Implanted passive engineering mechanism improves hand function after tendon transfer surgery: a cadaver-based study
Tóm tắt
The purpose of this study was to investigate if a new tendon transfer surgical procedure that uses an implanted passive engineering mechanism for attaching multiple tendons to a single donor muscle in place of directly suturing the tendons to the muscle improves hand function in physical interaction tasks such as grasping. The tendon transfer surgery for high median ulnar palsy was used as an exemplar, where all four flexor digitorum profundus (FDP) tendons are directly sutured to the extensor carpi radialis longus (ECRL) muscle to restore flexion. The new procedure used a passive hierarchical artificial pulley system to connect the muscle to the tendons. Both the suture-based and pulley-based procedures were conducted on N = 6 cadaver hands. The fingers’ ability to close around four objects when the ECRL tendon was pulled was tested. Post-surgery hand function was evaluated based on the actuation force required to create a grasp and the slip between the fingers and the object after the grasp was created. When compared with the suture-based procedure, the pulley-based procedure (i) reduced the actuation force required to close all four fingers around the object by 45 % and (ii) improved the fingers’ individual adaptation to the object’s shape during the grasping process and reduced slip by 52 % after object contact (2.99° ± 0.28° versus 6.22° ± 0.66°). The cadaver study showed that the implanted engineering mechanism for attaching multiple tendons to one muscle significantly improved hand function in grasping tasks when compared with the current procedure.
Tài liệu tham khảo
Balasubramanian R, Montgomery J, Mardula KL, et al. Implanted miniature engineering mechanisms in tendon-transfer surgery improve robustness of post-surgery hand function. Hamlyn Symp Med Robot. 2013.
Beaton DE, Davis AM, Hudak P, et al. The DASH (disabilities of the arm, shoulder, and hand) outcome measure: what do we know about it now? Br J Hand Ther. 2001;6(4):109–18.
Bennett DJ, Hollerbach JM, Xu Y, et al. Time-varying stiffness of human elbow joint during cyclic voluntary movement. 1992; 88:433–442.
Birglen L, Lalibert’e T, Gosselin C. Underactuated robotic hands. Springer, 2008.
Bookman A, Harrington M, Pass L, et al. Family caregiver handbook. Cambridge: MIT Press; 2007.
Bosse M, Ficke JR. Extremity war injuries V: barriers to return of function and duty. J Am Acad Orthop Surg. 2011.
Brand PW, Hollister A. Clinical mechanics of the hand. 2nd ed. Mosby Year Book Inc.; 1993.
Bullock IM, Dollar AM. Classifying human manipulation behavior. In: 2011 I.E. international conference on rehabilitation robotics (ICORR). Switzerland, EHT Surich Science City; 2011.
Cater DR, Belenman PR, Beaupr GS. Correlations between mechanical stress history and tissue differentiation in initial fracture healing. J Orthop Res. 1988;6(5):736–48.
Chen S, Kao I. Conservative congruence transformation for joint and Cartesian stiffness matrices of robotic hands and fingers. Int J Robot Res. 2000;19(9):835–47.
Cooney WP, Linscheid RL, An KN. Opposition of the thumb: an anatomic and biomechanical study of tendon transfers. J Hand Surg. 1984;9A(6):777–86.
Cross J, Ficke J, Hsu J, et al. Battlefield orthopedic injuries cause the majority of long-term disabilities. J Am Acad Orthop Surg. 2011;19 suppl 1:S1–7.
Dollar AM, Howe RD. The highly adaptive SDM hand: design and performance evaluation. Int J Robot Res. 2010;29(5):585–97.
Friden J, Lieber R. Tendon transfer surgery: clinical implications of experimental studies. Clin Orthop Relat Res. 2002; 403S(S163-S170).
Green DP, Hotchkiss RN, Pederson WC, et al. Green’s operative hand surgery, volume 1. 2. fifth ed. Elsevier Churchill Livingstone; 2005.
Holzbaur KRS, Murray WM, Delp SL. A model of the upper extremity for simulating musculoskeletal surgery and analyzing neuromuscular control. Ann Biomed Eng. 2005;33(6):829–40.
Hunter Implants. Ortotech. http://www.ortotech.c.
Labview. National Instruments. http://www.ni.com/labvie.
Lieber RL. Biology and mechanics of skeletal muscle: what hand surgeons need to know when tensioning a tendon transfer. J Hand Surg. 2008. doi:10.1016/j.jhsa.2008.08.010.
Lilla JA, Vistnes LM. Long-term study of reactions to various silicone breast implants in rabbits. Plast Reconstr Surg. 1976;57(5):637–49.
Melvin AJ, Litsky AS, Mayerson JL, et al. Extended healing validation of an artificial tendon to connect the quadriceps muscle to the tibia: 180-day study. J Orthop Res. 2012;30(7):1112–7.
Murray WM, Buchanan TS, Delp SL. The isometric functional capacity of muscles that cross the elbow. J Biomech. 2000;30:943–52.
OptiTrack. Natural point. http://www.naturalpoint.com/optitrac.
Riordan DC. Tendon transfers for median, ulnar or radial nerve palsy. Hand. 1969;1:42–6.
Sammer DM, Chung KC. Tendon transfers: part I. Principles of transfer and transfers for radial nerve palsy. Plast Reconstr Surg. 2009;123(5):169e–77.
Sepienza A, Green S. Correction of the claw hand. Hand Clin. 2012; 28(1).
Strickland JW, Graham TJ. The hand: master techniques in orthopedic surgery. Lippincott Williams & Wilkins; 2005.
Su BW, Solomans M, Barrow A, et al. A device for zone II flexor tendon repair. J BoneJoint Surg [AM]. 2006;88-A(Supplement 1):37–49.
Wikipedia. Differential mechanisms. http://en.wikipedia.org/wiki/Differential.
Zhang L, Cao Z, Bai T, et al. Zwitterionic hydrogels implanted in mice resist the foreign-body reaction. Nat Biotechnol. 2013;31:553–6.