Revol M
Service de Chirurgie Plastique, Hôpital Saint-Louis, Paris.
Ann Chir Plast Esthet. 1993 Apr;38(2):210-7.
The purpose of surgical restoration of the paralysed hand is to use or to reconstruct the physiological tenodesis effects which are linked on to flexion-extension motions of the wrist. Active movements of interphalangeal (IP) flexion and metacarpo-phalangeal (MP) extension of the fingers are made by extrinsic muscles coming from the forearm. The intrinsic muscles of the fingers produce MP flexion and IP extension. A claw deformity occurs when they are completely paralysed in a finger whose joints are flexible, and whose extrinsic muscles remains functional or are restored. When Bouvier's maneuver is positive, the claw is said simple, and its treatment is either MP capsuloplasty when there is no motors, or an active palliative procedure with proximal (or MP) effect when motors exist: lasso and/or direct interosseous activation. Indications of the classical active palliative procedures with distal (or IP) effect remain rare, only in a few complicated claw deformities. Circumduction of the thumb may be decomposed into three elementary movements: reposition, antepulsion, and adduction, which are respectively controlled by the radial, median, and ulnar nerves. Each of these movements may be restored by a specific tendinous transfer. In the total paralysis of the thumb as we observe in high tetraplegia, a key-grip may be restored by joint stabilization of the thumb, associated with activation of the Flexor Pollicis Longus and Extensor Pollicis Longus by means of tenodesis or tendinous transfers.
瘫痪手外科修复的目的是利用或重建与腕关节屈伸运动相关的生理性肌腱固定效应。手指指间（IP）屈曲和掌指（MP）伸展的主动运动由来自前臂的外在肌完成。手指的内在肌产生MP屈曲和IP伸展。当手指关节灵活且外在肌仍有功能或已恢复而内在肌完全瘫痪时，就会出现爪形畸形。当布维耶手法阳性时，爪形畸形被称为单纯性，若无动力，其治疗方法为MP关节囊成形术；若有动力，则采用具有近端（或MP）效应的主动姑息性手术：套索和/或直接骨间肌激活。具有远端（或IP）效应的经典主动姑息性手术的适应证仍然很少，仅见于少数复杂的爪形畸形。拇指的环转运动可分解为三个基本运动：复位、前推和内收，分别由桡神经、正中神经和尺神经控制。这些运动中的每一个都可通过特定的肌腱转移来恢复。在高位四肢瘫中观察到的拇指完全瘫痪情况下，可通过拇指关节稳定术恢复捏握功能，并通过肌腱固定术或肌腱转移术激活拇长屈肌和拇长伸肌。
