Jakubietz Michael G, Jakubietz Danni F, Gruenert Joerg G, Zahn Robert, Meffert Rainer H, Jakubietz Rafael G
Julius Maximilian University Wuerzburg, Department of Trauma, Hand, Plastic and Reconstructive Surgery, Wuerzburg, Germany.
J Hand Surg Am. 2011 Apr;36(4):695-8. doi: 10.1016/j.jhsa.2011.01.007.
The reconstruction of tendon defects is challenging. The palmaris longus and plantaris tendon are generally considered best for tendon grafting. Only a few studies have examined whether these tendons, when present, meet criteria for successful grafting. The purpose of this study was to evaluate these tendons in regard to adequacy as tendon grafts.
To evaluate adequacy for grafting, the palmaris longus and plantaris tendons were harvested from 92 arms and legs of 46 cadavers. Macroscopic evaluation and measurements concerning presence, length, and diameter of the tendons were obtained. Criteria for adequacy were a minimum length of 15 cm with diameter of 3 mm or, alternatively, 30 cm with a diameter of 1.5 mm.
The palmaris longus tendon was present bilaterally in 36 cases and was absent bilaterally in 4 cases. The plantaris tendon was present bilaterally in 38 cases and absent bilaterally in 4 cases. In 29 cadavers, the palmaris longus tendon did not meet the criteria to be used as a tendon graft. Only in 8 cases were the tendons satisfactory for grafting bilaterally. The plantaris tendon met criteria for grafting in 20 cases bilaterally. In 17 cases, the tendons were considered inadequate bilaterally.
Despite their presence, the palmaris longus and plantaris tendons are adequate for grafting less often than previously thought. In less than 50%, the tendons, although present, would serve as useful grafts.
Our findings underscore the importance of choosing a second donor site before surgery in case the primarily selected tendon is not found to be suitable.
肌腱缺损的重建具有挑战性。掌长肌腱和跖肌腱通常被认为是肌腱移植的最佳选择。仅有少数研究探讨了这些肌腱在存在时是否符合成功移植的标准。本研究的目的是评估这些肌腱作为肌腱移植物的适用性。
为评估移植的适用性，从46具尸体的92条手臂和腿部获取掌长肌腱和跖肌腱。对肌腱的存在、长度和直径进行宏观评估和测量。适用性标准为最小长度15厘米且直径3毫米，或者长度30厘米且直径1.5毫米。
掌长肌腱双侧存在的有36例，双侧缺如的有4例。跖肌腱双侧存在的有38例，双侧缺如的有4例。在29具尸体中，掌长肌腱不符合用作肌腱移植物的标准。仅有8例双侧肌腱适合移植。跖肌腱双侧符合移植标准的有20例。在17例中，双侧肌腱被认为不适用。
尽管掌长肌腱和跖肌腱存在，但它们适合移植的情况比之前认为的要少。不到50%的情况下，这些肌腱虽然存在，但可作为有用的移植物。
我们的研究结果强调了在手术前选择第二个供区的重要性，以防最初选择的肌腱不合适。
