O'Keefe Kevin D, Werner Frederick W, Boyette Melissa, Palmer Andrew K, Garcia-Elias Marc, Harley Brian J
Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY; Institut Kaplan, Barcelona, Spain.
J Hand Surg Am. 2013 Oct;38(10):1913-8. doi: 10.1016/j.jhsa.2013.07.021. Epub 2013 Sep 8.
To determine whether flexor carpi ulnaris (FCU) forces and tendon displacements change after pisotriquetral arthrodesis or after pisiform excision.
Nine cadaver wrists were moved through 4 variations of a dart throw motion, each having an oblique plane of motion, but with different ranges of motion and different antagonistic forces. The FCU tendon force and movement were measured in the intact wrist, following pisotriquetral arthrodesis, and following pisiform excision. Changes in force and tendon movement were compared using a repeated measures analysis of variance.
After excision of the pisiform, a significantly greater FCU force was required during the 2 variations of the dart throw motion having a larger range of motion and during the smaller motion having a larger antagonistic force. Pisotriquetral arthrodesis did not cause a significant increase in the peak FCU force. Excision of the pisiform caused the FCU tendon to significantly retract during all wrist motions as compared to the intact wrist or after pisotriquetral arthrodesis.
Greater FCU forces are required to move the wrist when the pisiform with its moment arm function has been removed. This occurs during large oblique plane wrist motions and also in a smaller motion when greater antagonistic forces are applied. Excision of the pisiform also allows the FCU to move proximally, again because its moment arm function has been eliminated.
Excision of the pisiform requires greater FCU forces during large wrist motions and during motions that include large gripping forces such that excision may be a concern in high-demand patients with pisotriquetral arthritis. Although pisotriquetral arthrodesis does not alter the mechanical advantage of the FCU, its use in high-demand patients with pisotriquetral osteoarthritis cannot yet be recommended until the effects of that arthrodesis on midcarpal kinematics are further clarified.
确定豌豆三角骨融合术或豌豆骨切除术后尺侧腕屈肌（FCU）的力量及肌腱位移是否发生变化。
对九个尸体手腕进行四种不同的飞镖投掷动作变化测试，每个动作都有一个斜向运动平面，但运动范围和对抗力不同。在完整手腕、豌豆三角骨融合术后以及豌豆骨切除术后，测量FCU肌腱的力量和运动情况。使用重复测量方差分析比较力量和肌腱运动的变化。
切除豌豆骨后，在飞镖投掷动作的两种较大运动范围变化以及较小运动范围但对抗力较大的变化过程中，需要显著更大的FCU力量。豌豆三角骨融合术并未导致FCU力量峰值显著增加。与完整手腕或豌豆三角骨融合术后相比，切除豌豆骨导致FCU肌腱在所有手腕运动中均显著回缩。
当具有力臂功能的豌豆骨被移除后，移动手腕需要更大的FCU力量。这在大斜向平面手腕运动中以及施加更大对抗力的较小运动中都会发生。切除豌豆骨还会使FCU向近端移动，同样是因为其力臂功能已被消除。
切除豌豆骨在大手腕运动以及包括大握力的运动中需要更大的FCU力量，因此对于患有豌豆三角骨关节炎且需求较高的患者，切除豌豆骨可能是一个需要关注的问题。虽然豌豆三角骨融合术不会改变FCU的机械优势，但在其对腕中关节运动学的影响进一步明确之前，尚不能推荐将其用于患有豌豆三角骨骨关节炎且需求较高的患者。
