指浅屈肌腱束经骨隧道重建中央腱止点的解剖学研究

目的　模拟指浅屈肌腱束经骨隧道重建中央腱止点的手术方法，验证手术可行性和安全性。 方法　采用8例新鲜成人尸体手标本，用示、中、环指共24指，解剖观测指浅屈肌腱及中央腱、伸肌腱的相关解剖结构。选取12指（示、中、环指各4指）新鲜成人手指标本进行模拟手术，均人为设计中央腱止点断裂。将指浅屈肌腱两侧部分腱束从中节掌侧止点处经指骨钻孔后引至背侧，与背侧中央腱断端编织缝合重建中央腱止点，测量不同缝合间距的PIP（近指间关节）被动伸直角度和被动屈曲角度。 结果　指浅屈肌腱缝合间距大时，被动伸屈角度大，但中央腱和指浅屈肌腱松弛明显；指浅屈肌腱缝合间距小时，被动伸屈角度小，且中央腱和指浅屈肌腱张力大，均不能保证手指被动伸屈活动。指浅屈肌腱的缝合间距在1.5 cm时，PIP的被动屈曲角度约75°，缝合间距在1.0 cm时，PIP的被动屈曲角度约30°，缝合间距在1.0~1.5 cm时，即切取到Camper腱交叉时，PIP被动伸直和屈曲角度最接近手指功能位时的角度。 结论　切取转移的指浅屈肌腱至Camper腱交叉时可以完成中央腱止点重建，供腱损伤小，重建止点是相对安全和可行的。

Anatomical study of the central tendon reconstruction by manipulation of the superficial flexor tendon through bone tunnel

Objective To imitate the surgical methods of the central tendon reconstruction by manipulation of the superficial flexor tendon through bone tunnel，and to verify the feasibility and safety of the operation. Methods　Eight fresh adult cadavers hand specimens , with a total of 24 fingers in index finger, middle finger and ring finger，were collected to dissect and observe the anatomic structure of superficial flexor tendon, central tendon and extensor tendon. Four index fingers, four middle fingers and four ring fingers, 12 fresh adult finger specimens were selected for imitated operation. The rupture of central tendon insertion was artificially designed. Tendon bundles on both sides of flexor digitorum were passed through base of the middle palmar segment to dorsal part by drilling through the phalanx，and the rupture of central tendon insertion was reconstructed by woven suture with central tendon rupture. Then the passive stretch angle and the passive buckling angle of PIP formed by different suture spacing were measured.　Results When the suture spacing of superficial flexor tendon was large, the angle of passive extension and flexion were also large, but the central tendon and the superficial flexor tendon were loose obviously. When the suture spacing was small, the angle of passive extension and flexion were also small, the tension of the central tendon and the superficial flexor tendon were large. Therefore, none of them could ensure the flexion and extension of fingers. When the suture spacing of superficial flexor tendon was 1.5cm，the passive buckling angle of PIP was about 75°.When the suture spacing was 1.0cm，the passive buckling angle of PIP was about 30°. When the suture spacing was 1.0~1.5cm, that is, when cutting through the Camper tendon chiasma, the angle of passive stretch and flexion of PIP were closest to the functional angle of finger. Conclusions Central tendon insertion can be reconstructed when the superficial flexor tendon is removed to Camper tendon chiasma. The tendon injury in donor area is small, and the central tendon reconstruction is safe and feasible relatively.