Schöffl Isabelle, Meisel Julia, Lutter Christoph, Schöffl Volker
Department of Pediatrics, Klinikum Bamberg, Bamberg, Germany.
Institute of Anatomy, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.
J Hand Surg Am. 2018 Apr;43(4):380.e1-380.e7. doi: 10.1016/j.jhsa.2017.08.028. Epub 2017 Oct 4.
In this study, the feasibility of a new pulley reconstruction in which the tendon graft is pulled through a tunnel in the proximal phalanx, was evaluated using a cadaver model, with particular attention paid to the weakening of the bone structure by the drill hole.
Nine fingers from 6 cadaver hands with intact pulley systems were compared with 9 fingers from 6 cadaver hands with missing A2 to A4 pulleys but that included a repair using the new surgical technique. Each finger was fixed to an isokinetic loading device. The forces in the flexor tendons were recorded in each finger using a force transducer.
The forces recorded in the flexor tendons of the control group were significantly higher than in the reconstructed fingers. The most common event in the reconstructed fingers was graft failure. A fracture of the bone due to the drill hole was not observed.
The new pulley reconstruction could represent an alternative to existing reconstructive techniques. The cause for the higher forces recorded in the control group could be attributed to sutures used in the operated fingers.
The new pulley reconstruction method may enable reduced extensor tendon irritation because it avoids contact with the extensor hood and could possibly prohibit cortical bone loss, a serious side effect in the "one and one-half loop" technique.
在本研究中，使用尸体模型评估了一种新的滑车重建的可行性，即肌腱移植物穿过近节指骨隧道，特别关注钻孔对骨结构的削弱。
将6具尸体手上完整滑车系统的9根手指与6具尸体手上A2至A4滑车缺失但采用新手术技术修复的9根手指进行比较。每根手指固定在等速加载装置上。使用力传感器记录每根手指屈肌腱中的力。
对照组屈肌腱记录的力明显高于重建手指。重建手指中最常见的情况是移植物失败。未观察到因钻孔导致的骨折。
新的滑车重建可能是现有重建技术的一种替代方法。对照组记录的力较高的原因可能归因于手术手指中使用的缝线。
新的滑车重建方法可能会减少伸肌腱刺激，因为它避免了与伸肌帽接触，并且可能防止皮质骨丢失，这是“1.5环”技术中的一种严重副作用。
