Extensor tendon transposition and hand intrinsic muscle transfer

Extensor tendon displacement and intramuscular infarction for surgical treatment of hand joint rheumatoid arthritis. Treating diseases: rheumatoid arthritis Indication Extensor tendon displacement and intramuscular infarction are suitable for mild and moderate ulnar deviation. The dislocated MP joint is not seriously damaged. The malformation is caused by the ulnar displacement of the flexor and extensor tendon, the internal muscle imbalance and the joint capsule. swelling. Surgical procedure 1. Incision and exposure A transverse arc-shaped incision is made through the metacarpal bone on the back of the hand, from the temporal side of the second metacarpophalangeal joint to the ulnar side of the fifth metacarpophalangeal joint, the skin and subcutaneous tissue are cut open, and the main vein of the back of the hand is carefully separated and protected. The extensor hood was excised from the extensor tendon, and the extensor tendon was freed from the surface of the metacarpophalangeal joint capsule, and the extensor tendon displaced by the ulnar side was released. Cut the switch capsule longitudinally, but do not directly under the tendon cap. 2. Cut off the synovium Separate the joint capsule and synovial membrane, and remove the synovial tissue of the lesion as much as possible. Special attention should be paid to the removal of the synovial membrane from the dorsal side of the metacarpal neck. In severe cases, most of the dorsal joint capsules will be difficult to retain. At the metacarpal head, a small gauze test piece is clamped with the tip of the hemostatic forceps, and the synovial membrane under the collateral ligaments on both sides is gradually removed to avoid ligament injury. 3. Tendon shift The aponeurosis was cut longitudinally on the lateral edge of the medial bundle of the extensor tendon, the tendon was repositioned, the ulnar incision was not sutured, and the extensor tendon was sutured with a 4-0 non-absorbable suture or overlapping suture to make the extensor tendon Maintained on the dorsal side of the metacarpophalangeal joint. If the deviation of the fingertip is obvious, the intrinsic extension finger tendon can be disconnected from the side of the ulnar ulnar, and the finger muscle can be passed under the extension, and the suture is fixed on the side of the extensor tendon. 4. Adductor tendon release shift On the ulnar side edge of the extensor tendon of the finger, the intrinsic tendon abutment point of the hand is cut, and the proximal side is released, and the suture is fixed to the lateral edge of the adjacent finger. Cut off a small section of abductor finger muscles to improve their ruler bias. The index finger can be sutured after the first interosseous tendon is shortened, so as to enhance its traction on the temporal side of the index finger. 5. Stitch the skin incision.