Geary Michael B, English Christopher, Yaseen Zaneb, Stanbury Spencer, Awad Hani, Elfar John C
Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY; Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY.
Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY; Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY.
J Hand Surg Am. 2015 Apr;40(4):653-9. doi: 10.1016/j.jhsa.2014.12.045. Epub 2015 Feb 24.
To evaluate the changes in maximum flexion angle, gliding coefficient, and bowstringing after a combined repair of both flexor tendons with the flexor digitorum superficialis (FDS) rerouted outside the A2 pulley in cadaveric hands.
We performed 4 different repairs on cadaveric hands, with each repair tested on 9 unique digits. In total, 12 cadaveric hands and 36 digits were used. The thumb and little finger were removed from each hand and excluded from testing. Group 1 was sham surgery. Group 2 combined flexor digitorum profundus (FDP) and FDS laceration and repair with both slips of the FDS repaired inside the A2 pulley. Group 3 was FDP repair with one slip of the FDS repaired inside A2 and the other slip left unrepaired. Group 4 was FDP repair with both slips of the FDS rerouted and repaired outside the A2 pulley. Maximum flexion angle, gliding coefficient, and bowstringing were measured in simulated active digital motion for each group.
Rerouting and repairing the FDS outside the A2 pulley (group 4) significantly lowered gliding coefficient compared with repairs with both slips inside A2, with values similar to sham surgery. We observed no significant differences in maximum flexion angle among the 4 groups. Increased bowstringing was observed with both slips of the FDS repaired and rerouted outside the A2 pulley.
In this cadaveric model, repair of both slips of the FDS outside the A2 pulley improved the gliding coefficient relative to repair within the A2 pulley, which suggests decreased resistance to finger flexion. Repair of the FDS outside the A2 pulley led to a slight increase in bowstringing of the FDS tendon.
We describe a technique for managing combined laceration of the FDP and FDS tendons that improves gliding function and merits consideration.
评估在尸体手上将指浅屈肌（FDS）在A2滑车外侧重新路由后对两根屈肌腱进行联合修复后，最大屈曲角度、滑动系数和弓弦状畸形的变化。
我们在尸体手上进行了4种不同的修复，每种修复在9个不同的手指上进行测试。总共使用了12具尸体手和36个手指。每只手的拇指和小指被切除并排除在测试之外。第1组为假手术。第2组为指深屈肌（FDP）和FDS断裂并修复，FDS的两条肌腱均在A2滑车内修复。第3组为FDP修复，FDS的一条肌腱在A2滑车内修复，另一条肌腱未修复。第4组为FDP修复，FDS的两条肌腱均在A2滑车外侧重新路由并修复。对每组进行模拟主动手指运动时测量最大屈曲角度、滑动系数和弓弦状畸形。
与FDS两条肌腱均在A2滑车内修复相比，将FDS在A2滑车外侧重新路由并修复（第4组）显著降低了滑动系数，其值与假手术相似。我们观察到4组之间最大屈曲角度无显著差异。当FDS的两条肌腱均在A2滑车外侧修复并重新路由时，观察到弓弦状畸形增加。
在这个尸体模型中，相对于在A2滑车内修复，在A2滑车外侧修复FDS的两条肌腱可改善滑动系数，这表明手指屈曲阻力降低。在A2滑车外侧修复FDS导致FDS肌腱的弓弦状畸形略有增加。
我们描述了一种处理FDP和FDS肌腱联合撕裂的技术，该技术可改善滑动功能，值得考虑。
