Delattre J F, Ducasse A, Flament J B, Kénési C
Anat Clin. 1983;5(3):187-97. doi: 10.1007/BF01799004.
The movements of flexion of the digital articular chain are dependent upon a vast functional complex comprising the long flexor tendons, their antagonist long extensor tendons, and the coupled action of the interosseous and lumbricales muscles. Based on theoretical biomechanical data backed up by experimental investigation, the authors emphasize the important role of the digital fibrous sheath in the mechanism of action of the long flexor tendon. Any proximal resection (even of minor degree) of the proximal pulley of the digit induces severe mechanical disturbances by enhancing flexion of the metacarpophalangeal joint to the detriment of the proximal interphalangeal joint. Conversely, distal resection of the pulley enhances flexion of the interphalangeal joint to the detriment of the metacarpophalangeal articulation, although the resulting abnormalities are less pronounced than those due to proximal resection. The fibrous pulley plays a role in tendinous orientation in the frontal plane and in digital orientation of the index finger where the angulation between the pulley and flexor tendon is most pronounced. In this latter case ulnar deviation of the second finger occurs on flexion. Reconstructive surgery of the long flexor tendons requires that the digital fibrous sheath, especially its proximal segment, be preserved. The metacarpophalangeal joint seems to be the most vulnerable to morphological modifications of the pulley, as stressed from the anatomical standpoint by the absence of insertion of the long flexor tendons on the proximal phalanx.
指关节链的屈曲运动取决于一个庞大的功能复合体，该复合体包括长屈肌腱、其拮抗肌长伸肌腱以及骨间肌和蚓状肌的协同作用。基于实验研究支持的理论生物力学数据，作者强调了指纤维鞘在长屈肌腱作用机制中的重要作用。手指近端滑车的任何近端切除（即使程度较轻）都会通过增强掌指关节的屈曲而对近端指间关节造成严重的机械干扰。相反，滑车的远端切除会增强指间关节的屈曲而对掌指关节造成损害，尽管由此产生的异常不如近端切除所致的明显。纤维滑车在额状面的肌腱定向以及食指的手指定向中起作用，在滑车与屈肌腱之间的成角最为明显。在后一种情况下，第二指在屈曲时会出现尺侧偏斜。长屈肌腱的重建手术要求保留指纤维鞘，尤其是其近端部分。从解剖学角度来看，由于长屈肌腱在近端指骨上没有附着点，掌指关节似乎最容易受到滑车形态改变的影响。
