Transfer Of Superficial Flexor Tendon Of Ring To Restore Opposition Of The Thumb And The DASH Question For The Outcomes

Objective:Opposition, one of the most important functions of the hand, is lost or impaired after median nerve injury.Complete recovery does not always occur after treatment, and various techniques of opponensplasty are used for restoring opposition. This study was performed in order to develop an alternative method for selective restoration of thenar muscle function.The purpose of this paper is transfer of superficial flexor tendon of ring to restore opposition of the thumb and the DASH question for the outcomes.Method:Analyse eleven people from September 2008 to December 2010 that ten is in irreparable injuries of the median nerve or, if there has been no functional recovery of the thenar muscles after nerve repair, restoring opposition by tendon transfer has stimulated the inventiveness of many investigators, and many of the techniques have had widespread clinical application and one is congenital deformity.All the patients were carried out the operation for opposition.We ues DASH(disability of arm- shoulder- hand, DASH)questions to evaluate the clinic outcom.Operative technique:The patient is place in a supine position.The operation is done in brachial plexus block anesthesia, make a lateral incision at the close section of ring, incide the tendons at the proximal of PIP joint, extract the tendon in the distal forearm palmar incision.At the dorsal of thumb metacarpophalangeal joint make a"S"shape incision,along the axis of abductor pollicis brevis make a subcutaneous tunnel,draw the tendon to the thumb dorsal, the wrist was passive flexed about 45°, the thumb extreme abduct and to straighten, suture the superficial flexor muscle of finger to the tendon of abductor pollicis brevis,then cross the extensor pollicis longus muscle tendon and suture to it,at last suture the stump to itself.Fixing the hand with a"U"shape plaster slab,the wrist flexed about 45°, the thumb extreme abduct and to straighten.Result:At an average follow-up of 7 months (4～11m),the mean DASH score was 21.8(p<0.05), There were significant statistical differences.Of the total 7cases were excellent, can meet the job and life demands;and 4cases were good.The average strength of Opposition was over the third grade.And there were not any patinets suffering adhesion of tendon and tendon rupture.Conclusion: Transfer of superficial flexor tendon of ring to restore opposition of the thumb is a good method,easily to perform. The opposition of the thumb function restore can use superficial flexor tendon of ring in dynamic tendons, make a lateral incision at the close section of ring, incide the tendons at the proximal of PIP joint off, reduce the chance of tendon adhesions ,the incision concealment, guarantee the beautiful.DASH questions are more meticulous and quantization for function evaluation, and from the angle of patients to evaluate the efficacy of the treatment, the more appropriate for the patient as the center of biological - social -mental state medical model.And DASH questions is good for evaluating the clinic outcome of the transfering of superficial flexor tendon of ring to restore opposition of the thumb.