拇短伸肌腱移位重建拇对掌功能的应用解剖和临床经验

Anatomical and clinical study for reconstruction of thumb oppsition with transfer of extensor pollicis brevis tendon

目的 研究拇短伸肌腱和桡侧腕屈肌腱纤维鞘管的解剖特点 ,寻找拇指对掌功能重建的方法。方法 对 2 4侧新鲜成人上肢标本 ,建立拇短伸肌腱、桡侧腕屈肌腱纤维鞘管的解剖模型。为 8例拇指对掌功能障碍者 ,设计以桡侧腕屈肌腱纤维鞘管为滑车 ,行拇短伸肌腱移位、重建拇对掌功能术。结果 拇短伸肌腱止点恒定 ,肌腹长度为 [(85 .67± 1.67)mm , x±s,下同 ] ,肌腱长 (10 2 .41± 1.65 )mm。桡侧腕屈肌纤维鞘管长度为 (13.76± 0 .40 )mm ,宽度为 (6.18± 0 .16)mm ,高度为 (4.11± 0 .18)mm。 8例拇对掌功能重建者 ,按吉林大学中日联谊医院手外科制定的评定标准 :优 4例 ,良 2例 ,可 2例。结论 拇短伸肌腱位置恒定 ,长度、肌力足够 ,移位后其作用方向与拇短展肌作用方向一致。以桡侧腕屈肌腱纤维鞘管作滑车 ,用拇短伸肌腱移位重建拇对掌功能 。

Objective To study the anatomical characteristics of extensor pollicis brevis tendon (EPB) and fibrous sheath of flexor carpi radialis (FCR), and search for a new method of reconstruction of the thumb opposition.Methods The anatomical model of EPB and fibrous sheath of FCR was set up in 24 fresh forearm specimens of adults. Using the fibrous sheath of FCR as a pulley, transfer of EPB tendon for reconstruction of thumb opposition was done in 8 cases. Results The insertion of the EPB tendon was constant, with the length of the muscle and tendon (85.67 ± 1.67) mm and (102.41 ± 1.65) mm, respectively. The length, width and height of the fibrous sheath of FCR were (13.76 ± 0.40) mm, (6.18 ± 0.16) mm, and (4.11 ± 0.18) mm, respectively. In 8 cases with thumb opposition reconstruction, results were obtained excellent in 4 cases, good in 2 cases, fair in 2 cases, according to the criterion issued by jilin university.Conclusions The EPB tendon had constant anatomical position, sufficient length and strength. The direction of EPB after transfer was consistent with that of abductor pollicis brevis. It was a convenient and efficient procedure for reconstruction of thumb opposition with transfer of EPB tendon by using the fibrous sheath of FCR tendon as a pulley.