Kennedy J A, Dias J J
University of Leicester, Leicester, UK
Department of Health Sciences, Leicester General Hospital, Leicester, UK.
J Hand Surg Eur Vol. 2014 Sep;39(7):708-13. doi: 10.1177/1753193413490898. Epub 2013 Jun 3.
The optimal management of partial flexor tendon laceration is controversial and remains a clinical challenge. Abnormal tendon gliding (triggering and entrapment) was assessed at the A2 pulley in 40 turkey tendons in three groups: intact, partially divided (palmar or lateral), and trimmed. Testing was of gliding resistance and friction coefficient at 30° and 70° of flexion, loaded with 2 and 4 N. We observed for triggering and entrapment. The changes in gliding properties were compared and analysed using Wilcoxon matched pair testing. A significant difference was found in the change in gliding properties of intact to lacerated and lacerated to trimmed tendons and between tendons that glided normally compared with those exhibiting triggering or entrapment. This suggests that palmar and lateral lacerations which, through clinical examination and visualization, are found to glide normally should be treated with early mobilization. However, partial lacerations that exhibit triggering or entrapment should be trimmed.
部分屈肌腱撕裂伤的最佳处理方法存在争议,仍是一项临床挑战。在A2滑车处对三组共40条火鸡肌腱的异常肌腱滑动(卡顿和卡压)情况进行了评估:完整组、部分切断组(掌侧或外侧)和修整组。测试在30°和70°屈曲时的滑动阻力和摩擦系数,加载力为2 N和4 N。观察是否存在卡顿和卡压情况。使用Wilcoxon配对检验对滑动特性的变化进行比较和分析。发现完整肌腱与撕裂肌腱以及撕裂肌腱与修整肌腱之间的滑动特性变化存在显著差异,并且正常滑动的肌腱与出现卡顿或卡压的肌腱之间也存在显著差异。这表明,经临床检查和可视化发现能正常滑动的掌侧和外侧撕裂伤应尽早进行活动治疗。然而,出现卡顿或卡压的部分撕裂伤则应进行修整。