Başparmak oppozisyon rekonstrüksiyonu için tendon transferinde pulley lokalizasyonlarının başparmak fonksiyonu ve tendon kayma direnci üzerinde etkisi: Biyomekanik kadavra çalışması
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Tarih
2009
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Başparmak oppozisyonu için yapılan tendon transferlerinin etkisi transfer edilen kasa, pulley yerleşimine ve bu yerleşim yerindeki tendon kayma drencine bağlıdır. Kas seçimi ve pulley yerleşimi üzerinde geniş çalışmalar mevcut iken, transferin başarısında veya yetmezliğinde potansiyel bir sebep olan pulley yerleşiminde kayma direnci ile ilglili çok az sayıda çalışmalar yapılmıştır. Çalışmamızın amacı; tendon transferinde en sık kullanılan 3 pulley lokalizasyonunda tendonun kayma drencini biyomekanik olarak karşılaştırmak ve en düşük kayma direnci oluşturan pulley yerleşimine karar vermektir.Çalışmada, kayma drencini hesaplamak için 8 taze donmuş kadavranın önkolu kullanıldı. Donör tendon olarak tüm kadavralarda 4. parmak fleksör dijitorum süperfisiyalis (FDS) seçildi. Oppozisyon tendon transferi için seçilen üç pulley; 1- Guyon kanal, 2- fleksör karpi ulnaris (FKU) loop pulley ve 3- Royle-Thompson pulley ( palmar aponörozun ulnar kenarı ile transvers karpal ligamanın distal kenarının birleşme yeridir). FDS tendonu tüm kadavra örneklerinde abduktör pollisis brevisin (APB) palmar-radial tarafına sütüre edildi. Transfer edilen tendonun kayma direnci ile fonksiyonel değerlendirilmesi 3 farklı pulley sahasında, modifiye edilmiş tendon kayma direnci düzeneğiyle direkt olarak ölçüldü. Fonksiyonel değerlendirme için; başparmak abduksiyonu ve oppozisyonu hassas cetvel kullanılarak sırayla başparmak ucu ile ikinci ve beşinci metakarp başı arasındaki mesafe ölçüldü.Royle-Thompson, Guyon kanal ve FKU loop pulleyleri içinde transfer edilen tendonun ortalama kayma direnci sırayla 129.83 (±103.57), 59.44 (±53.99), 45.37 (±42.03) (Newton) idi. Royle-Thompson pulleyinde kayma direnci FKU loop ve Guyon kanalı pulleylerinden istatistiksel olarak anlamlı daha yüksek bulundu (p < 0.05). Guyon kanal ile FKU loop pulleyleri arasında oluşan kayma direncinde istatistiksel olarak anlamlı fark yoktu. Fonksiyonel olarak; Royle-Thompson ile Guyon kanal pulleyi en fazla başparmak pulpasını beşinci parmak metakarp başına yaklaştırırken (oppozisyon) (p < 0.05), FKU loop pulley ise en fazla palmar abdüksiyon sağladı (p < 0.05).Sonuç olarak, Guyon kanal ile FKU loop pulleyleri 4. parmak FDS tendonu kullanılarak yapılan oppozisyon transferinde daha az kayma direnci üretir. Guyon kanal pulleyi ayrıca FKU loop pulleyi ile karşılaştırıldığında daha fazla oppozisyon hareketi sağladığından dolayı oppozisyon rekonstrüksiyonunda en uygun pulley yerleşimi Guyon kanalı olduğu tespit edildi.
The function of tendon transfers for thumb opposition depends on the muscle transferred, pulley location and the amount of friction created at the pulley site. While muscle choice and pulley location have been extensively studied, few studies have examined friction at pulley site as a potential cause for transfer success or failure. The purpose of this study was to biomechanically compare the gliding resistance (GR) of 3 commonly used pulley sites and to determine the pulley location which produces the lowest GR on the transferred tendon.Eight fresh-frozen cadaver forearms were used to examine GR. The flexor digitorum superficialis (FDS) of the ring finger was used as a donor tendon in all 8 specimens. An oppositional transfer was created to the thumb using three pulley sites: 1.) Guyon?s canal (GC) 2.) a Flexor carpi ulnaris (FCU) loop pulley and 3.) a Royle-Thompson pulley (RT) which is placed at the junction between the ulnar border of the palmar aponeurosis and the distal edge of the transverse carpal ligament. The FDS was inserted into the palmar radial portion of the abductor pollicis brevis in all cases. GR and functional evaluation of the transferred tendon were measured directly in 3 different pulley sites using a tendon friction testing device modified from a previously described and validated gliding resistance testing machine. For functional evaluation of the thumb, thumb abduction and opposition were measured as the distances between the thumb tip and the second/fifth metacarpal heads by digital ruler respectively.The mean GR of the tendon within the Royle-Thompson, Guyon?s canal, and FCU loop pulleys was 129.83 (±103.57), 59.44 (±53.99) and 45.37(±42.03) (Newton) respectively. The GR for the RT pulley was found to be significantly higher than the FCU loop or GC (p < 0.05). There was no statistically significant difference between GC, and FCU loop pulley with regard to friction generated following transfer. Functionally the FCU loop pulley obtained the greatest amount of palmar abduction (p < 0.05), while the GC and RT pulleys produced the largest amount of opposition, as measured by the thumb pulp?s final distance from the fifth metacarpal head (p < 0.05).GC and a FCU loop produced lower friction when used as a pulley location for oppositional transfers using the ring FDS. Because the GC also produced greater oppositional motion when compared to the FCU loop, the most appropriate pulley for tendon transfer in opponensplasty was found Guyon?s canal pulley.
The function of tendon transfers for thumb opposition depends on the muscle transferred, pulley location and the amount of friction created at the pulley site. While muscle choice and pulley location have been extensively studied, few studies have examined friction at pulley site as a potential cause for transfer success or failure. The purpose of this study was to biomechanically compare the gliding resistance (GR) of 3 commonly used pulley sites and to determine the pulley location which produces the lowest GR on the transferred tendon.Eight fresh-frozen cadaver forearms were used to examine GR. The flexor digitorum superficialis (FDS) of the ring finger was used as a donor tendon in all 8 specimens. An oppositional transfer was created to the thumb using three pulley sites: 1.) Guyon?s canal (GC) 2.) a Flexor carpi ulnaris (FCU) loop pulley and 3.) a Royle-Thompson pulley (RT) which is placed at the junction between the ulnar border of the palmar aponeurosis and the distal edge of the transverse carpal ligament. The FDS was inserted into the palmar radial portion of the abductor pollicis brevis in all cases. GR and functional evaluation of the transferred tendon were measured directly in 3 different pulley sites using a tendon friction testing device modified from a previously described and validated gliding resistance testing machine. For functional evaluation of the thumb, thumb abduction and opposition were measured as the distances between the thumb tip and the second/fifth metacarpal heads by digital ruler respectively.The mean GR of the tendon within the Royle-Thompson, Guyon?s canal, and FCU loop pulleys was 129.83 (±103.57), 59.44 (±53.99) and 45.37(±42.03) (Newton) respectively. The GR for the RT pulley was found to be significantly higher than the FCU loop or GC (p < 0.05). There was no statistically significant difference between GC, and FCU loop pulley with regard to friction generated following transfer. Functionally the FCU loop pulley obtained the greatest amount of palmar abduction (p < 0.05), while the GC and RT pulleys produced the largest amount of opposition, as measured by the thumb pulp?s final distance from the fifth metacarpal head (p < 0.05).GC and a FCU loop produced lower friction when used as a pulley location for oppositional transfers using the ring FDS. Because the GC also produced greater oppositional motion when compared to the FCU loop, the most appropriate pulley for tendon transfer in opponensplasty was found Guyon?s canal pulley.
Açıklama
Anahtar Kelimeler
Başparmak-el, Thumb, Biyomekanik, Biomechanics, Cerrahi tedavi, Surgical treatment
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Duymaz, A. (2009). Başparmak oppozisyon rekonstrüksiyonu için tendon transferinde pulley lokalizasyonlarının başparmak fonksiyonu ve tendon kayma direnci üzerinde etkisi: Biyomekanik kadavra çalışması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Plastik Cerrahi Anabilim Dalı, Konya.
