Zusammenfassung
Die rekonstruktive Handchirurgie kann Patienten mit Lähmungen der oberen Extremität
infolge einer Verletzung des Halsrückenmarks entscheidend helfen, weniger von fremder
Hilfe abhängig zu sein und ihr Leben wieder selbst zu gestalten. Durch Verlagerungen
von Muskel-Sehnen-Einheiten können Schlüsselfunktionen wie die Ellenbogen- und Handgelenkstreckung
und ein kontrolliertes Greifen wiederhergestellt, Gelenke bei Spastizität stabilisiert,
Schmerzen gemindert und Kontrakturen vorgebeugt werden. Die Wahl des am besten geeigneten
Spendermuskels stützt sich auf ein genaues Verständnis der biomechanischen Grundlagen
der Muskel-Sehnen-Einheit. Durch die intraoperative Messung der Sarkomerlänge kann
das Verhältnis zwischen Muskellänge und Muskelkraft optimal eingestellt werden und
so vor allem eine Überdehnung des Muskels mit erheblich verminderter Kraftentwicklung
verhindert werden. Die passive Spannung des Muskels wird durch Stützproteine innerhalb
des Sarkomers und durch die extramuskuläre Matrix verliehen. Die Erkenntnis, dass
spastische Muskeln steifere und kürzere Sarkomere und eine extrazelluläre Matrix mit
ungünstigeren mechanischen Eigenschaften aufweisen als normale Muskelfasern, beeinflusst
das chirurgische Vorgehen. Neben der Grundlagenforschung sind vor allem klinische
Studien in Zusammenarbeit mit internationalen Zentren wichtig, um die Entwicklung
verfeinerter Techniken zur chirurgischen Rekonstruktion und Rehabilitation der Arm-
und Handfunktion von tetraplegischen Patienten voranzubringen.
Abstract
Reconstructive hand surgery improves the ability to meet the needs of daily life and
the independence of patients who have lost their upper extremity function due to cervical
spinal cord injury. Tendon transfer procedures provide the potential to restore key
functions, such as elbow and wrist extension or hand grip control, ameliorate joint
balance, reduce pain in spasticity and prevent joint contractures. The choice of the
optimal donor muscle should be based on a thorough understanding of the biomechanical
principles of the muscle-tendon unit. Intraoperative sarcomere length measurements
allow to predict and set the optimal muscle-tendon unit length during reconstructive
upper extremity surgery in order to prevent overstretch which may lead to insufficient
active force generation. Macro-proteins and the extracellular matrix are in charge
of the muscle ultrastructure, elasticity and thus passive muscle tension. Spastic
muscles are characterized by greater stiffness, a shorter sarcomere length and an
extracellular matrix with inferior mechanical properties. Basic science research and
clinical studies in cooperation with international centers are of great importance
to promote the development of refined techniques of surgical reconstruction and postoperative
rehabilitation of upper extremity function in tetraplegic patients.
Schlüsselwörter
Tetraplegie - Muskeltransposition - Muskelarchitektur - Sarkomerlänge - Muskelspannung
Key words
Tetraplegia - tendon transfer - muscle mechanics - muscle architecture - sarcomere
length - muscle tension
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Prof. M. D., Ph. D. Jan Fridén
Handkirurgiska Kliniken
Sahlgrenska Universitetshuset
413 45 Göteborg
Schweden
Email: jan.friden@orthop.gu.se
