Yamaguchi Taihei, Osamura Naoki, Zhao Chunfeng, An Kai-Nan, Amadio Peter C
Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic College of Medicine, Rochester, MN, USA.
J Hand Surg Am. 2008 Jul-Aug;33(6):888-92. doi: 10.1016/j.jhsa.2008.02.017.
The normal gliding environment in the carpal tunnel is complex. The median nerve and flexor tendons are surrounded by a multilayered subsynovial tissue. To date, observations of the relative motions of the flexor tendon, median nerve and multilayered subsynovial tissue have been through a surgically released open carpal tunnel. The purpose of this study was to compare the motions of these tissues in an intact and open carpal tunnel.
We measured the relative motion of the middle finger flexor digitorum superficialis tendon, its surrounding subsynovial connective tissue (SSCT) and the median nerve in 8 human cadavers. The flexor retinaculum was used as a fixed reference point. The motions were compared for simulated isolated middle finger and simulated fist motion as measured fluoroscopically in the closed carpal tunnel and directly in the open carpal tunnel.
While the simulated isolated finger motion produced significantly less SSCT and median nerve motion (p<.05), there was no difference in flexor digitorum superficialis, SSCT, or nerve motion when comparing the fluoroscopic measurements in the closed carpal tunnel with the direct visual measurements in the open carpal tunnel.
Relative motion of the flexor tendons, SSCT, and median nerve within the carpal tunnel follows a certain pattern, which may indicate the physiological state of the SSCT. This relative motion pattern was not affected by flexor retinaculum release.
腕管内正常的滑动环境较为复杂。正中神经和屈肌腱被多层滑膜下组织所包围。迄今为止，对于屈肌腱、正中神经和多层滑膜下组织相对运动的观察都是通过手术切开的腕管进行的。本研究的目的是比较这些组织在完整腕管和切开腕管中的运动情况。
我们在8具人体尸体上测量了示指浅屈肌腱、其周围的滑膜下结缔组织（SSCT）和正中神经的相对运动。屈肌支持带被用作固定参考点。比较了在闭合腕管中通过荧光透视测量以及在切开腕管中直接测量所得到的模拟孤立示指运动和模拟握拳运动时的运动情况。
虽然模拟孤立手指运动时SSCT和正中神经的运动明显较少（p<0.05），但比较闭合腕管中的荧光透视测量结果与切开腕管中的直接视觉测量结果时，示指浅屈肌、SSCT或神经的运动并无差异。
腕管内屈肌腱、SSCT和正中神经的相对运动遵循一定模式，这可能表明SSCT的生理状态。这种相对运动模式不受屈肌支持带松解的影响。
