Lowrie A G, Lees V C
1Ninewells Hospital, Dundee, UK.
J Hand Surg Eur Vol. 2014 Jan;39(1):54-9. doi: 10.1177/1753193413508705. Epub 2013 Oct 29.
The use of the digital flexor sheath to reconstruct damaged structures in the fingers is an intriguing but under-investigated subject. The sheath is anchored firmly to the phalanges and palmar plates and has well-vascularized outer and synovial inner layers. The middle layer is strong and fibrous and not all of it is required for its main biomechanical function of maintaining the moment arm of the flexor tendons. These characteristics have led to several descriptions of different reconstructive uses. In sheath reconstruction, flaps can be used to repair damaged A2 and A4 pulleys. As an anchor, the sheath is useful for tenodeses and tendon transfers. It has been used in the correction of ulnar claw and swan neck deformities. In ligament reconstruction, the A1 pulley has been used to reconstruct the transverse intermetacarpal ligament in cleft hand and ray amputations. The sheath has also been used to cover tendon repairs and periosteal defects with the aim of decreasing adhesions. There is potential for further use of the flexor sheath in reconstructive surgery. The digital flexor sheath can be used to restore various finger functions providing its physiological roles are recognized and preserved. This review considers the different techniques described and their potential uses.
利用指屈肌腱鞘重建手指受损结构是一个有趣但研究不足的课题。腱鞘牢固地附着于指骨和掌板，其外层血管丰富，内层为滑膜层。中间层坚韧且呈纤维状，维持屈肌腱力臂的主要生物力学功能并不需要其全部结构。这些特性引发了对其不同重建用途的多种描述。在腱鞘重建中，皮瓣可用于修复受损的A2和A4滑车。作为一种锚定物，腱鞘可用于肌腱固定术和肌腱转移。它已被用于矫正尺侧爪形手和鹅颈畸形。在韧带重建中，A1滑车已被用于修复裂手和射线截肢中的掌骨间横韧带。腱鞘还被用于覆盖肌腱修复处和骨膜缺损处，以减少粘连。屈肌腱鞘在重建手术中还有进一步应用的潜力。只要认识并保留其生理功能，指屈肌腱鞘可用于恢复手指的多种功能。本文综述了所描述的不同技术及其潜在用途。
