Delineation of the mechanisms of tendon gliding resistance within the carpal tunnel.
Delineation of the mechanisms of tendon gliding resistance within the carpal tunnel.
复制标题
描绘腕管内肌腱滑行抗性的机理。
DOI：
10.1016/j.clinbiomech.2016.12.001
复制
发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Amadio PC
中科院分区：
文献类型：
--
作者：
Filius A;Thoreson AR;Ozasa Y;An KN;Zhao C;Amadio PC
腕管综合征的症状有哪些？腕管综合征的症状有哪些？本研究旨在分离和识别有助于腕管中肌腱滑动阻力的机制。使用了八只人类尸体手（四对）。在不同条件下测量肌腱滑动阻力（力、能量和刚度）：完整和分离的滑膜下结缔组织，肌腱偏移速度为2 mm/s和60 mm/s，肌腱偏移前有和无松弛时间。滑膜下结缔组织拉伸在很大程度上导致了较高肌腱偏移速度期间滑动阻力和能量的增加，并且观察到滑膜下结缔组织硬化。肌腱（可能还有滑膜下结缔组织）的多孔弹性特性似乎也参与其中，因为松弛时间显著增加了滑动阻力和能量（P<0.01），并且随着松弛时间的增加，高速和低速肌腱偏移之间的能量和力的差异增加（P= 0.01和P<0.01）。最后，在没有松弛时间的情况下，没有观察到力和能量的差异（P= 0.06和P= 0.60），表明接触摩擦。这些发现与肌腱在腕管内运动的力学受到滑膜下结缔组织完整性影响的假设是一致的。虽然这里没有测试，但在腕管综合征中，该组织已知是纤维化的，增厚的，并且液体渗透性较低。我们的研究结果的外推表明，这些变化在滑膜下结缔组织的腕管综合征患者可能会增加接触摩擦和腕管压力。
Forceful, high-velocity, and repetitive manual hand tasks contribute to the onset of carpal tunnel syndrome. This study aimed to isolate and identify mechanisms that contribute to tendon gliding resistance in the carpal tunnel. Eight human cadaver hands (four pairs) were used. Tendon gliding resistance (force, energy, and stiffness) was measured under different conditions: with intact and with divided subsynovial connective tissue, at 2 mm/s and 60 mm/s tendon excursion velocity, and with and without relaxation time before tendon excursion. Subsynovial connective tissue stretching substantially contributed to increased gliding resistance force and energy during higher tendon excursion velocities, and subsynovial connective tissue stiffening was observed. Poroelastic properties of the tendon (and possibly the subsynovial connective tissue) also appear to be involved because relaxation time significantly increased gliding resistance force and energy (P<.01), and the difference in energy and force between high- and low-velocity tendon excursions increased with relaxation time (P=.01 and P<.01). Lastly, without relaxation time, no difference in force and energy was observed (P=.06 and P=.60), suggesting contact friction. These findings are consistent with the hypothesis that the mechanics of tendon motion within the carpal tunnel are affected by the integrity of the subsynovial connective tissue. While not tested here, in carpal tunnel syndrome this tissue is known to be the fibrotic, thickened, and less-fluid-permeable. An extrapolation of our findings suggests that these changes in the subsynovial connective tissue of carpal tunnel syndrome patients could increase contact friction and carpal tunnel pressure.