Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Hand Surg Am. 2023 Aug;48(8):835.e1-835.e4. doi: 10.1016/j.jhsa.2022.02.011. Epub 2022 Apr 19.
Variations in the description of the flexor pulley system exist, particularly in whether the A1 and A2 pulleys represent discrete or confluent entities. This has potentially important clinical relevance at the time of A1 pulley release for symptomatic trigger finger, given the goal of adequate release without overrelease. The purpose of this study was to determine the relative prevalence of confluent A1 pulleys on a digit-by-digit basis employing 2.5× loupes alone, thereby simulating a clinical surgical environment.
Cadaveric anatomic specimens underwent flexor pulley system dissection under 2.5× loupe magnification by 2 hand surgeons. The presence of pulley confluence and length (measured from the proximal aspect to the distal aspect) was recorded and compared on a digit-to-digit basis.
Forty-five digits, comprising 9 adult forearm or hand specimens (5 right and 4 left) obtained from 6 donors (4 men and 2 women, age: 67 ± 8 years), were dissected. A total of 19 confluent A1 pulleys were encountered, with notable digit-by-digit variation in the prevalence of confluent pulleys. There were 0 confluent pulleys observed in the thumb, compared with 6 confluent pulleys observed in the middle finger. The average overall A1 pulley length was 5.0 ± 1.5 mm, with a similar pulley length observed between the digits.
A1 pulley confluence varies on a digit-to-digit basis, with no observed confluence in the thumb and the most common confluence observed in the middle finger.
In the setting of intraoperatively observed pulley confluence, we suggest pulley release under traction in order to develop the plane between the A1 and A2 pulleys and, thus, confirm the complete and isolated release of the A1 pulley.
屈肌支持带系统的描述存在差异，特别是在 A1 和 A2 滑车是否代表离散或融合实体方面。这在因症状性扳机指而行 A1 滑车切开松解时具有潜在的重要临床意义，因为其目标是在不过度松解的情况下进行充分松解。本研究旨在通过仅使用 2.5 倍手术放大镜确定指节为基础的 A1 滑车融合的相对发生率，从而模拟临床手术环境。
2 位手外科医生在 2.5 倍手术放大镜下解剖屈肌支持带系统，记录滑车融合的存在情况和长度（从近端到远端测量），并进行指节为基础的比较。
45 个手指，包括 9 个成人前臂或手部标本（5 个右手和 4 个左手），来自 6 名供体（4 名男性和 2 名女性，年龄：67 ± 8 岁），进行了解剖。共发现 19 个融合的 A1 滑车，融合滑车的发生率在指节之间存在显著差异。拇指未见融合滑车，而中指有 6 个融合滑车。总的 A1 滑车长度平均为 5.0 ± 1.5mm，各指节之间的滑车长度相似。
A1 滑车融合在指节之间存在差异，拇指未见融合，中指最常见融合。
在术中观察到滑车融合的情况下，我们建议在牵引下进行滑车松解，以便在 A1 和 A2 滑车之间形成平面，从而确认 A1 滑车的完全和单独松解。
