Zafonte Brian, Rendulic Dora, Szabo Robert M
Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA.
Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA.
J Hand Surg Am. 2014 Dec;39(12):2525-32; quiz 2533. doi: 10.1016/j.jhsa.2014.06.005. Epub 2014 Nov 21.
Flexor pulley injuries are most commonly seen in avid rock climbers; however, reports of pulley ruptures in nonclimbers are increasing. In addition to traumatic disruption, corticosteroid-induced pulley rupture has been reported as a complication of treating stenosing tenosynovitis. Over the last decade, there have been 2 new developments in the way hand surgeons think about the flexor pulley system. First, the thumb pulley system has been shown to have 4 component constituents, in contrast to the classic teaching of 3 pulleys. Second, in cases of zone II flexor tendon injury, the intentional partial A2 and/or A4 pulley excision or venting is emerging as a component for successful treatment. This is challenging the once-held dogma that preserving the integrity of the entire A2 and A4 pulleys is indispensable for normal digit function.
屈指肌腱滑车损伤在狂热的攀岩者中最为常见；然而，非攀岩者滑车破裂的报告也在增加。除了创伤性断裂外，皮质类固醇诱导的滑车破裂已被报告为治疗狭窄性腱鞘炎的一种并发症。在过去十年中，手外科医生对屈指肌腱滑车系统的认识有两个新进展。首先，与传统的三个滑车的理论不同，拇指滑车系统已被证明有四个组成部分。其次，在Ⅱ区屈指肌腱损伤的病例中，有意部分切除或切开A2和/或A4滑车正成为成功治疗的一个组成部分。这正在挑战曾经的教条，即保持整个A2和A4滑车的完整性对正常手指功能是不可或缺的。
