House J H
Clin Orthop Relat Res. 1985 May(195):117-28.
Functional positioning of the thumb is paramount to the restoration of lateral pinch to the hands in patients with tetraplegia as the result of spinal cord injury. Useful lateral pinch can be provided to patients with at least wrist extension control preserved by use of a combination of flexor pollicis longus tenodesis or transfer and carpometacarpal and inter phalangeal joint stabilization. In patients who retain function in the brachioradialis, extensor carpi radialis longus and brevis, pronator teres, and flexor carpi radialis, strong grasp as well as effective lateral pinch can be restored to the hand by surgery. Thumb control for flexion and extension is provided by tendon transfer to the flexor pollicis longus and tenodesis or transfer to the extensor pollicis longus. Proper positioning for lateral pinch can be accomplished by either arthrodesis of the first metacarpal-trapezial joint or tendon transfer to restore adduction-opposition to the thumb. The surgical concepts presented in this paper have been applied to the functional reconstruction of the hands of more than 50 patients with spinal cord injury during the last 15 years. The patients have been pleased with the significant improvement in function, strength, and speed that has resulted from surgery and have been cooperative advocates as the alternate methods of thumb control have been evaluated.
对于因脊髓损伤导致四肢瘫痪的患者而言，拇指的功能定位对于恢复手部的侧捏功能至关重要。对于至少保留腕关节伸展控制功能的患者，通过结合使用拇长屈肌腱固定术或肌腱转移术以及腕掌关节和指间关节稳定术，可为其提供有效的侧捏功能。对于在桡侧腕长伸肌、桡侧腕短伸肌、旋前圆肌和桡侧腕屈肌仍保留功能的患者，可通过手术恢复手部的强力抓握以及有效的侧捏功能。通过将肌腱转移至拇长屈肌以及腱固定术或将肌腱转移至拇长伸肌，可实现拇指的屈伸控制。可通过第一掌骨-大多角骨关节融合术或肌腱转移术来恢复拇指的内收-对掌功能，从而实现侧捏的正确定位。在过去15年中，本文所介绍的手术理念已应用于50多名脊髓损伤患者手部的功能重建。患者对手术所带来的功能、力量和速度方面的显著改善感到满意，并且在评估拇指控制的替代方法时一直积极配合。
