骨科英文书籍精读（177）｜手外伤（16）
TENDONS
Primary suture may have been contraindicated by wound contamination, undue delay between injury and repair, massive skin loss or inadequate operating facilities. In these circumstances secondary repair or tendon grafting may be necessary.
In a late-presenting injury of the profundus tendon with an intact superficialis, advancement of a retracted tendon can cause a flexion deformity of the entire finger. Tendon grafting also is risky: the finger could end up even stiffer. Unless the patient’s work or hobby demands flexion of the distal joint and maximum power in the finger, fusion or tenodesis of the distal interphalangeal joint is a more reliable option.
If both the superficialis and profundus tendons have been divided and have retracted, a tendon graft is needed. Full passive joint movement is a prerequisite.
If the pulley system is in good condition and there are no adhesions, the tendons are excised from the flexor sheath and replaced with a tendon graft (palmaris longus, plantaris or a toe extensor). Rehabilitation is the same as for a primary repair.
If the pulleys are damaged, the skin cover poor, the passive range of movement limited or the sheath scarred, a two-stage procedure is preferred. The tendons are excised and the pulleys reconstructed with extensor retinaculum or excised tendon. A Silastic rod is sutured to the distal stump of the profundus tendon and left free proximally either in the palm or distal forearm. Rehabilitation is planned to maintain a good passive range of movement. A smooth gliding surface
forms around the rod. At least 3 months later, the rod is removed through two smaller incisions and a tendon graft (palmaris longus, plantaris or a lesser toe extensor) is sutured to the proximal and distal stumps of flexor digitorum profundus. Rehabilitation is the same as that for a primary repair.
Tenolysis is sometimes indicated. After flexor tendon repair in Zone II, a poor excursion is not infrequent because of adhesions between the tendons and the sheath. There is some active movement – indicating that the tendon is intact – but not enough for good function. The passive range of movement should be good if the tenolysis is to succeed. The tendons are painstakingly freed through small windows in the flexor sheath.Postoperatively an intensive programme of movement is essential, otherwise there will be even more scar tissue than before and the tenolysis will have made matters worse.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
contraindicate /ˌkɑːntrəˈɪndɪkeɪt/v. 禁忌
undue /ˌʌnˈduː/adj. 过度的，过分的；不适当的；未到期的
late-presenting 晚期
hobby /ˈhɑːbi/n. 嗜好；业余爱好
fusion or tenodesis of the distal interphalangeal joint is a more reliable option.远端指间关节融合或肌腱固定术是一种更可靠的选择。
prerequisite /ˌpriːˈrekwəzɪt/n. 先决条件adj. 首要必备的
pulley /ˈpʊli/n. 滑轮；皮带轮；滑车
retinaculum /ˌretəˈnækjələm/n. 支持带；韧带；
Rehabilitation /ˌriːəˌbɪlɪˈteɪʃn/n. 复原
gliding /ˈɡlaɪdɪŋ/adj. 滑行的；流畅的；滑顺的v. 滑翔；消逝；溜走（glide的ing形式）
Tenolysis腱粘连松解术
painstakingly /ˈpeɪnzteɪkɪŋli/adv. 煞费苦心地；费力地
Postoperatively an intensive programme of movement is essential, otherwise there will be even more scar tissue than before and the tenolysis will have made matters worse.术后加强运动是必要的，否则会有比以前更多的疤痕组织，肌腱松解会使情况变得更糟。
百度翻译：
肌腱
一期缝合可能由于伤口污染、受伤和修复之间的不当延迟、大量皮肤脱落或操作设施不足而禁用。在这种情况下，二次修复或肌腱移植可能是必要的。
在浅表完整的深肌腱迟发性损伤中，前伸肌腱可导致整个鳍的屈曲畸形。肌腱移植也有风险：手指可能会变得更僵硬。除非患者的工作或爱好要求远端关节屈曲和手指最大力量，否则远端指间关节的融合或肌腱固定是更可靠的选择。
如果浅层肌腱和深部肌腱都被分开并缩回，就需要进行肌腱移植。完全被动关节运动是前提。
如果滑轮系统状况良好且无粘连，则从屈肌鞘中切除肌腱，并用肌腱移植（pal maris longus、跖或趾伸肌）代替。修复与大修相同。
如果滑轮损坏、皮肤覆盖不良、被动活动范围受限或护套有疤痕，最好采用两阶段程序。切除10个牙，用伸肌支持带或切除肌腱重建滑轮。硅橡胶棒缝合到深肌腱的远端残端，并在手掌或前臂远端的近端游离。康复计划保持良好的被动活动范围。光滑的滑动面
在杆子周围形成。至少3个月后，通过两个较小的切口取出鱼竿，并在趾深屈肌的近端和远端残端缝合一个10°的移植物（掌长肌、足底肌或小趾伸肌）。康复与初级修复相同。
有时也有肌腱松解症。在II区屈肌腱修复术后，由于肌腱和腱鞘之间的粘连，不良的偏移并不少见。有一些积极的运动-表明肌腱是完整的-但不足以良好的功能。如果肌腱松解术要成功，被动活动范围应该是好的。肌腱通过屈肌鞘上的小窗口艰难地释放出来。术后必须加强活动，否则会有更多的疤痕组织，肌腱松解术会使情况恶化。