目的:已经描述了手腕和手指屈曲挛缩和痉挛的多种手术。前臂屈肌肌腱的分段延长涉及在肌肌腱连接处进行平行的横向肌腱切开术以延长肌肉。目前,有有限的文献来定义这种加长技术的生物力学后果。
方法:从8个配对的上肢收集48个屈肌肌腱,包括桡骨腕屈肌,尺尖腕屈肌,长屈肌,指屈肌腱。每个延长的肌腱与对侧肌腱配对作为对照。完成了一对横向肌腱切开术,用于部分延长。第一次肌腱切开术是在肌腱连接处进行的,肌腱变窄到其最大宽度的75%。第二次肌腱切开术在第一次肌腱远端1厘米处进行。在1N的恒定静止张力下,在部分延长之前和之后测量肌腱长度。分别测量每个肌腱失效时的最大载荷和失效机理,并与对侧进行比较。
结果:分数延长后,静息肌腱长度平均增加4mm.当加载到失败时,延长肌腱的平均最大载荷是完整肌腱的平均最大载荷的42%。所有延长的肌腱在远端肌腱切开术部位均失效。
结论:分段延长导致在静息张力下肌腱长度增加3-6mm(平均:4mm)。与完整的肌肉肌腱单元相比,分数延长后的拉伸强度和破坏载荷显着损失。
结论:部分加长后拉伸强度的降低会导致破坏时的载荷,在某些情况下,低于执行基本任务所需的估计部队。在治疗和康复期间需要谨慎。
OBJECTIVE: Multiple procedures have been described for wrist and finger flexion contractures and spasticity. Fractional lengthening of forearm flexor tendons involves making parallel transverse tenotomies at the musculotendinous junction to elongate the muscle. Currently, there is limited literature to define the biomechanical consequences of this lengthening technique.
METHODS: Forty-eight flexor tendons were harvested from eight paired upper limbs including flexor carpi radialis, flexor carpi ulnaris, flexor pollicis longus, and flexor digitorum superficialis tendons. Each tendon that was lengthened was paired with the contralateral tendon as a control. A pair of transverse tenotomies were completed for the fractional lengthening. The first tenotomy was performed at the musculotendinous junction where the tendon narrowed to 75% of its maximal width. The second tenotomy was made 1 cm distal to the first. Tendon length was measured before and after fractional lengthening at a constant resting tension of 1 N. The maximum load at failure of each tendon and the mechanism of failure were each measured and compared with the contralateral side.
RESULTS: After fractional lengthening, the mean increase in resting tendon length was 4 mm. When loaded to failure, the mean maximum load of fractionally lengthened tendons was 42% of the mean maximum load of intact tendons. All lengthened tendons failed at the distal tenotomy site.
CONCLUSIONS: Fractional lengthening resulted in an increase of 3-6 mm (mean: 4 mm) in tendon length at resting tension. There was a significant loss in tensile strength and load to failure following fractional lengthening compared with an intact musculotendinous unit.
CONCLUSIONS: The reduction in tensile strength following fractional lengthening results in loads at failure that are, in some cases, lower than the estimated forces required to perform basic tasks. Caution during the healing and rehabilitation period is warranted.