CAJ | 학술논문

目的：探讨示指固有伸肌腱移位重建伸拇功能术后对拇指和示指功能的影响及其解剖学机制。方法对12例进行回顾性研究，男7例，女5例，年龄18～78岁，平均42.3岁，拇长伸肌腱损伤的平面为III区4例，IV区5例，V区3例。采用示指固有伸肌腱移位重建伸拇功能，术后8～83(33.5±29.9)个月进行电话随访。评价指标包括拇指和示指的功能。拇指功能评价指标：(1)患手手掌向下平置于桌面，能否主动将拇指指尖抬离桌面；(2)能否完成“挑大拇指”的动作；(3)在保持拇指掌指关节和指间关节伸直的情况下，能否完成以第一腕掌关节为支点的拇指划圈运动；(4)在拇指处于中立位时，能否较好地完成拇指指间关节屈曲动作。示指功能评价指标：(1)患手手掌向下平置于桌面时，能否主动将示指指尖单独抬离桌面；(2)在第3～5指呈握拳位时，能否将示指伸直至与手背同一平面，完成指示的动作；(3)能否完成“兰花指”的动作；(4)示指能否自如地使用鼠标，并完成连续双击左键的动作。另外，对5具成年男性尸体的前臂标本进行解剖学研究，重点测量了指总伸肌腱中示指和中指伸肌腱腱性起点的位置。结果术后所有患者都能使用患手较为顺利地完成日常生活和工作中的常用动作，年轻患者中除1例外，均恢复了原工作。12例中有11例主观评价手术疗效满意，1例表示对疗效不满意。其中有8例能完成全部4项拇指功能评价的动作，有3例可以完成拇指功能评价动作的3项，1例仅能完成拇指功能评价动作中的2项。12例均能使用示指自如地使用鼠标，有9例能够在患手手掌向下平置于桌面时主动将示指指尖单独抬离桌面。12例均能单独伸示指，完成指示动作，但仅有7例能在第3～5指呈握拳位时将示指伸直至与手背同一平面，另5例单独伸示指时为-20°和-30°。解剖学研究发现在指总伸肌腱中，示指的肌腹比较独立，示、中指的肌腱起点位置较高。结论示指固有伸肌腱移位重建伸拇功能在适应证恰当的情况下能够获得较好的伸拇功能，对示指的功能影响非常小。指总伸肌腱中的示指伸肌肌腹独立分化较好，去除示指固有伸肌腱后仍能完成独立伸示指的功能。目的：探討示指固有伸肌腱移位重建伸拇功能術後對拇指和示指功能的影響及其解剖學機製。方法對12例進行迴顧性研究，男7例，女5例，年齡18～78歲，平均42.3歲，拇長伸肌腱損傷的平麵為III區4例，IV區5例，V區3例。採用示指固有伸肌腱移位重建伸拇功能，術後8～83(33.5±29.9)箇月進行電話隨訪。評價指標包括拇指和示指的功能。拇指功能評價指標：(1)患手手掌嚮下平置于桌麵，能否主動將拇指指尖抬離桌麵；(2)能否完成“挑大拇指”的動作；(3)在保持拇指掌指關節和指間關節伸直的情況下，能否完成以第一腕掌關節為支點的拇指劃圈運動；(4)在拇指處于中立位時，能否較好地完成拇指指間關節屈麯動作。示指功能評價指標：(1)患手手掌嚮下平置于桌麵時，能否主動將示指指尖單獨抬離桌麵；(2)在第3～5指呈握拳位時，能否將示指伸直至與手揹同一平麵，完成指示的動作；(3)能否完成“蘭花指”的動作；(4)示指能否自如地使用鼠標，併完成連續雙擊左鍵的動作。另外，對5具成年男性尸體的前臂標本進行解剖學研究，重點測量瞭指總伸肌腱中示指和中指伸肌腱腱性起點的位置。結果術後所有患者都能使用患手較為順利地完成日常生活和工作中的常用動作，年輕患者中除1例外，均恢複瞭原工作。12例中有11例主觀評價手術療效滿意，1例錶示對療效不滿意。其中有8例能完成全部4項拇指功能評價的動作，有3例可以完成拇指功能評價動作的3項，1例僅能完成拇指功能評價動作中的2項。12例均能使用示指自如地使用鼠標，有9例能夠在患手手掌嚮下平置于桌麵時主動將示指指尖單獨抬離桌麵。12例均能單獨伸示指，完成指示動作，但僅有7例能在第3～5指呈握拳位時將示指伸直至與手揹同一平麵，另5例單獨伸示指時為-20°和-30°。解剖學研究髮現在指總伸肌腱中，示指的肌腹比較獨立，示、中指的肌腱起點位置較高。結論示指固有伸肌腱移位重建伸拇功能在適應證恰噹的情況下能夠穫得較好的伸拇功能，對示指的功能影響非常小。指總伸肌腱中的示指伸肌肌腹獨立分化較好，去除示指固有伸肌腱後仍能完成獨立伸示指的功能。
목적：탐토시지고유신기건이위중건신무공능술후대무지화시지공능적영향급기해부학궤제。방법대12례진행회고성연구，남7례，녀5례，년령18～78세，평균42.3세，무장신기건손상적평면위III구4례，IV구5례，V구3례。채용시지고유신기건이위중건신무공능，술후8～83(33.5±29.9)개월진행전화수방。평개지표포괄무지화시지적공능。무지공능평개지표：(1)환수수장향하평치우탁면，능부주동장무지지첨태리탁면；(2)능부완성“도대무지”적동작；(3)재보지무지장지관절화지간관절신직적정황하，능부완성이제일완장관절위지점적무지화권운동；(4)재무지처우중립위시，능부교호지완성무지지간관절굴곡동작。시지공능평개지표：(1)환수수장향하평치우탁면시，능부주동장시지지첨단독태리탁면；(2)재제3～5지정악권위시，능부장시지신직지여수배동일평면，완성지시적동작；(3)능부완성“란화지”적동작；(4)시지능부자여지사용서표，병완성련속쌍격좌건적동작。령외，대5구성년남성시체적전비표본진행해부학연구，중점측량료지총신기건중시지화중지신기건건성기점적위치。결과술후소유환자도능사용환수교위순리지완성일상생활화공작중적상용동작，년경환자중제1예외，균회복료원공작。12례중유11례주관평개수술료효만의，1례표시대료효불만의。기중유8례능완성전부4항무지공능평개적동작，유3례가이완성무지공능평개동작적3항，1례부능완성무지공능평개동작중적2항。12례균능사용시지자여지사용서표，유9례능구재환수수장향하평치우탁면시주동장시지지첨단독태리탁면。12례균능단독신시지，완성지시동작，단부유7례능재제3～5지정악권위시장시지신직지여수배동일평면，령5례단독신시지시위-20°화-30°。해부학연구발현재지총신기건중，시지적기복비교독립，시、중지적기건기점위치교고。결론시지고유신기건이위중건신무공능재괄응증흡당적정황하능구획득교호적신무공능，대시지적공능영향비상소。지총신기건중적시지신기기복독립분화교호，거제시지고유신기건후잉능완성독립신시지적공능。
Objective To explore the effects on the functions of the thumb and index ifnger and the related anatomical mechanism of extensor indicis proprius ( EIP ) transfer for reconstruction of thumb extension. Methods A total of 12 patients were retrospectively studied, including 7 males and 5 females, whose mean age was 42.3 years old ( range;18-78 years ). The extensor pollicis longus ( EPL ) was injured in zone III in 4 cases, in zone IV in 5 cases and in zone V for 3 cases. All the patients received EIP transfer for reconstruction of thumb extension. After the operation, the follow-up was carried out through telephone for a mean period of ( 33.5±29.9 ) months ( range;8-83 months ). The functions of the thumb and index ifnger were evaluated. The evaluation indexes of the thumb function were stated as following. ( 1 ) Whether the patient could actively lift the tip of the thumb from the table when the operated hand was placed on the table with the palm down. ( 2 ) Whether the patient could pick the thumb. ( 3 ) Whether the thumb could circle with the first carpometacarpal joint as the pivot when the metacarpophalangeal joint and the interphalangeal joint were maintained unbent. ( 4 ) Whether the interphalangeal joint of the thumb could bend well when the thumb was in the neutral position. The evaluation indexes of the index ifnger function were stated as following. ( 1 ) Whether the patient could actively lift the tip of the index ifnger from the table alone when the operated hand was placed on the table with the palm down. ( 2 ) Whether the patient could extend the index ifnger to the same level of the back of the hand and complete the action of pointing to somebody when the patient clenched the 3rd-5th fingers. ( 3 ) Whether the patient could stilfe an arethusa. ( 4 ) Whether the patient could use the mouse without any dififculty or click the left mouse button twice continuously. In addition, the anatomy research was carried out on 5 adult male cadaver forearm specimens. The original points of the index ifnger and middle ifnger extensor tendons in the extensor digitorum communis ( EDC ) tendons were measured. Results All the patients could use their operated hands for almost all kinds of the daily life and work activities after the operation. Among the young patients, all but one returned to their original jobs. As to the subjective evaluation, 11 patients were satisifed with the surgical results while 1 patient were unsatisifed. Among the 12 patients, 8 patients could fulifll all the 4 pre-designed actions of the thumb, while 3 patients could fulifll 3 actions and 1 patient could fulifll only 2 actions. All the patients can use the mouse without any dififculties. Nine patients could lift the index ifnger from the table when the operated hand was placed on the table with the palm down. All the patients could extend their index ifngers independently, and completed the action of pointing to somebody. Only 7 patients could extend their index ifngers to the same level of the back of the hand with the 3rd and 5th ifngers clenched, while the others could just extend their index ifngers to-20° or-30°. Anatomy research showed that the muscle belly of the index ifnger in the EDC tendon was fairly independent, and the original points of the index ifnger and middle ifnger tendons were quite high. Conclusions EIP transfer for reconstruction of thumb extension can achieve satisfactory results if the indication is proper, with good function of the involved thumb and little functional impairment of the index ifnger. The muscle belly of the index ifnger in the EDC tendons is well differentiated and almost become independent, and the index ifnger can extend independently without the EIP.