Graham David J, Clitherow Harry D S, Singh Harvinder P, Clarke Elizabeth C, Smith Belinda J, Tonkin Michael A
Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, Australia.
Murray Maxwell Biomechanics Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia.
J Hand Surg Am. 2019 Oct;44(10):903.e1-903.e5. doi: 10.1016/j.jhsa.2018.12.011. Epub 2019 Feb 4.
To quantify the amount and pattern of finger range of motion loss at the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints with a simulated extensor tendon adhesion at the level of the proximal phalanx or metacarpal.
In 10 cadaveric specimens, traction sutures were placed in the forearm extensor digitorum communis and flexor digitorum profundus tendons of the middle and ring fingers. Active motion was simulated by suspending weights from the traction sutures via pulleys. The angles of the MCP, PIP, and DIP joints were measured at the position of maximum flexion and extension. Extensor tendon adhesions were simulated alternately at the proximal phalanx and metacarpal levels of the middle and ring fingers, using suture anchors. Repeat measurements were taken using the same amount of force.
There was an average total loss of flexion of 38° and of extension of 6° with a proximal phalanx adhesion, with a greater contribution of flexion loss at the PIP joint. The loss of flexion was 17° and of extension was 50° with a metacarpal adhesion, with a loss of extension mostly at the MCP joint.
The results of this study identified clear patterns of motion loss that are associated with isolated simulated adhesions in different locations along the extensor mechanism. The greatest motion loss occurred at the joint immediately distal to the simulated adhesion.
Although extrapolation of these findings to clinical relevance remains unclear, the ability to predict the level of adhesion by the pattern of motion restriction may allow for a targeted tenolysis procedure. This would reduce the amount of soft tissue dissection required, which in turn, could be expected to reduce the degree of repeat adhesion formation.
量化在近端指骨或掌骨水平模拟伸肌腱粘连时，掌指（MCP）、近端指间（PIP）和远端指间（DIP）关节的手指活动度丧失的量和模式。
在10个尸体标本中，在前臂的中指和环指的指总伸肌腱和指深屈肌腱中放置牵引缝线。通过滑轮从牵引缝线上悬挂重物来模拟主动运动。在最大屈曲和伸展位置测量MCP、PIP和DIP关节的角度。使用缝线锚钉在中指和环指的近端指骨和掌骨水平交替模拟伸肌腱粘连。使用相同的力量进行重复测量。
近端指骨粘连时，平均屈曲总丧失为38°，伸展总丧失为6°，PIP关节的屈曲丧失贡献更大。掌骨粘连时，屈曲丧失为17°，伸展丧失为50°，伸展丧失主要发生在MCP关节。
本研究结果确定了与伸肌机制不同位置的孤立模拟粘连相关的明确活动丧失模式。最大的活动丧失发生在模拟粘连紧邻的远端关节。
尽管这些发现与临床相关性的推断仍不明确，但通过活动受限模式预测粘连水平的能力可能允许进行有针对性的肌腱松解手术。这将减少所需的软组织分离量，进而有望减少重复粘连形成的程度。
