Intrinsic Hand Muscle Function, Part 1: Creating a Functional Grasp
Intrinsic Hand Muscle Function, Part 1: Creating a Functional Grasp
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DOI：
10.1016/j.jhsa.2013.08.099
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发表时间：
2013-11-01
影响因子：
1.9
通讯作者：
Lieber, Richard L.
中科院分区：
文献类型：
--
作者：
Arnet, Ursina;Muzykewicz, David A.;Lieber, Richard L.
恢复手部功能已被确定为四肢瘫痪患者的最高优先级。在许多患者中，手指屈曲可以通过将桡侧腕长伸肌肌腱转移到指深屈肌（FDP）来恢复。在缺乏内在功能的情况下，这导致了手指的卷起运动，这往往会把大的物体推到抓不到的地方。为了使患者能够抓取不同大小的物体，需要一种功能性抓取，它比没有内在功能的抓取具有更大的指尖到手掌的距离偏移。本研究的目的是量化内在肌肉力量在创造功能性抓握中的作用。方法对5只尸体手进行抓握过程中手指运动的测量。为了模拟手指屈曲，FDP被马达激活，内在肌肉被加载到不同的水平（0、125、250、375或500 g）。手指运动的特征是掌指关节屈曲、近端指间关节屈曲和远端指间关节屈曲的顺序，以及手指闭合时指尖到手掌的最大距离。结果在没有任何内在肌肉贡献（0-g负荷）的情况下，EDP激活导致所有3个关节屈曲，屈曲始于近端指间关节，其次是远端指间关节，然后是掌指关节。随着固有肌肉负荷的增加，手指屈曲始于掌指关节，其次是近端指间关节和远端指间关节。这种改变的关节屈曲顺序导致手指屈曲时指尖到手掌的最大距离增大。两种极端条件（0 g和500 g内在肌肉负荷）之间的差异为19毫米。结论这些发现表明，与单独激活FDP相比，FDP和内在肌肉同时激活会导致明显更有效的手部闭合，因为FDP的运动学改变和指尖到手掌的距离更大。(版权归美国手部外科学会所有。版权所有。)
Purpose Regaining hand function has been identified as the highest priority for persons with tetraplegia. In many patients, finger flexion can be restored with a tendon transfer of extensor carpi radialis longus to flexor digitorum profundus (FDP). In the absence of intrinsic function, this results in a roll-up finger movement, which tends to push large objects out of grasp. To enable patients to grasp objects of varying sizes, a functional grasp is required that has a larger excursion of fingertip-to-palm distance than can be supplied without intrinsic function. The aim of this study was to quantify the role of intrinsic muscle force in creating a functional grasp.Methods Finger kinematics during grasp were measured on 5 cadaveric hands. To simulate finger flexion, the FDP was activated by a motor and intrinsic muscles were loaded at various levels (0, 125, 250, 375, or 500 g). Finger movement was characterized by the order of metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joint flexion and by the maximal fingertip-to-palm distance during finger closure.Results Without any intrinsic muscle contribution (0-g load), EDP activation resulted in flexion of all 3 joints, whereby flexion began at the proximal interphalangeal joint, followed by the distal interphalangeal joint, and then the metacarpophalangeal joint. With increasing intrinsic muscle load, finger flexion was initiated at the metacarpophalangeal joint, followed by the proximal interphalangeal and distal interphalangeal joints. This altered joint flexion order resulted in a larger maximal fingertip-to-palm distance during finger flexion. The difference between the 2 extreme conditions (0 g vs 500 g of intrinsic muscle load) was 19 mm.Conclusions These findings demonstrate that simultaneous activation of the FDP and the intrinsic muscles results in an apparently more functional hand closing compared with FDP activation alone because of altered kinematics and larger fingertip-to-palm distances. (Copyright (C) 2013 by the American Society for Surgery of the Hand. All rights reserved.)