Seiler J G, Uchiyama S, Ellis F, Amadio P C, Gelberman R H, An K N
Section of Orthopaedics, The Emory Clinic, Atlanta, Georgia 30322, USA.
J Bone Joint Surg Am. 1998 May;80(5):699-703. doi: 10.2106/00004623-199805000-00010.
Flexor pulleys in the hindpaw digits of twenty-eight adult mixed-breed dogs were reconstructed in order to investigate the influence, on the reconstruction, of the source of the autogenous tissue (intrasynovial compared with extrasynovial tendon) and the tension applied during the repair. The ipsilateral peroneus longus tendon was used to reconstruct the A2 pulley with an around-the-bone technique in twenty-one digits; the graft was sutured at a tension of 0.49, 0.98, and 1.96 newtons in seven digits each. The flexor digitorum profundus tendon of an adjacent digit was used to reconstruct the A2 pulley, at a tension of 0.98 newton, in seven additional digits. The contralateral digits were used as controls for all twenty-eight treated digits. The digits were tested in a custom apparatus designed to measure the frictional force generated between the reconstructed pulley and the tendon beneath it. The frictional force did not differ significantly (p > 0.5) among the three groups repaired with peroneus longus tendon; however, the average value was more than five times that produced in the contralateral, control digits. The average frictional forces created by the flexor digitorum profundus grafts were similar to those in the contralateral, control digits. Reconstruction with the flexor digitorum profundus at a tension of 0.98 newton produced significantly less frictional force (p < 0.05) than that produced by the peroneus longus graft at the same tension. This in vitro model of reconstruction of the A2 pulley demonstrated that tendon from an intrasynovial source (the flexor digitorum profundus) produced less frictional resistance to gliding of the tendon than did tendon from an extrasynovial source (the peroneus longus). This result is consistent with previously published findings that intrasynovial tendons may make better grafts than extrasynovial tendons for the reconstruction of gliding flexor tendons because of decreased friction and better healing qualities. Intrasynovial tendons may also make better grafts for the reconstruction of flexor pulleys.
为了研究自体组织来源（滑膜内肌腱与滑膜外肌腱相比）以及修复过程中施加的张力对重建的影响，对28只成年杂种犬后爪趾的屈肌滑车进行了重建。在21个趾中，采用绕骨技术使用同侧的腓骨长肌腱重建A2滑车；在7个趾中，分别以0.49、0.98和1.96牛顿的张力缝合移植物。另外7个趾使用相邻趾的指深屈肌腱以0.98牛顿的张力重建A2滑车。对所有28个治疗趾，将对侧趾用作对照。在一个定制装置中对趾进行测试，该装置旨在测量重建滑车与其下方肌腱之间产生的摩擦力。在用腓骨长肌腱修复的三组之间，摩擦力没有显著差异（p>0.5）；然而，平均值是对侧对照趾产生的摩擦力的五倍多。指深屈肌移植物产生的平均摩擦力与对侧对照趾相似。与相同张力下腓骨长肌移植物相比，以0.98牛顿的张力用指深屈肌进行重建产生的摩擦力显著更小（p<0.05）。A2滑车重建的这个体外模型表明，滑膜内来源的肌腱（指深屈肌）对肌腱滑动产生的摩擦阻力小于滑膜外来源的肌腱（腓骨长肌）。该结果与先前发表的研究结果一致，即由于摩擦力降低和愈合质量更好，滑膜内肌腱可能比滑膜外肌腱更适合用于滑动屈肌腱重建的移植物。滑膜内肌腱也可能更适合用于屈肌滑车的重建。
