Doyle J R
John A. Burns School of Medicine, University of Hawaii, Honolulu, USA.
Clin Orthop Relat Res. 2001 Feb(383):84-96. doi: 10.1097/00003086-200102000-00011.
Retinacular structures, called pulleys, maintain the flexor tendons of the hand in constant relationship to the joint axes and promote economy and efficiency in finger flexion. This system is composed of the transverse carpal ligament, the palmar aponeurosis pulley, and the digital flexor pulley system. Of these three components, the digital pulleys are the most critical to finger flexion. In their normal state, these pulley components are ideal in all aspects including configuration and location, which accomodates a 260 degrees arc of motion without impingement and with minimum friction while at the same time using muscle tendon excursion that is well within the natural range of the muscle. An absent pulley results in an increased moment arm and requires increased tendon excursion to produce the same arc of motion. Because muscle excursion is not a limitless factor and is directly proportional to muscle fiber length, the effectiveness of tendon excursion is dependent on maintenance of the critical relationship between pulleys and the adjacent joints. Preservation and reconstruction of this system is based on knowledge of the anatomy and an understanding of the relative functional significance of each component of the system.
被称为滑车的支持带结构，可使手部的屈肌腱与关节轴保持恒定关系，并提高手指屈曲的经济性和效率。该系统由腕横韧带、掌腱膜滑车和指屈肌滑车系统组成。在这三个组成部分中，指滑车对手指屈曲最为关键。在正常状态下，这些滑车组成部分在各个方面都是理想的，包括形态和位置，可适应260度的运动弧度而无撞击且摩擦最小，同时使用的肌腱移动幅度完全在肌肉的自然范围内。滑车缺失会导致力臂增加，并且需要增加肌腱移动幅度才能产生相同的运动弧度。由于肌肉移动幅度并非无限因素且与肌纤维长度成正比，因此肌腱移动幅度的有效性取决于滑车与相邻关节之间关键关系的维持。该系统的保留和重建基于解剖学知识以及对系统各组成部分相对功能重要性的理解。
