Mechanical feasibility of immediate mobilization of the brachioradialis muscle after tendon transfer.
Mechanical feasibility of immediate mobilization of the brachioradialis muscle after tendon transfer.
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DOI：
10.1016/j.jhsa.2010.06.003
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发表时间：
2010-09
影响因子：
1.9
通讯作者：
Lieber, Richard L.
中科院分区：
文献类型：
--
作者：
Friden, Jan;Shillito, Matthew C.;Chehab, Eric F.;Finneran, John J.;Ward, Samuel R.;Lieber, Richard L.
肌腱移位是颈髓损伤后常用的关键性夹伤修复方法。目前的术后建议包括屈曲位肘关节固定，以保护肱桡肌-拇长屈肌（BR-FPL）修复。本研究的目的是测量一系列腕关节和肘关节角度范围内的BR-FPL肌腱张力，以确定关节运动是否会导致修复断裂。我们在新鲜冷冻的尸体手臂（n = 8）上进行了BR到FPL肌腱转移，并使用带扣传感器对BR-FPL肌腱进行了器械化。手臂的范围为4个腕关节角度（从屈曲45°到伸展45°）和8个肘关节角度（从屈曲90°到完全伸展），测量每个角度下BR-FPL修复的张力。随后，取出BR-FPL肌腱结构并延长至失效。在较宽的腕关节和肘关节活动范围内，BR-FPL肌腱张力低于20 N。重复测量的双因素方差分析显示腕关节角度（p<.001）和肘关节角度（p<.001）具有显著影响，肘关节和关节角度之间存在显著相互作用（p <.001）。由于修复部位的失效载荷为203 ± 19 N，是修复部位预期发生载荷的10倍以上，因此我们的结果表明修复的安全系数至少为10。我们的肌腱力的测量支持的断言，手肘关节不需要固定时，BR被用作肌腱转移到FPL的供体肌肉。这是基于我们的尸体模型中最大被动肌腱张力仅约为20 N，而这种特定修复的失效强度超过200 N。我们建议可以考虑在一个阶段进行多个肌腱转移，避免固定，这可能会对功能恢复产生不利影响。这些结果必须通过这样一个事实进行验证，即活体组织特有的问题，如术后水肿和肌腱滑动，不能通过该尸体模型来解释。
Tendon transfer is often used to restore key pinch after cervical spinal cord injury. Current postoperative recommendations include elbow immobilization in a flexed position to protect the brachioradialis–flexor pollicis longus (BR-FPL) repair. The purpose of this study was to measure the BR-FPL tendon tension across a range of wrist and elbow joint angles to determine whether joint motion could cause repair rupture. We performed BR-to-FPL tendon transfers on fresh-frozen cadaveric arms (n = 8) and instrumented the BR-FPL tendon with a buckle transducer. Arms were ranged at 4 wrist angles from 45° of flexion to 45° of extension and 8 elbow angles from 90° of flexion to full extension, measuring tension across the BR-FPL repair at each angle. Subsequently, the BR-FPL tendon constructs were removed and elongated to failure. Over a wide wrist and elbow range of motion, BR-FPL tendon tension was under 20 N. Two-way analysis of variance with repeated measures revealed a significant effect of wrist joint angle (p<.001) and elbow joint angle (p<.001) with significant interaction between elbow and joint angles (p<.001). Because the failure load of the repair site was 203 ± 19 N, over 10 times the loads that would be expected to occur at the repair site, our results demonstrate that the repair has a safety factor of at least 10. Our tendon force measurements support the assertion that the elbow joint need not be immobilized when the BR is used as a donor muscle in tendon transfer to the FPL. This is based on the fact that maximum passive tendon tension was only about 20 N in our cadaveric model and the failure strength of this specific repair was over 200 N. We suggest that it is possible to consider performing multiple tendon transfers in a single stage, avoiding immobilization, which may adversely affect functional recovery. These results must be qualified by the fact that issues unique to living tissues such as postoperative edema and tendon gliding cannot be accounted for by this cadaveric model.
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影响因子：
2.4
作者：
Murray, WM;Buchanan, TS;Delp, SL
通讯作者：
Delp, SL
影响因子：
1.9
作者：
LIEBER, RL;FAZELI, BM;BOTTE, MJ
通讯作者：
BOTTE, MJ
DOI：
10.1016/0072-968x(76)90007-3
发表时间：
1976-10-01
期刊：
The Hand
影响因子：
--
作者：
Lundborg, G
通讯作者：
Lundborg, G
影响因子：
2.4
作者：
MURRAY, WM;DELP, SL;BUCHANAN, TS
通讯作者：
BUCHANAN, TS
影响因子：
1.9
作者：
Lieber, RL;Amiel, D;Gelberman, RH
通讯作者：
Gelberman, RH