Centre Hospitalier Universitaire Vaudois, Service de Chirurgie Plastique et de la Main, Lausanne, Switzerland.
Centre Hospitalier Universitaire Vaudois, Service de Chirurgie Plastique et de la Main, Lausanne, Switzerland.
J Hand Surg Am. 2021 Nov;46(11):1023.e1-1023.e7. doi: 10.1016/j.jhsa.2021.02.018. Epub 2021 Apr 15.
The spiral oblique retinacular ligament (SORL) procedure acts as a dynamic tenodesis to restore distal interphalangeal joint (DIP) extension and restrain proximal interphalangeal hyperextension. Despite the ingenious technique based on the oblique retinacular ligament anatomy, obtaining strong internal fixation remains an issue during the SORL procedure. We present a modified technique using the flexor digitorum profundus (FDP) hemi-tendon transfer.
We dissected 5 fresh cadaveric specimens to evaluate morphometric parameters of the SORL procedure using the hemi-FDP. The volar groove of the FDP tendon was identified in zone I of the flexor sheath and the tendon was divided into radial and ulnar bundles. The selected hemi-tendon was divided at the proximal edge of the A1 pulley and a SORL procedure was performed through a transosseous tunnel in the distal phalanx. This technique was used in 3 patients with swan neck deformity.
The optimal distance between the DIP joint and the anterior drill hole of the transosseous tunnel was 7.6 mm (range, 6.8-8.5 mm). The relative loss of length of the tendon owing to the SORL path was 25.8 mm (range, 19.6-29.9 mm). In the clinical cases, the procedure improved DIP joint extension lag and prevented proximal interphalangeal joint hyperextension. Preserving one-half of the FDP allowed complete flexion of the DIP joint.
The procedure is technically feasible. Its main advantages are that a distal suture is not required and that the substantial length of the tendon allows sturdy proximal internal fixation.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
螺旋状斜侧支持带（SORL）术式作为一种动力性肌腱固定术，可恢复远指间关节（DIP）的伸展并限制近指间关节过度伸展。尽管该技术基于斜侧支持带的解剖结构，但在 SORL 术中获得牢固的内固定仍然是一个问题。我们提出了一种使用屈指深肌腱（FDP）半腱转移的改良技术。
我们解剖了 5 个新鲜的尸体标本，使用半 FDP 评估 SORL 术式的形态测量参数。在屈肌鞘的 I 区识别 FDP 肌腱的掌侧沟，并将肌腱分为桡侧和尺侧束。选择的半腱在 A1 滑车的近端边缘处分开，并在远节指骨上通过骨隧道进行 SORL 手术。该技术用于 3 例天鹅颈畸形患者。
DIP 关节与骨隧道前钻孔之间的最佳距离为 7.6mm（范围为 6.8-8.5mm）。由于 SORL 路径导致的肌腱相对长度损失为 25.8mm（范围为 19.6-29.9mm）。在临床病例中，该手术改善了 DIP 关节伸展滞后，并防止了近指间关节过度伸展。保留 FDP 的一半可使 DIP 关节完全弯曲。
该手术在技术上是可行的。其主要优点是不需要远端缝线，并且肌腱的大量长度允许牢固的近端内固定。
研究类型/证据水平：治疗性 V 级。
