CAJ | 학술논문

目的探讨手部屈肌腱修复术后在使用动力型支具后其屈、伸肌腱力学变化情况.方法将8根废弃的从掌骨远端平面至近节指骨近端平面离断的新鲜完好手指分成8个组并建立实验模型,以模拟手指伸、屈肌腱在动力型支具时的伸、屈活动.每组分别施以深屈肌腱0.2 ～0.5 N不等的初始拉力F模拟肌肉伸缩活动,用拉力计连接伸肌腱施以拉力F2牵拉手指伸直至近端指间关节活动度达20 ～ 50°,测量此时每组深屈肌腱张力值(Fx)及伸肌腱拉力值(F2);在每组手指指甲远端固定一模拟动力型支具的橡皮筋向手指近端牵拉,并施以0.1～0.4N不等的初始牵引力F1,用拉力计牵拉伸肌腱,活动手指至使用模拟动力型支具前相同位置,测量此时各组手指深屈肌腱张力值(Fx)及伸肌腱拉力值(F2).结果在相同活动范围内,使用模拟动力型支具后深屈肌腱张力值(Fx)与未使用支具时深屈肌腱张力值(Fx)比较,其间差异无统计学意义(P＞0.05);而使用模拟动力型支具后伸肌腱拉力值F2显著大于未使用支具时伸肌腱拉力值F2,其间差异具有统计学意义(P＜0.05).结论屈肌腱修复术后使用动力型支具不会使屈肌腱张力值产生显著变化,而伸肌腱拉力值则会显著增加,导致手指背伸时阻力增大,使术后锻炼变得困难.
목적 탐토수부굴기건수복술후재사용동력형지구후기굴、신기건역학변화정황.방법 장8근폐기적종장골원단평면지근절지골근단평면리단적신선완호수지분성8개조병건립실험모형,이모의수지신、굴기건재동력형지구시적신、굴활동.매조분별시이심굴기건0.2 ～0.5 N불등적초시랍력F모의기육신축활동,용랍력계련접신기건시이랍력F2견랍수지신직지근단지간관절활동도체20 ～ 50°,측량차시매조심굴기건장력치(Fx)급신기건랍력치(F2);재매조수지지갑원단고정일모의동력형지구적상피근향수지근단견랍,병시이0.1～0.4N불등적초시견인력F1,용랍력계견랍신기건,활동수지지사용모의동력형지구전상동위치,측량차시각조수지심굴기건장력치(Fx)급신기건랍력치(F2).결과 재상동활동범위내,사용모의동력형지구후심굴기건장력치(Fx)여미사용지구시심굴기건장력치(Fx)비교,기간차이무통계학의의(P＞0.05);이사용모의동력형지구후신기건랍력치F2현저대우미사용지구시신기건랍력치F2,기간차이구유통계학의의(P＜0.05).결론 굴기건수복술후사용동력형지구불회사굴기건장력치산생현저변화,이신기건랍력치칙회현저증가,도치수지배신시조력증대,사술후단련변득곤난.
Objective To study the mechanical changes of extensor and flexor tendons during use of dynamic orthosis after repair operation on the flexor tendons of hand.Methods An experiment model was established in eight groups (at different stages) using eight descarded fresh and integral human fingers which were broken from the distal plane to the proximal plane of metacarpal bone,thereby while using a dynamic orthosis the extension and flexion movement of extensor and flexor tendons of fingers were induced.An initial tensile force (F) of 0.2 N ～ 0.5 N was exerted on the flexor tendons of each group to simulate the extension and flexion movement of the muscle and a tensometer was connected to the extensor tendon exerting a tensile force (F2) and pulling the finger to the proximal interphalangeal joint at various positions of 20° ～ 50°,thus the tensile force (Fx) of flexor tendons and the tensile force (F2) of extensor tendons were measured.A rubber band was fixed at the distal end of the finger nails to simulate the dynamic orthosis and was pulled toward the proximal-end of the finger,while exerting an initial traction force (F1) of 0.1 N ～ 0.4 N and pull the extensor tendons with the tensometer to cause the finger extension until they reach the same position as that before the simulated dynamic orthosis was employed.Then the tensile force (Fx') of flexor tendons of each group as well as the tensile force (F2') of extensor tendons were measured,after which a statistical comparison was made with regard to the tensile force Fx and Fx' of flexor tendons and the tensile force F2 and F2' of extensor tendons before and after the simulated dynamic orthosis was employed.Results The tensile force (Fx') of flexor tendons during the simulated orthosis was used was compared with the tensile force (Fx) during the simulated orthosis was not used,it showed no statistical significant (P ＞ 0.05) ; in the meantime,by comparing the tensile force F2' and F2 of extensor tendons,it was found that the difference statistically significant (P ＜ 0.001) ; after the orthosis was used the tensile force of extensor tendons F2' increased remarkably with the increase of the initial tensile force F1 during the dynamic orthosis of rubber band was used.Conclusion The tensile force of flexor tendons would not be changed during a dynamic orthosis was used after repair operation on the flexor tendon of hand;however,with the increase of extensor tensile force,the resistance of finger extension would be multiplied and cause more difficulty to do exercise.