Durban Claire Marie, Antolin Bernard, Sau Chung Ying, Li Sheung Wai, Ip Wing Yuk
* Division of Hand and Foot Surgery, Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong, S.A.R., China.
† Rehabilitation Division, Department of Medicine, Tung Wah Hospital, Hong Kong, S.A.R., China.
J Hand Surg Asian Pac Vol. 2017 Sep;22(3):275-280. doi: 10.1142/S0218810417500290.
Various techniques of opponensplasty have been developed with the aim of restoring the thumb function. The modified Camitz opponensplasty is a simple technique done together with an open carpal tunnel release. It restores thumb palmar abduction soon after the procedure, during such time that the abductor pollicis brevis (APB) is still recovering. The aim of this study was to assess the recovery and level of activity of the abductor pollicis brevis and palmaris longus (PL) muscles during thumb opposition and abduction after performing the modified Camitz opponensplasty.
The records of 21 patients who underwent modified Camitz opponensplasty for severe carpal tunnel syndrome were reviewed. Thumb function was evaluated using the Van Wetter Apogee test, Kapandji index, tripod pinch strength, and power grip. Electromyography was utilized to evaluate APB recovery; ultrasonography was employed to evaluate PL activity.
Twenty patients reached 80% of the abduction height of the contralateral hand; the Kapandji index was good in thirteen. Palmaris longus activity was evaluated together with the APB muscle recovery. There was significant improvement in the average grip strength and average tripod pinch strength. However, this did not correlate with the degree of neurologic and muscular recovery of the APB. We surmise that the palmaris longus augmented the abductor pollicis brevis muscle even in those with full muscle recovery.
The modified Camitz opponensplasty is a practical option for patients suffering from severe carpal tunnel syndrome with diminished thumb function.
为恢复拇指功能，已开发出多种对掌肌成形术技术。改良的卡米茨对掌肌成形术是一种与开放性腕管松解术同时进行的简单技术。它在术后不久就能恢复拇指掌侧外展，此时拇短展肌（APB）仍在恢复中。本研究的目的是评估在进行改良的卡米茨对掌肌成形术后，拇指对掌和外展过程中拇短展肌和掌长肌（PL）的恢复情况及活动水平。
回顾了21例因严重腕管综合征接受改良卡米茨对掌肌成形术患者的记录。使用范·韦特远距测试、卡潘迪指数、三指捏力和强力握力来评估拇指功能。采用肌电图评估APB的恢复情况；利用超声检查评估PL的活动情况。
20例患者达到对侧手外展高度的80%；13例患者的卡潘迪指数良好。在评估APB肌肉恢复情况的同时也评估了掌长肌的活动。平均握力和平均三指捏力有显著改善。然而，这与APB的神经和肌肉恢复程度无关。我们推测，即使在肌肉完全恢复的患者中，掌长肌也增强了拇短展肌的功能。
改良的卡米茨对掌肌成形术是拇指功能减退的严重腕管综合征患者的一种实用选择。
