Anatomic measurement regarding the effect of proximal interphalangeal joint motion on the tension of the zone I extensor tendon

doi:10.3969/j.issn.2095-4344.0041

Abstract

Abstract:

BACKGROUND: Many conservative and surgical techniques for mallet finger have been described. Most of them have reached an agreement, but the fixation of the proximal interphalangeal joint has not reached a consensus.

OBJECTIVE: To discuss the effect of proximal interphalangeal joint motion on the tension of the zone I extensor tendon and to search the fixation position of proximal interphalangeal joint at the minimum tension of the zone I extensor tendon through measuring extensor tendon so as to provide reference for selecting optimal fixation position in the treatment of mallet finger.

METHODS: The maximal passive flexion angles of the distal interphalangeal joint of the index, middle, ring and little fingers were measured in 20 cadaver hands when the proximal interphalangeal joint flexed at 0°, 20°, 40°, 60°, 80° and 100°. An incision was made over the back of the distal interphalangeal joint to expose the zone I extensor tendon. The extensor tendon was incised laterally at the level of the distal interphalangeal joint with the distal interphalangeal joint fixed in extension position to make a mallet finger. A Kirschner wire was used to pierce through and perpendicular to the distal phalangeal basement as a sign. Paralleling to this sign, the zone I extensor tendon was marked and its relative distance to the sign was measured as the sliding distance of the extensor. The widest gap between the tendon edges and the tendon sliding distance were recorded, while the proximal interphalangeal joint was in extension and 20°, 40°, 60°, 80° and 100° flexion positions.

RESULTS AND CONCLUSION: (1) The maximal passive flexion angle of the distal interphalangeal joint increased with the proximal interphalangeal joint flexion increased. (2) The gap between the extensor tendon edges in zone I reduced when the angle of proximal interphalangeal joint increased. The proximal extensor tendon gliding distance increased, while the proximal interphalangeal joint flexion increased. The gap between the extensor tendon edges in zone I was (1.322 8±1.0788 9) mm when the proximal interphalangeal joint was in extension position. The proximal extensor tendon glided distally, when the proximal interphalangeal joint flexed to 100° with an average sliding distance of (1.540 5±0.690 70) mm. (3) The zone I extensor tendon has the maximal tension while the proximal interphalangeal joint is in extension position. The tension in the zone I extensor tendon reduced when the angle of proximal interphalangeal joint increased. The tension in the zone I extensor tendon was minimal when the proximal interphalangeal joint flexed to 100°.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Anatomy, Biomechanics, Muscle Tonus, Tissue Engineering

CLC Number:

R318

Wang Chao-dong, Wang Jian-ye, Wang Yu, Xian Ming-bo. Anatomic measurement regarding the effect of proximal interphalangeal joint motion on the tension of the zone I extensor tendon [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(3): 420-425.

Figures/Tables 3

2.1 Ⅰ区伸肌腱断端距离随近指间关节屈曲角度增大而减小通过人工制作锤状指模型，观察到当近指间关节处于伸直位时，Ⅰ区伸肌腱末端近侧断端向近端回缩，断端处出现间隙，大小为(1.322 8±1.078 9) mm。当逐渐屈曲近指间关节至100°位时，近侧断端向远侧滑移，平均滑移距离为(1.540 5±0.690 7) mm，断端间隙逐渐缩小；当近指间关节屈曲至100°位时，两断端逐渐靠近，甚至出现肌腱断端重叠。 2.2 远指间关节最大被动屈曲角度随近指间关节屈曲角度的增大而增大对不同手指在近指间关节处于不同屈曲角度(0°，20°，40°，60°，80°，100°)时远指间关节的最大被动屈曲角度分别进行单因素方差分析，差异均有显著性意义(P < 0.05)，详见表1。图2是将近指间关节处于不同屈曲角度时对应远指间关节最大被动屈曲角度的均值做出的线性图，更加直观地展现出二者的线性关系，可以得出远指间关节最大被动屈曲角度随着近指间关节屈曲角度的增大而增大。 2.3 伸肌腱Ⅰ区两断端距离及近端向远端滑动距离同近指间关节屈曲角度之间的关系对不同手指在近指间关节处于不同屈曲角度(0°，20°，40°，60°，80°，100°)时伸肌腱Ⅰ区两断端的距离分别进行单因素方差分析，差异均有显著性意义(P < 0.05)，详见表2；对不同手指在近指间关节处于不同屈曲角度(0°，20°，40°，60°，80°，100°)时伸肌腱Ⅰ区两断端中的近端向远端滑动的距离分别进行单因素方差分析，差异均有显著性意义(P < 0.05)，详见表3。图3是将近指间关节处于不同屈曲角度时对应伸肌腱Ⅰ区两断端的距离及伸肌腱Ⅰ区两断端近端向远端滑动的距离的均值做出的线性图，更加直观地展现出二者分别与近指间关节屈曲角度的线性关系，可以得出伸肌腱Ⅰ区两断端的距离随着近指间关节屈曲角度的增大而减小，伸肌腱Ⅰ区两断端近端向远端滑动的距离随着近指间关节屈曲角度的增大而增大。 2.4 近指间关节处于相同屈曲角度时不同手指远指间关节最大被动屈曲角度之间的关系如表4所示，对近指间关节处于不同角度时不同手指：示指、中指、环指、小指的远指间关节的最大被动屈曲角度分别进行单因素方差分析，当近指间关节处于不同屈曲角度时4组手指之间的差异有显著性意义；进一步两两比较，示指组与小指组差异有显著性意义(近指间关节屈曲0°时，LSD法P=0.004，Bonferroni法P=0.022；近指间关节屈曲20°时，LSD法P=0.002，Bonferroni法P=0.011；近指间关节屈曲40°时，LSD法P=0.004，Bonferroni法P=0.026；近指间关节屈曲60°时，LSD法P=0.004，Bonferroni法P=0.026；近指间关节屈曲80°时，LSD法P=0.003，Bonferroni法P=0.021；近指间关节屈曲100°时，LSD法P=0.001，Bonferroni法P=0.005)，而示指组与环指组、示指组与中指组、中指组与环指组、中指组与小指组、环指组与小指组之间差异无显著性意义。可以得出近指间关节处于相同屈曲角度时示指组与小指组远指间关节的最大被动屈曲角度差异有显著性意义，这同两指解剖结构是相符的。"

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