Filius Anika, Thoreson Andrew R, Ozasa Yasuhiro, An Kai-Nan, Zhao Chunfeng, Amadio Peter C
Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA; Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, The Netherlands.
Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
Clin Biomech (Bristol). 2017 Jan;41:48-53. doi: 10.1016/j.clinbiomech.2016.12.001. Epub 2016 Dec 5.
Forceful, high-velocity, and repetitive manual hand tasks contribute to the onset of carpal tunnel syndrome. This study aimed to isolate and identify mechanisms that contribute to tendon gliding resistance in the carpal tunnel.
Eight human cadaver hands (four pairs) were used. Tendon gliding resistance (force, energy, and stiffness) was measured under different conditions: with intact and with divided subsynovial connective tissue, at 2mm/s and 60mm/s tendon excursion velocity, and with and without relaxation time before tendon excursion.
Subsynovial connective tissue stretching substantially contributed to increased gliding resistance force and energy during higher tendon excursion velocities, and subsynovial connective tissue stiffening was observed. Poroelastic properties of the tendon (and possibly the subsynovial connective tissue) also appear to be involved because relaxation time significantly increased gliding resistance force and energy (P<0.01), and the difference in energy and force between high- and low-velocity tendon excursions increased with relaxation time (P=0.01 and P<0.01). Lastly, without relaxation time, no difference in force and energy was observed (P=0.06 and P=0.60), suggesting contact friction.
These findings are consistent with the hypothesis that the mechanics of tendon motion within the carpal tunnel are affected by the integrity of the subsynovial connective tissue. While not tested here, in carpal tunnel syndrome this tissue is known to be the fibrotic, thickened, and less-fluid-permeable. An extrapolation of our findings suggests that these changes in the subsynovial connective tissue of carpal tunnel syndrome patients could increase contact friction and carpal tunnel pressure.
高强度、高速且重复性的手部体力劳动会导致腕管综合征的发生。本研究旨在分离并确定导致腕管内肌腱滑动阻力的机制。
使用了八只人类尸体手（四对）。在不同条件下测量肌腱滑动阻力（力、能量和刚度）：滑膜下结缔组织完整和切断时，肌腱移动速度为2mm/s和60mm/s时，以及肌腱移动前有无松弛时间的情况下。
在较高的肌腱移动速度下，滑膜下结缔组织的拉伸显著增加了滑动阻力和能量，并观察到滑膜下结缔组织变硬。肌腱（可能还有滑膜下结缔组织）的多孔弹性特性似乎也有影响，因为松弛时间显著增加了滑动阻力和能量（P<0.01），并且高速和低速肌腱移动之间的能量和力差异随松弛时间增加（P=0.01和P<0.01）。最后，没有松弛时间时，未观察到力和能量的差异（P=0.06和P=0.60），提示存在接触摩擦。
这些发现与以下假设一致，即腕管内肌腱运动的力学受到滑膜下结缔组织完整性的影响。虽然此处未进行测试，但已知在腕管综合征中该组织会发生纤维化、增厚且液体渗透性降低。对我们研究结果的推断表明，腕管综合征患者滑膜下结缔组织的这些变化可能会增加接触摩擦和腕管压力。
