McCarthy C K, House J H, Van Heest A, Kawiecki J A, Dahl A, Hanson D
Department of Surgery, University of Minnesota School of Medicine, Minneapolis 55455, USA.
J Hand Surg Am. 1997 Jul;22(4):596-604. doi: 10.1016/S0363-5023(97)80115-3.
This article reviews 183 hand reconstructions in 135 consecutive tetraplegic patients. Comparisons were made between 103 extrinsic reconstructions with intrinsic balancing procedures and 80 extrinsic reconstructions without intrinsic balancing procedures. Extrinsic reconstructions (tendon transfers and tenodesis in the forearm muscles) were augmented by intrinsic reconstructive procedures (tendon transfers or tenodesis to improve the intrinsic balance of the fingers) in patients exhibiting digital imbalance. Intrinsic procedures included primarily the flexor digitorum superficialis (FDS) lasso procedure or the intrinsic tenodesis procedure. The patients were stratified by level of spinal cord injury and by type of extrinsic and intrinsic reconstruction. Hands reconstructed with intrinsic balancing versus without intrinsic balancing, as well as intrinsic balancing using a FDS lasso procedure versus an intrinsic tenodesis procedure, were compared with patients with the same level of spinal cord function. Patients who underwent reconstructions with intrinsic balancing had more grip strength, by an average of 13-26 N, than those who did not undergo intrinsic balancing. When different intrinsic procedures were compared, there was improvement in grip strength and function in activities of daily living for all hands, but there was no significant difference between FDS lasso or intrinsic tenodesis procedures. The indications for intrinsic balancing during extrinsic reconstruction are developed into treatment algorithms based on the senior author's surgical experience. The authors recommended that digital intrinsic procedures be included in hand reconstruction for tetraplegic patients exhibiting intrinsic imbalance to help improve digital function and provide increased grip strength.
本文回顾了135例连续性四肢瘫痪患者的183例手部重建手术。对103例采用内在平衡术式的外在重建手术与80例未采用内在平衡术式的外在重建手术进行了比较。对于存在手指失衡的患者，外在重建手术（前臂肌肉的肌腱转移和肌腱固定术）通过内在重建手术（肌腱转移或肌腱固定术以改善手指的内在平衡）得到加强。内在手术主要包括指浅屈肌（FDS）套索术或内在肌腱固定术。患者根据脊髓损伤水平以及外在和内在重建类型进行分层。将采用内在平衡术式重建的手与未采用内在平衡术式重建的手，以及采用FDS套索术式的内在平衡术与内在肌腱固定术式的内在平衡术进行比较，对比具有相同脊髓功能水平的患者。接受内在平衡重建手术的患者握力平均比未接受内在平衡手术的患者多13 - 26牛。当比较不同的内在手术时，所有手部的握力和日常生活活动功能均有改善，但FDS套索术与内在肌腱固定术之间无显著差异。基于资深作者的手术经验，将外在重建过程中进行内在平衡的指征制定为治疗算法。作者建议，对于存在内在失衡的四肢瘫痪患者，手部重建应包括手指内在手术，以帮助改善手指功能并增强握力。
