Surgical management of the thumb with intrinsic palsy
Surgical management of the thumb with intrinsic palsy
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DOI：
10.1016/j.main.2007.02.001
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发表时间：
2007-02-01
影响因子：
--
通讯作者：
Chaise, F.
中科院分区：
文献类型：
--
作者：
Chaise, F.
控制拇指的肌肉麻痹导致的长期残疾在很大程度上取决于这些问题的处理（手术和物理治疗），这些问题必须在功能残疾的背景下考虑，因此可以考虑特定的肌腱转移来改善对掌功能。这项工作涉及鱼际肌肉的麻痹。考虑恢复第一掌骨的前位、旋转和内收有助于治疗。在拇短展肌（APB）和拇长伸肌（OP）麻痹时，可以使用拇短伸肌（EPB）或食指固有伸肌（EPB）肌腱或掌长肌（PL）作为运动转移。当拇短屈肌麻痹时，可采用Bunnel所述的拇短屈肌转移术。当所有鱼际肌肉都瘫痪时，评估腕掌关节的活动范围以及第一蹼空间是否存在挛缩是非常重要的。掌指关节和指间关节的稳定性必须通过拇指和食指之间的捏握来评估。术前仔细评估剩余的功能可以准确诊断，从而确定哪些肌腱转移是可能的，哪些其他手术是必要的，如MP关节的关节融合术，第一个web的开放或IP的稳定。这些问题的管理是困难的，必须考虑许多因素，如年龄，病因和外科医生的经验。(c)2007年，Elsevier Masson SAS。图斯所有权保留。
The long term disability resulting from paralysis of the muscle that control the thumb depends largely of the management (surgical and physiotherapic) of these problems that must be considered in the contex of functional disability, and so it is possible to consider specific tendon transfers to improve opposition. This work dealt with paralysis of the thenar muscles. It is helpful to treat such a problem to consider restoring of the anteposition, rotation and adduction of the first inetacarpal. In paralysis of the abductor pollicis brevis (APB) and opponens pollicis (OP) it is possible to use as a motor transfer the tendon of extensor pollicis brevis (EPB) or extensor indicis proprius (EPB) or occasionaly by palmaris longus (PL). When the flexor pollicis brevis is paralysed, transfer of the flexor sublimis ot the third or the ring finger is used as described by Bunnel. When all thenar muscles are paralysed is very important to assess the range of movment of the trapeziometcarpal joint as well as the presence of any contracture of the first web space. The stability of the metacarpophalangeal and interphalangeal joints must be assessed with pinch grip between thumb and index finger. Careful preoperative assessment of remaining function allows accurate diagnosis and thus what tendon transfer is possible and what other procedure are necessary like arthrodesis of the MP joint, opening of the first web, or stabilization of the IP.The management of these problems is difficult and many factors must be taken into consideration like age, aetiology and experience of the surgeon. (c) 2007 Elsevier Masson SAS. Tous droits reserves.