在指浅屈肌（FDS）和指深屈肌（FDP）Ⅱ区修复中，滑车重建对最大屈曲、弓弦状畸形及滑动系数的影响：一项尸体研究

The Effect of Pulley Reconstruction on Maximum Flexion, Bowstringing, and Gliding Coefficient in the Setting of Zone II Repair of FDS and FDP: a Cadaveric Investigation.

作者信息

Stanbury Spencer J, English Christopher, Yaseen Zaneb, Reed Jeffrey D, Chen Tony, Awad Hani, Elfar John C

机构信息

Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642 USA.

出版信息

Hand (N Y). 2014 Mar;9(1):99-104. doi: 10.1007/s11552-013-9560-3.

DOI:10.1007/s11552-013-9560-3

PMID:24570645

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3928377/

Abstract

PURPOSE

The purpose of this experiment was to determine the effect of A2 pulley reconstruction on gliding coefficient (GC), bowstringing, and proximal interphalangeal (PIP) joint maximum flexion angle after zone II repair of flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) lacerations.

METHODS

Fresh frozen cadaver forearms were mounted, and the wrist and MCP joints fixed. FDS and FDP tendons were dissected free, and sequential loads were applied while digital images were captured. The dissected digit with intact native A2 pulley, FDS, and FDP tendons was used as the control (group 1). Zone II lacerations followed by four-stranded repair of FDP plus epitendinous suture and repair of FDS were then performed, and the data recorded (group 2). A2 pulley excision and reconstruction with a loop of palmaris longus autograft was then completed and the specimens sequentially loaded and photographed (group 3). Using the digital images, GC, bowstringing, and maximum flexion angle were calculated.

RESULTS

No difference in maximum flexion angle was observed across the three testing conditions. Zone II laceration and subsequent FDS and FDP tendon repair significantly increased the GC for group 2 specimens; however, pulley reconstruction alleviated some of this increase for group 3. Bowstringing was significantly greater after pulley reconstruction, with a mean increase of 1.9 mm at maximum flexion for group 3 specimens relative to group 1 controls.

DISCUSSION

Strong flexor tendon repairs are needed to prevent gap formation and subsequent triggering; however, the increased bulk from these large repairs can itself produce deleterious triggering, as well as tendon abrasion. Pulley reconstruction, in the setting FDP and FDS repair (group 3), significantly reduced the GC relative to tendon repair alone (group 2). While bowstringing was significantly greater after pulley reconstruction (group 3), it averaged only 1.9 mm over group 1 specimens and did not compromise maximum flexion angle compared to the uninjured controls (group 1) or the isolated tendon repair digits (group 2).

摘要

目的

本实验旨在确定在指浅屈肌（FDS）和指深屈肌（FDP）II区裂伤修复后，A2滑车重建对滑动系数（GC）、弓弦状畸形及近端指间（PIP）关节最大屈曲角度的影响。

方法

将新鲜冷冻的尸体前臂固定，腕关节和掌指关节保持固定。游离FDS和FDP肌腱，施加连续负荷并采集数字图像。将具有完整天然A2滑车、FDS和FDP肌腱的解剖手指用作对照（第1组）。然后进行II区裂伤，接着对FDP进行四股修复并加用腱周缝合，同时修复FDS，并记录数据（第2组）。随后完成A2滑车切除并用掌长肌自体移植环进行重建，对标本施加连续负荷并拍照（第3组）。利用数字图像计算GC、弓弦状畸形及最大屈曲角度。

结果

在三种测试条件下，最大屈曲角度未观察到差异。II区裂伤及随后的FDS和FDP肌腱修复显著增加了第2组标本的GC；然而，滑车重建减轻了第3组的部分增加。滑车重建后弓弦状畸形明显更严重，第3组标本在最大屈曲时相对于第1组对照平均增加1.9毫米。

讨论

需要进行牢固的屈肌腱修复以防止间隙形成及随后的扳机现象；然而，这些大型修复增加的体积本身可能会产生有害的扳机现象以及肌腱磨损。在FDP和FDS修复（第3组）的情况下，滑车重建相对于单纯肌腱修复（第2组）显著降低了GC。虽然滑车重建后弓弦状畸形明显更严重（第3组），但相对于第1组标本，其平均仅为1.9毫米，与未受伤对照（第1组）或单纯肌腱修复的手指（第2组）相比，并未影响最大屈曲角度。