Wilhelmi B J, Snyder N, Verbesey J E, Ganchi P A, Lee W P
Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Plast Reconstr Surg. 2001 Sep 15;108(4):908-15. doi: 10.1097/00006534-200109150-00014.
The purpose of this study was to identify surface landmark ratios to locate the A1 pulley and clarify the controversy of differing anatomic descriptions of the A1, C0, and A2 pulleys. Minimally invasive and percutaneous approaches to A1 pulley release may be facilitated with surface landmark ratios, which identify and predict the proximal and distal margins of the A1 pulley. Two-hundred fifty-sixty fingers were dissected in 64 preserved cadaver hands. Measurements of A1 pulley lengths and pulley margins in relation to surface landmarks were obtained. We found that the distance from the palmar digital crease to the proximal interphalangeal crease (mean, 2.42 +/- 0.03 cm) corresponds to the distance of the proximal edge of the A1 pulley from the palmar digital crease (mean, 2.45 +/- 0.03 cm). The mean absolute difference between these two measured distances in each finger was 0.13 cm, with a 95 percent confidence interval of 0.11 to 0.14 cm. Thus, the distance between the palmar digital crease and the proximal interphalangeal crease can be used to predict the distance between the palmar digital crease and the A1 pulley proximal edge with reasonable accuracy. A1 pulley length averaged 0.98 +/- 0.02 cm for the small finger and 1.17 +/- 0.02 cm for the index, middle, and ring fingers. The length of the A1 pulley was significantly shorter (p < 0.001) for the small finger than for the index, middle, and ring fingers. Additionally, a cruciate (C0) pulley was consistently located between the A1 and A2 pulleys, an average of 0.46 cm proximal to the palmar digital crease, which can serve as guide for concluding the release of the A1 pulley. Clinically, hand surface landmark ratios were used to release 32 trigger fingers with a minimally invasive technique, without a complication during 4- to 30-week follow-up. We conclude that hand surface landmark ratios can serve to locate the proximal A1 pulley edge, thus facilitating complete trigger finger release by either open or minimally invasive techniques. Additionally, our study clarifies the discrepancy of prior smaller reports of the pulley system anatomy regarding the existence of the C0 pulley between the A1 and A2 pulleys. The cruciate fibers of this C0 pulley can serve as the distal boundary for release of trigger finger.
本研究的目的是确定用于定位A1滑车的体表标志比例，并澄清关于A1、C0和A2滑车不同解剖描述的争议。体表标志比例可能有助于A1滑车松解的微创和经皮入路，其可识别并预测A1滑车的近端和远端边缘。在64只保存的尸体手上解剖了256根手指。获得了A1滑车长度及滑车边缘相对于体表标志的测量值。我们发现，从掌指横纹到近端指间横纹的距离（平均2.42±0.03 cm）与A1滑车近端边缘到掌指横纹的距离（平均2.45±0.03 cm）相对应。每根手指这两个测量距离之间的平均绝对差值为0.13 cm，95%置信区间为0.11至0.14 cm。因此，掌指横纹与近端指间横纹之间的距离可用于较为准确地预测掌指横纹与A1滑车近端边缘之间的距离。小指的A1滑车长度平均为0.98±0.02 cm，示指、中指和环指的平均长度为1.17±0.02 cm。小指的A1滑车长度明显短于示指、中指和环指（p<0.001）。此外，十字形（C0）滑车始终位于A1和A2滑车之间，平均位于掌指横纹近端0.46 cm处，这可作为判断A1滑车松解是否完成的标志。临床上，采用体表标志比例通过微创技术松解了32例扳机指，在4至30周的随访期间无并发症发生。我们得出结论，手部体表标志比例可用于定位A1滑车近端边缘，从而便于通过开放或微创技术完全松解扳机指。此外，我们的研究澄清了先前关于滑车系统解剖的较小报告中关于A1和A2滑车之间C0滑车存在与否的差异。该C0滑车的十字形纤维可作为扳机指松解的远端边界。
