Harley Brian J, Werner Frederick W, Green Jason K
Department of Orthopedic Surgery, State University of New York Upstate Medical University, Syracuse, NY, USA.
J Hand Surg Am. 2004 Sep;29(5):915-20. doi: 10.1016/j.jhsa.2004.04.017.
The use of early active motion protocols after repair of the thumb ulnar collateral ligament (UCL) theoretically could avoid the complications of postoperative immobilization and improve ligament healing. The goals of this study were as follows: (1) to develop an accurate model of acute UCL rupture, (2) to determine the strain pattern in the UCL during constrained active thumb motion in intact and repaired thumbs, and (3) to determine the load to failure and strain of the UCL during rupture in forced abduction.
Sixteen fresh-frozen adult cadaver thumbs were mounted in a testing apparatus designed for testing the strain in the UCL during constrained active motion and abduction load to failure. Strain data for the UCL during motion were measured. Specimens were tested to failure using an MTS machine. Dynamic strain data were acquired throughout the loading cycle. Repair of the torn ligament was performed with a suture anchor technique. Strain and load-to-failure measurements then were repeated in the repaired specimens. Differences in the strain values and failure forces between the intact and repaired specimens then were compared.
A reliable model of a UCL rupture was created. Strains in the UCL were similar during active motion in both intact and repaired specimens. A significant decrease in maximum load to failure was noted in repaired specimens but failure reliably occurred at strains 3 times greater than expected with active motion.
A controlled active motion therapy protocol after suture anchor repair of a ruptured UCL of the thumb is safe from a biomechanical point of view.
理论上，在拇指尺侧副韧带（UCL）修复后采用早期主动活动方案可避免术后制动的并发症并促进韧带愈合。本研究的目标如下：（1）建立急性UCL断裂的精确模型；（2）确定完整和修复后的拇指在受限主动拇指运动过程中UCL的应变模式；（3）确定在强制外展时UCL断裂时的破坏载荷和应变。
将16个新鲜冷冻的成人尸体拇指安装在一个测试装置中，该装置用于测试受限主动运动和外展破坏载荷过程中UCL的应变。测量运动过程中UCL的应变数据。使用MTS机器对标本进行破坏测试。在整个加载周期中采集动态应变数据。采用缝线锚钉技术修复撕裂的韧带。然后在修复后的标本中重复进行应变和破坏载荷测量。随后比较完整标本和修复标本之间的应变值和破坏力差异。
创建了一个可靠的UCL断裂模型。完整和修复后的标本在主动运动过程中UCL的应变相似。修复后的标本破坏最大载荷显著降低，但破坏时的应变可靠地出现在比主动运动预期大3倍的水平。
从生物力学角度来看，拇指UCL断裂采用缝线锚钉修复后进行可控的主动运动治疗方案是安全的。
