Ettema Anke M, An Kai-Nan, Zhao Chunfeng, O'Byrne Megan M, Amadio Peter C
Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
J Biomech. 2008;41(2):292-8. doi: 10.1016/j.jbiomech.2007.09.017. Epub 2007 Oct 22.
The characteristic pathological finding in carpal tunnel syndrome (CTS) is non-inflammatory fibrosis of the subsynovial connective tissue (SSCT), which lies between the flexor tendons and the visceral synovium (VS). How this fibrosis might affect tendon function is unknown. To better understand the normal function of the SSCT, the relative motion of the middle finger flexor digitorum superficialis (FDS III) tendon and VS was observed during finger flexion in patients with CTS and cadavers with a history of CTS and compared to normal cadavers. A digital camcorder was used to monitor the gliding motion of the FDS III tendon and SSCT in eight patients with idiopathic CTS undergoing carpal tunnel release surgery (CTR), in eight cadavers with an antemortem history of CTS and compared these with eight cadaver controls. There were no significant differences noted in the total movement of the SSCT relative to the FDS III. However, the pattern of SSCT movement relative to the FDS III in the CTS patients and cadavers with an antemortem history of CTS differed from the controls in one of two patterns, reflecting either increased SSCT adherence to FDS III or increased SSCT dissociation from FDS III. In CTS, the gliding characteristics of the SSCT are qualitatively altered. These changes may be the result of increased fibrosis within the SSCT, which in some cases has ruptured, resulting in SSCT-tendon dissociation. Similar changes are also identified postmortem in the CTS patient.
腕管综合征（CTS）的特征性病理表现是位于屈肌腱和脏层滑膜（VS）之间的滑膜下结缔组织（SSCT）出现非炎性纤维化。这种纤维化如何影响肌腱功能尚不清楚。为了更好地理解SSCT的正常功能，观察了CTS患者和有CTS病史的尸体在手指屈曲过程中示指浅屈肌腱（FDS III）与VS的相对运动，并与正常尸体进行比较。使用数码摄像机监测8例接受腕管松解术（CTR）的特发性CTS患者、8例有生前CTS病史的尸体中FDS III肌腱和SSCT的滑动运动，并将其与8例尸体对照进行比较。相对于FDS III，SSCT的总移动量没有显著差异。然而，CTS患者和有生前CTS病史的尸体中，SSCT相对于FDS III的移动模式与对照组在两种模式中的一种不同，这反映出SSCT与FDS III的粘连增加或SSCT与FDS III的分离增加。在CTS中，SSCT的滑动特性发生了质性改变。这些变化可能是SSCT内纤维化增加的结果，在某些情况下，纤维化已经破裂，导致SSCT与肌腱分离。在CTS患者的尸体中也发现了类似的变化。
