Beger Orhan, Tumentemür Gamze, Uzun Coşar, Keskinöz Elif Nedret, Elvan Özlem, Uzmansel Deniz, Keskinbora Mert, Erdal Nurten, Taşdelen Bahar, Kurtoğlu Zeliha
J Am Podiatr Med Assoc. 2019 Jul;109(4):282-290. doi: 10.7547/17-063. Epub 2017 Nov 13.
We sought to show the biomechanical and morphometric properties of flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon grafts harvested by specific surgical approaches and to assess the contribution of FHL slips to the long flexor tendons of the toes.
Thirteen fresh-frozen amputated feet (average age, 79 years) were dissected. The connections between the FHL and FDL tendons and the contribution of FHL slips to the long flexor tendons were classified. The biomechanical properties of the tendons and slips were measured using a tensile device.
The connections between the FHL and FDL tendons were reviewed in two groups. Group 1 had FHL slips (11 cases) and group 2 had cross-slips (two cases). The FHL slips joined the second and third toe long flexor tendon structures. Tendon length decreased significantly from the second to the fifth toe ( < .001). Apart from the second toe tendon being thicker than that of the fourth toe ( = .02) and Young's modulus being relatively smaller in the third versus the fourth toe tendon ( = .01), biomechanical and morphometric properties of second to fourth tendons were similar. Mechanical properties of those tendons were significantly different from fifth toe tendons and FHL slips. Morphometric and biomechanical properties of FHL slips were similar to those of the fifth toe tendon.
Herein, FHL slips were shown to have biomechanical properties that might contribute to flexor functions of the toes. During the harvesting of tendon grafts from the FHL by minimally invasive incision techniques from the distal plane of the master knot of Henry, cutting slips between FHL and FDL tendons could be considered a cause of postoperative function loss in toes.
我们试图展示通过特定手术方法获取的拇长屈肌腱（FHL）和趾长屈肌腱（FDL）移植物的生物力学和形态学特性，并评估FHL分支对趾长屈肌腱的作用。
解剖了13只新鲜冷冻的截肢足（平均年龄79岁）。对FHL和FDL肌腱之间的连接以及FHL分支对趾长屈肌腱的作用进行了分类。使用拉伸装置测量肌腱和分支的生物力学特性。
对FHL和FDL肌腱之间的连接进行了两组分析。第1组有FHL分支（11例），第2组有交叉分支（2例）。FHL分支连接到第二和第三趾长屈肌腱结构。从第二趾到第五趾，肌腱长度显著缩短（<.001）。除了第二趾肌腱比第四趾肌腱厚（=.02）以及第三趾肌腱的杨氏模量相对于第四趾肌腱较小（=.01）外，第二至第四趾肌腱的生物力学和形态学特性相似。这些肌腱的力学性能与第五趾肌腱和FHL分支显著不同。FHL分支的形态学和生物力学特性与第五趾肌腱相似。
在此，FHL分支显示出可能有助于趾部屈肌功能的生物力学特性。在通过亨利主结远侧平面的微创切口技术从FHL获取肌腱移植物时，FHL和FDL肌腱之间的分支切断可能被认为是术后趾部功能丧失的一个原因。
