Chaudhuri Gaurab Ranjan, Chakraborty Sourabh Shankar, Rai Abhishek Kumar, Chattopadhyay Prasenjit, Humnekar Akhilesh
All India Institute of Medical Sciences, Kalyani, India.
All India Institute of Medical Sciences, Deoghar, India.
Hand (N Y). 2025 Aug 25:15589447251364568. doi: 10.1177/15589447251364568.
Leprosy, caused by , leads to peripheral neuropathy, commonly affecting the ulnar nerve, resulting in claw hand deformity. Various tendon transfer techniques, such as the Modified Stiles-Bunnell (flexor digitorum superficialis 4-tail [FDS-4T]) transfer and Zancolli lasso procedure (ZLP), are used for surgical correction. However, comparative studies assessing their functional outcomes are scarce. This prospective, randomized comparative study aimed to evaluate improvements in hand function, grip strength, and range of motion (ROM) between the 2 techniques.
Fifty patients with post-leprosy ulnar claw hand were randomly assigned to undergo either FDS-4T (n = 25) or ZLP (n = 25). Preoperative and postoperative assessments included active metacarpophalangeal (MCP) joint ROM, grip strength, patient-reported outcome measures, and photographic grading of claw correction. Statistical analyses were performed using paired tests and Pearson correlation, with significance set at < .05.
Both groups showed significant postoperative improvement in MCP joint ROM ( = .0001) and grip strength ( = .0001). Grip strength recovery was higher in ZLP (129%) than in FDS-4T (117%; = .013). Claw correction was rated excellent in 12 patients (FDS-4T) versus 7 patients (ZLP), although not statistically significant. Zancolli lasso procedure had shorter operating time and faster return to daily activities ( = .02).
Both procedures significantly improved hand function without a clear superiority of one over the other. While ZLP offered faster recovery and grip strength, FDS-4T showed slightly better claw correction. The choice of procedure should be tailored to patient needs.
由[病原体名称未给出]引起的麻风病会导致周围神经病变，通常影响尺神经，进而导致爪形手畸形。多种肌腱转移技术，如改良的斯泰尔斯 - 邦内尔（指浅屈肌四尾 [FDS - 4T]）转移术和赞科利套索手术（ZLP），被用于手术矫正。然而，评估它们功能结局的比较研究较少。这项前瞻性、随机对照研究旨在评估这两种技术在手部功能、握力和活动范围（ROM）方面的改善情况。
50例麻风病后尺神经爪形手患者被随机分配接受FDS - 4T手术（n = 25）或ZLP手术（n = 25）。术前和术后评估包括掌指（MCP）关节主动活动范围、握力、患者报告的结局指标以及爪形矫正的照片分级。采用配对t检验和皮尔逊相关性进行统计分析，显著性设定为P <.05。
两组患者术后MCP关节活动范围（P =.0001）和握力（P =.0001）均有显著改善。ZLP组握力恢复率（129%）高于FDS - 4T组（117%；P =.013）。12例患者（FDS - 4T组）与7例患者（ZLP组）的爪形矫正被评为优秀，尽管差异无统计学意义。赞科利套索手术的手术时间较短，恢复日常活动更快（P =.02）。
两种手术均能显著改善手部功能，且没有一种手术明显优于另一种。虽然ZLP手术恢复更快且握力改善更好，但FDS - 4T手术在爪形矫正方面表现稍好。手术方式的选择应根据患者需求进行调整。
