Farr Leela D, Werner Frederick W, McGrattan Michael L, Zwerling Sierra R, Harley Brian J
Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
J Hand Surg Am. 2013 Jan;38(1):35-9. doi: 10.1016/j.jhsa.2012.10.012. Epub 2012 Dec 4.
Early motion therapy protocols are desirable to reduce wrist stiffness after carpal injuries and distal radius fractures. Based on our assumption that a reduction in wrist tendon forces will be associated with a reduction in radioulnar carpal joint reaction force, the goal of this study was to determine the forearm position at which the wrist tendon forces required to initiate wrist motion were the least.
We tested 8 fresh-frozen cadaver forearms in a wrist and forearm motion simulator. In each specimen, we generated a wrist flexion-extension motion and a radioulnar deviation motion by pulling on the wrist flexor and extensor tendons with the forearm in supination, pronation, or neutral. We also performed a wrist flexion-extension motion during active forearm rotation. During each motion, we continuously recorded the forces in the 5 wrist tendons. We used repeated-measure analyses of variance to compare tendon forces.
During the wrist flexion-extension motion, the summed peak wrist extensor forces were significantly less with the wrist in forearm supination than with the forearm in neutral or during active forearm rotation. For the summed peak wrist flexor forces, flexor tendon forces were significantly less with the forearm in supination compared with active forearm rotation. The extensor carpi radialis longus and flexor carpi ulnaris forces were significantly less in supination than during active forearm motion. During wrist radioulnar deviation motion, peak extensor carpi ulnaris force was significantly less with the forearm in supination than in neutral, and peak flexor carpi radialis force was significantly less with the forearm in supination than in pronation.
Peak wrist tendon forces were least in the static forearm supinated position.
To reduce deforming forces on a fresh carpal injury or distal radial fracture, active rehabilitation appears to be best initiated with the forearm held in supination.
早期运动疗法方案有助于减轻腕部损伤和桡骨远端骨折后的腕关节僵硬。基于我们的假设，即腕部肌腱力的降低将与桡尺腕关节反作用力的降低相关联，本研究的目的是确定启动腕关节运动所需的腕部肌腱力最小的前臂位置。
我们在腕部和前臂运动模拟器中测试了8个新鲜冷冻的尸体前臂。在每个标本中，通过在前臂旋前、旋后或中立位时牵拉腕屈肌腱和伸肌腱，我们产生了腕关节屈伸运动和桡尺偏斜运动。我们还在主动前臂旋转过程中进行了腕关节屈伸运动。在每次运动过程中，我们持续记录5条腕部肌腱中的力。我们使用重复测量方差分析来比较肌腱力。
在腕关节屈伸运动中，腕关节处于前臂旋前位时的腕伸肌总峰值力显著低于前臂中立位或主动前臂旋转时。对于腕屈肌总峰值力，前臂旋前位时的屈肌腱力显著低于主动前臂旋转时。桡侧腕长伸肌和尺侧腕屈肌在前臂旋前位时的力显著低于主动前臂运动时。在腕关节桡尺偏斜运动中，前臂旋前位时尺侧腕伸肌的峰值力显著低于中立位，前臂旋前位时桡侧腕屈肌的峰值力显著低于旋后位。
在前臂静态旋前位时，腕部肌腱峰值力最小。
为了减少新鲜腕部损伤或桡骨远端骨折上的变形力，主动康复似乎最好在前臂旋前位开始。
