Tang Jin Bo, Cao Yi, Wu Ya Fang, Wang Gu Heng
Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
J Hand Surg Am. 2009 Jul-Aug;34(6):1080-7. doi: 10.1016/j.jhsa.2009.04.010.
Release of part of the A2 pulley has been suggested to improve function after zone II primary flexor tendon repairs. The purpose of this study was to measure the effect of A2 pulley release compared with pulley preservation on repaired tendon gliding resistance and rupture in the early postoperative period in a chicken model.
We divided 104 long toes from 52 Leghorn chickens into 2 experimental groups. In group 1, the flexor digitorum profundus tendons were cut completely and repaired surgically with either release or preservation of the A2 pulley. The tendon laceration was positioned so that the repair had to glide through the pulley with toe flexion. The toes were subjected to simulated active flexion at the end of the 2nd and 4th postsurgical weeks. The rupture rates of the tendons were recorded. In group 2, the volar two thirds of the tendons were cut and repaired, also in the region of the A2 pulley, with the pulley released or preserved. The force resisting tendon motion and the work of digital flexion with simulated active digital flexion were tested 3, 5, 7, and 14 days after surgery.
At the end of the 2nd and 4th weeks, the tendon repairs showed significantly higher rates of rupture in the presence of an intact A2 pulley compared with those with the pulley released. Tendon gliding resistance was significantly increased with preservation of the pulley on postsurgical days 3, 5, 7, and 14; these toes required a greater number of motion cycles to reach steady levels of resistance and showed significantly higher steady resistance after digital motion.
Release of the A2 pulley decreases the rate of repair rupture and the resistance to tendon gliding when the site of tendon repair has to glide through the pulley in the early postsurgical period. The findings of this study support partial release of the A2 pulley to favor successful tendon repair.
有人提出，在Ⅱ区原发性屈肌腱修复术后，部分松解A2滑车可改善功能。本研究的目的是在鸡模型中，比较保留滑车与松解A2滑车对术后早期修复肌腱滑动阻力和断裂的影响。
我们将52只来亨鸡的104根长趾分为2个实验组。在第1组中，将趾深屈肌腱完全切断，并在松解或保留A2滑车的情况下进行手术修复。肌腱撕裂的位置使得修复后的肌腱在脚趾屈曲时必须通过滑车滑动。在术后第2周和第4周结束时，对脚趾进行模拟主动屈曲。记录肌腱的断裂率。在第2组中，也在A2滑车区域切断并修复肌腱掌侧的三分之二，滑车松解或保留。在术后3、5、7和14天测试抵抗肌腱运动的力以及模拟主动趾屈曲时的趾屈功。
在第2周和第4周结束时，与松解滑车的肌腱修复相比，完整保留A2滑车时肌腱修复的断裂率显著更高。在术后第3、5、7和14天保留滑车时，肌腱滑动阻力显著增加；这些脚趾需要更多的运动周期才能达到稳定的阻力水平，并且在趾运动后显示出显著更高的稳定阻力。
当肌腱修复部位在术后早期必须通过滑车滑动时，松解A2滑车可降低修复断裂率和肌腱滑动阻力。本研究结果支持部分松解A2滑车以利于肌腱修复成功。
