Gupta Vikas, Consul Ashu, Swamy M K S
Central Institute of Orthopaedics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.
J Orthop Surg (Hong Kong). 2015 Apr;23(1):15-8. doi: 10.1177/230949901502300104.
To evaluate the outcome of 20 claw hands corrected with the Zancolli lasso procedure.
20 patients aged 7 to 48 (mean, 28) years with claw hand deformity for a mean of 33.3 months secondary to leprosy (n=17), traumatic ulnar nerve injury (n=2), or tardy ulnar nerve palsy (n=1) underwent the Zancolli lasso procedure, in which the flexor digitorum superficialis (FDS) of the middle finger was divided in to 4 slips (one for each finger) and reattached to itself after passing through the proximal pulley. Deformity, power, movement, and function of the hands were evaluated before and after surgery.
The mean duration of surgery was 58.4 (range, 50-107) minutes. The mean duration of follow-up was 18 (range, 12-24) months. Deformity correction was good in 15 patients, fair in 3, and poor in 2. The mean angle improvement was maximum in the little finger, followed by the ring, index, and middle fingers. The transverse metacarpal arch (compared with the normal hand) was increased/reversed in 7 patients and decreased in 13 patients. The grip and pinch strength increased in 13 patients, remained unchanged in 6, and decreased in one. Motion and function of the hand was good in 12 patients, fair in 6, and poor in 2. One patient developed swan neck deformity in the little finger owing to suture tension of the transferred slip, and another had paraesthesia over the index finger. They underwent reoperation using the FDS of the ring finger; no sensory or motor recovery was achieved.
The Zancolli lasso procedure is easy to perform and does not require extensive postoperative training. It restores synchronous finger flexion and spares other superficialis tendons, thus avoiding swan neck deformity of the fingers.
评估采用赞科利套索手术矫正20例爪形手的疗效。
20例年龄在7至48岁（平均28岁）的爪形手畸形患者，继发于麻风病（n = 17）、创伤性尺神经损伤（n = 2）或迟发性尺神经麻痹（n = 1），平均患病时间为33.3个月，接受了赞科利套索手术，即中指的指浅屈肌（FDS）被分成4条肌腱束（每个手指1条），穿过近端滑车后重新附着于自身。术前和术后对手部的畸形、力量、活动和功能进行了评估。
手术平均时长为58.4（范围50 - 107）分钟。平均随访时长为18（范围12 - 24）个月。15例患者畸形矫正良好，3例尚可，2例较差。小指的平均角度改善最大，其次是环指、示指和中指。与正常手相比，7例患者的掌横弓增大/反转，13例减小。13例患者的握力和捏力增加，6例不变，1例下降。12例患者手部的活动和功能良好，6例尚可，2例较差。1例患者因转移肌腱束的缝线张力导致小指出现鹅颈畸形，另1例患者示指感觉异常。他们接受了使用环指指浅屈肌的再次手术；未实现感觉或运动功能恢复。
赞科利套索手术操作简便，术后无需广泛训练。它能恢复手指同步屈曲，保留其他浅肌腱，从而避免手指鹅颈畸形。
