Aper R L, Saltzman C L, Brown T D
Department of Orthopaedic Surgery, University of Iowa, Iowa City 52242, USA.
Clin Orthop Relat Res. 1996 Apr(325):209-17. doi: 10.1097/00003086-199604000-00025.
Surgical treatments for chronic, painful hallux sesamoid disorders typically involve partial or complete resection of 1 or both sesamoids. Although these approaches generally result in satisfactory symptom relief, their effect on biomechanical function of the major hallux flexors is not completely understood. The effects of selective sesamoid resections on the effective tendon moment arm of the flexor hallucis longus tendon were evaluated. Twelve fresh frozen cadaver first rays were each mounted in a device that held rigid the metatarsal. A ramp-controlled displacement of an MTS ram supplied a functional load input force to the flexor hallucis longus. The components of the resultant output force necessary to resist the input flexor hallucis longus force were transduced simultaneously by a multicomponent load cell. Subsequently, 3 progressively more extensive seasamoid resections were done: (1) distal hemiresection, (2) complete resection, and (3) resection of both sesamoids. Six specimens were tested with the medial sesamoid removed first and 6 with the lateral sesamoid removed first. Statistical analysis showed that significant decreases in the effective tendon moment arms occurred with full medial sesamoid resection, full lateral sesamoid resection, and resection of both the medial and lateral sesamoids.
慢性疼痛性拇籽骨疾病的手术治疗通常包括部分或完全切除一侧或双侧籽骨。尽管这些方法通常能使症状得到满意缓解，但其对拇主要屈肌生物力学功能的影响尚未完全明确。本研究评估了选择性籽骨切除对拇长屈肌腱有效腱力矩臂的影响。选取12例新鲜冷冻尸体的第一跖列，每例均固定于一个使跖骨保持刚性的装置中。通过MTS推杆的斜坡控制位移向拇长屈肌施加功能性负荷输入力。由多分量测力传感器同时测量抵抗输入的拇长屈肌力量所需的合成输出力的各个分量。随后，进行3种逐渐扩大范围的籽骨切除：(1)远端半切除，(2)完全切除，(3)双侧籽骨切除。6个标本先切除内侧籽骨进行测试，6个标本先切除外侧籽骨进行测试。统计分析表明，内侧籽骨完全切除、外侧籽骨完全切除以及双侧籽骨切除后，有效腱力矩臂均显著减小。
