侧腱束延长术治疗手内在肌挛缩的解剖基础与临床应用

Lengthening of the Lateral Band of the Finger forthe Treatment of Contracture of the Intrinsic Musclesof the Hand:An Anatomical Study and the ClinicalApplication

通过６具尸手解剖研究，设计了侧腱束延长术治疗轻、中度手内在肌挛缩。手术方法：阶梯形切断侧腱束，保持掌指关节伸直位屈曲指间关节，同时切断被绷紧的腱帽斜纤维直至指间关节屈至正常，拉紧侧腱束重叠缝合。１９９１年以来，９例２９指行本手术，随访１～４年，９例手内在肌阳性畸形均消失，２３指屈伸完全正常，６指欠屈１０°～３０°。手内在肌肌腱可分为止于近节指骨基底侧方的短腱及包括侧腱束、腱帽斜纤维和横纤维的长腱。内在肌挛缩的功能障碍即指间关节屈曲受限及掌指关节伸直受限，是长腱过紧所致，与短腱无关。因此，延长长腱就能解除内在肌阳性症状，且不妨碍内在肌残存功能的发挥。该手术创伤小，对正常结构影响小，效果可靠，优于传统手术。

AbstractThe authors designed the operation of lengtheningof the lateral band of the finger for the treatment ofmild and moderate contracture of the intrinsic musclesof the hand,after an anatomical study of 6 cadaverhand specimens。The lateral band was lengthened by'z'plasty and the tense oblique fibers of the extensorhood was divided when the MP joint was kept in ex-tension and the IP joint in flexion。The division wasdone to the extent of allowing normal range motion ofthe IP joint.Nine cases(29 fingers)had been operatedupon with this procedure;a follow-up of l～4 yearsrevealed complete correction of the contracture of theintrinsic muscles in all the 9 cases。Normal range offlexion and extension was attained in 23 fingers。Aflexion lag of l0°～30°was seen in 6 fingers。The ten-dons of the intrinsic muscles can be grouped into theshort tendons which insert at the lateral side of thebase of the proximal phalanx and the long tendonswhich are composed of the lateral band,oblique andtransverse fibers of the extensor hood.Functional dis-turbance caused by contracture of the intrinsic musclsmanifests with limitation of flexion of the IP joint andlimitation of extension of the MP joint.This is the re-sult of the tightening of the long tendon and has no re-lationship with the short tendon。Therefore,lengthen-ing of the long tendon can correct the deformity with-out any negative effect。