Phillips C, Mass D
Department of Surgery, University of Chicago Hospitals, IL, USA.
J Hand Surg Am. 1996 Mar;21(2):240-4. doi: 10.1016/S0363-5023(96)80107-9.
The anatomy of the palmar aponeurosis pulley has been well described, but its biomechanical function is not as well characterized. This study describes the functional importance of the palmar aponeurosis pulley by using efficiency parameters. We obtained data by generating load, excursion, and work efficiencies in the intact pulley system and compared these to the efficiencies obtained after sectioning the palmar aponeurosis pulley alone and in combination with the proximal annular pulleys. The variability associated with comparisons between different fingers and hands was therefore diminished. Sectioning the palmar aponeurosis pulley alone did not significantly change any of the efficiency parameters. When the palmar aponeurosis pulley was sectioned in combination with either or both of the proximal annular pulleys (A1, A2) there was a significant decrease in excursion efficiency. Only after all three proximal pulleys were sectioned did the load efficiency increase and the work efficiency decrease significantly. These findings prove that the palmar aponeurosis pulley in combination with the proximal annular pulleys acts to decrease the tendency to bowstringing around the metacarpophalangeal joint. The increased load efficiency is probably the result of a decrease in friction and counteractive forces generated by the integrated fibers of the intact palmar aponeurosis pulley. Change in work is due not only to an increase in excursion, but also to the increased resistance that results from the acute angulation that the tendon must endure as it follows behind the remaining pulleys during flexion. Intergroup comparisons show a significant contribution by the palmar aponeurosis pulley. This study demonstrates a significant biomechanical role for the palmar aponeurosis pulleys and suggests that it be considered similar to the annular and cruciate flexor tendon pulleys in importance.
手掌腱膜滑车的解剖结构已得到充分描述，但其生物力学功能尚未得到很好的界定。本研究通过使用效率参数来描述手掌腱膜滑车的功能重要性。我们通过在完整的滑车系统中生成负荷、行程和工作效率来获取数据，并将这些数据与单独切断手掌腱膜滑车以及与近端环形滑车联合切断后获得的效率进行比较。因此，不同手指和手部之间比较所涉及的变异性得以减小。单独切断手掌腱膜滑车并未显著改变任何效率参数。当手掌腱膜滑车与一个或两个近端环形滑车（A1、A2）联合切断时，行程效率显著降低。只有在所有三个近端滑车都被切断后，负荷效率才会增加，而工作效率则会显著降低。这些发现证明，手掌腱膜滑车与近端环形滑车共同作用可降低在掌指关节周围出现弓弦状畸形的倾向。负荷效率的提高可能是由于完整手掌腱膜滑车的整合纤维所产生的摩擦力和反作用力减小所致。工作效率的变化不仅归因于行程的增加，还归因于在屈曲过程中肌腱在其余滑车后方移动时必须承受的急性成角所导致的阻力增加。组间比较显示手掌腱膜滑车有显著贡献。本研究证明了手掌腱膜滑车具有重要的生物力学作用，并表明其在重要性方面应被视为与环形和十字形屈肌腱滑车相似。
