橈骨遠位端骨折の術後に生じた長母指屈筋腱断裂例とその予防策について

Prevention of Flexor Pollicis Longus Tendon Rupture after Volar Plating for Distal Radius Fractures

　背景：橈骨遠位端骨折に対する掌側プレートの合併症として長母指屈筋腱断裂が問題視されている．今回，われわれの経験した腱断裂例ならびに「腱刺激症状」を認める例に抜釘を行う腱断裂予防策の妥当性について検討した．

　対象：Acu-Loc^® distal radius plate systemを用いて骨接合術を行い，骨癒合後に抜釘を行った28手を対象とした．

　結果：腱刺激症状は28手中22手に認めた．抜釘時における腱の粗雑化を28手中7例に認めた．腱の粗雑化に関する腱刺激症状の感度は100％，特異度は28.6％であった．

　まとめ：腱刺激症状の評価は腱断裂予防策として有用であると考えられた．

　Background：Flexor pollicis longus (FPL) tendon rupture has been highlighted as a complication after volar plating for distal radius fractures.　We reviewed 8 cases of FPL tendon rupture and assessed the validity of our policy of recommending hardware removal in "tendon irritation sign" cases.

　Methods：We evaluated 28 wrists all of which had been treated for a distal radius fracture with the Acu-Loc^® distal radius plate system (ACUMED LLC, USA).

　Results：The "tendon irritation sign" was positive in 22 of the 28 wrists.　We intra-operatively diagnosed frayed tendons in 7 wrists.　The sensitivity of the "tendon irritation sign" for frayed FPL tendons was 100%, and its specificity was 28.6%.

　Conclusions：Evaluation for the "tendon irritation sign" was useful as a means of preventing flexor pollicis longus tendon rupture.