[Reconstruction of the Extensor Apparatus of the Wrist and the Hand in RA.].
Reconstruction of the extensor apparatus of the wrist and the hand is one of the common rheumato-surgical operations. Primary suture of the tendon which produces the best results is only rarely possible. The patient usually attends late, very frequently does not even notice at first an isolated rupture of the extensor. The authors recorded in a group of 39 rheumato-surgical operations of the wrist a disorder of the extensor apparatus in 14 instances. In nine instances the repair of the extensor was part of a total arthrodesis of the carpus, in two instances part of simple synovectomy, in one instance the authors repaired extensors in conjunction with radio-lunate desis and in one instance in conjunction with the solution of a caput ulnae syndrome operation according to Sauvé-Kapandji. Discontinuation of the tendon of the m. extensor pollicis longus was found three times, discontinuation of the tendon of the fourth finger five times, of the fifth finger three times, of the third finger also three times. Repair was achieved by several approaches. In two instances where the retraction of tendinous stumps was minimal they made an "end-to-end" suture. Twice they used a free bridging graft, collected from the m. palmaris longus. Tendon transposition was used five times, five times they used the course of intact neighbouring tendons to fix to them distal stumps of the discontinued extensors by the "end-to-side" or "side-to-side" method. The functional gain was beyond doubt in all patients, the smallerst deficit of extension of the finger, assessed six months after operation, was recorded in direct suture and in tendinous transposition. The greatest deficit of extension was recorded by the authors when they used a free graft. In cases of multiple rupture of tendons the authors used a combination of several methods of repair, depending on the surgical finding. Key words: rheumatic destruction of the carpus, rheumatic synovialitis of the hand, repair of the extensors of the hand.
Pech
J
J
Ortopedická klinika 1. lékarské fakulty KU, Praha.
Popelka
S
S