Milone Michael T, Starecki Mikael, Ayalon Omri, Aversano Michael W, Sapienza Anthony
NYU Langone Orthopaedics, Hospital for Joint Diseases, New York, NY.
NYU Langone Orthopaedics, Hospital for Joint Diseases, New York, NY.
J Hand Surg Am. 2017 Aug;42(8):664.e1-664.e5. doi: 10.1016/j.jhsa.2017.05.015. Epub 2017 Jun 9.
The availability of tendon grafts is an important consideration for successful upper extremity reconstructive surgery, including flexor or extensor tendon reconstructions, tendon transfers, and ligament reconstructions. Graft selection is based on availability, expendability, ease of harvest, and length. Given variations in patient height and extremity length, existing average values may provide suboptimal insight into actual tendon lengths available. The purpose of this study is, therefore, to pursue a method of estimating available donor tendon lengths based on easily measured anatomical surface landmarks.
Thirty cadaveric upper and lower extremity limbs were dissected and the length of commonly harvested tendon grafts including the palmaris longus, extensor indicis proprius, extensor digiti minimi, plantaris, and second long toe extensor was measured. Surface forearm length (from finger tip to cubital fossa) and surface fibular length (from lateral malleolus to fibular head) were also measured. Correlations between surface measurements and underlying tendon lengths were analyzed, and linear models were generated that predicted tendon length as a function of surface measurements.
Surface measurements were correlated with underlying tendon length (R = 0.46 - 0.66). Linear models could predict tendon lengths based on surface measurements. A ratio of donor tendon length compared with the limb segment measured was established for each tendon and can be applied to estimate donor tendon length. For the upper extremity tendons, the multipliers for the palmaris longus, extensor indicis proprius, and extensor digiti minimi were 0.51, 0.20, and 0.18, respectively. Lower extremity tendon ratios for the plantaris and extensor digitorum longus were 0.69 and 0.60, respectively.
Although length of available donor tendon can be a limiting variable at the time of surgery, surgeons may be better able to estimate underlying tendon lengths using easily obtained superficial measurements.
Information obtained from these cadaveric measurements may aid in preoperative planning in hand and upper extremity surgery.
肌腱移植物的可用性是上肢重建手术成功的重要考虑因素，包括屈肌腱或伸肌腱重建、肌腱转位和韧带重建。移植物的选择基于可用性、可消耗性、取材的难易程度和长度。鉴于患者身高和肢体长度存在差异，现有的平均值可能无法很好地反映实际可用的肌腱长度。因此，本研究的目的是探索一种基于易于测量的解剖体表标志来估计可用供体肌腱长度的方法。
解剖30具尸体的上下肢，测量常用取材的肌腱移植物的长度，包括掌长肌、示指固有伸肌、小指伸肌、跖肌和第二趾长伸肌。同时测量前臂体表长度（从指尖到肘窝）和腓骨体表长度（从外踝到腓骨小头）。分析体表测量值与深部肌腱长度之间的相关性，并建立线性模型，将肌腱长度预测为体表测量值的函数。
体表测量值与深部肌腱长度相关（R = 0.46 - 0.66）。线性模型可根据体表测量值预测肌腱长度。为每条肌腱建立了供体肌腱长度与所测肢体节段长度的比值，可用于估计供体肌腱长度。在上肢肌腱中，掌长肌、示指固有伸肌和小指伸肌的倍数分别为0.51、0.20和0.18。下肢肌腱中，跖肌和趾长伸肌的比值分别为0.69和0.60。
虽然可用供体肌腱的长度在手术时可能是一个限制变量，但外科医生或许能够通过易于获得的体表测量值更好地估计深部肌腱的长度。
从这些尸体测量中获得的信息可能有助于手部和上肢手术的术前规划。
