z, Kubek T, Hýža P, Stupka I, Veselý J. [Treatment of a ruptured extensor policis longus tendon by extensor carpi radialis longus transfer]. Acta Chir Orthop Traumatol Cech 2012; 79 (04) 367-369
• 12 Diao E, Hariharan JS, Soejima O, Lotz JC. Effect of peripheral suture depth on strength of tendon repairs. J Hand Surg Am 1996; 21 (02) 234-239
• 13 Wu YF, Cao Y, Zhou YL, Tang JB. Biomechanical comparisons of four-strand tendon repairs with double-stranded sutures: effects of different locks and suture geometry. J Hand Surg Eur Vol 2011; 36 (01) 34-39
• 14 Jeon SH, Chung MS, Baek GH, Lee YH, Kim SH, Gong HS. Comparison of loop-tendon versus end-weave methods for tendon transfer or grafting in rabbits. J Hand Surg Am 2009; 34 (06) 1074-1079
• 15 Kulikov YI, Dodd S, Gheduzzi S, Miles AW, Giddins GE. An in vitro biomechanical study comparing the spiral linking technique against the pulvertaft weave for tendon repair. J Hand Surg Eur Vol 2007; 32 (04) 377-381
• 16 Bidic SM, Varshney A, Ruff MD, Orenstein HH. Biomechanical comparison of lasso, Pulvertaft weave, and side-by-side tendon repairs. Plast Reconstr Surg 2009; 124 (02) 567-571
• 17 Pulvertaft RG. Tendon grafts for flexor tendon injuries in the fingers and thumb; a study of technique and results. J Bone Joint Surg Br 1956; 38-B [phone]
• 18 Adler L, Blazar P, Lee B. Acute attenuation of the extensor pollicis longus tendon. A case report. Clin Orthop Relat Res 1997; (345) 171-173
• 19 Kleinert HE, Verdan C. Report of the Committee on Tendon Injuries (International Federation of Societies for Surgery of the Hand). J Hand Surg Am 1983; 8 (5 Pt 2): 794-798
• 20 https://es.scribd.com/document/47698551/ntp-177
• 21 Cui S, Yang G, Li Q. , y col . Tendon transfer to restore the extension of the thumb using the extensor carpi radialis brevis: A long-term follow-up. J Plast Reconstr Aesthet Surg 2017; 70 (11) 1577-1581 ; [ Epub ahead of print ]. Doi: 10.1016/j.bjps.2017.07.002
• 22 Noorda RJP, Hage JJ. Extensor indicis proprius transfer for loss of extensor pollicis longus function. Arch Orthop Trauma Surg 1994; 113 (06) 327-329
• 23 Magnell TD, Pochron MD, Condit DP. The intercalated tendon graft for treatment of extensor pollicis longus tendon rupture. J Hand Surg Am 1988; 13 (01) 105-109
• 24 Lobo-Escolar L, López Moreno I, Montoya MP, Bosch-Aguilá M. Functional Recovery Following an L-Lengthening Local Tendon Flap for Extensor Pollicis Longus Chronic Ruptures. J Hand Surg Am 2017; 42 (01) e41-e47
• 25 Abad JM, Garcia-Lopez I, Torrejón EF, Garcia de Lucas F. A loop suture for dynamic tendon transfer in the repair of chronic or acute extensor pollicis longus ruptures. Tech Hand Up Extrem Surg 2014; 18 (02) 62-65
• 26 Strauch RJ, Strauch CB. Extensor pollicis brevis tendon can hyperextend thumb interphalangeal joint in absence of extensor pollicis longus: Case report and review of the literature. World J Orthop 2016; 7 (07) 448-451
• 27 Brunelli GA, Brunelli GR. Anatomy of the extensor pollicis brevis muscle. J Hand Surg [Br] 1992; 17 (03) 267-269
• 28 Alemohammad AM, Yazaki N, Morris RP, Buford WL, Viegas SF. Thumb interphalangeal joint extension by the extensor pollicis brevis: association with a subcompartment and de Quervain's disease. J Hand Surg Am 2009; 34 (04) 719-723