拇指腕掌关节韧带的解剖学特点及其临床意义
Anatomic characteristic and clinical significance of carpometacarpal ligament of thumb
目的 研究拇指腕掌关节韧带的解剖学特点及各韧带在拇指运动中的作用,为韧带重建提供形态学基础。 方法 放大镜下解剖成人男性尸体20例新鲜手标本,观察拇指腕掌关节韧带的起止点及附着部位,分别测量各韧带在中立位下的长、宽、厚及最大拉伸长度,测量关节的活动范围。 结果 拇指腕掌关节周围共5条韧带,其中桡背韧带、后斜韧带、前斜韧带为囊内韧带,第1骨间韧带、尺侧韧带为囊外韧带。在囊内韧带中,最厚的是桡背韧带(2.08±0.27) mm,最薄的是前斜韧带(1.14±0.17) mm。最宽的是前斜韧带(9.33±1.09) mm,最窄的是后斜韧带(7.23±0.88) mm。延伸率最大的是桡背韧带(57.33±9.21%),最小的是前斜韧带(38.43±8.26%)。 结论 拇指腕掌关节存在三级稳定结构,在关节囊韧带中,桡背韧带厚韧而紧张,对维持关节稳定性起重要作用,前斜韧带薄而松弛,外伤或自发性劳损引起退行性变可能性较大,拇指腕掌关节炎应该首选重建前斜韧带。
Objective To study the anatomical characteristics of the ligaments of the carpometacarpal joint of thumb and the role of the ligaments in the thumb movement. Methods 20 fresh hand specimens of adult male cadavers were dissected under the magnifying glass, and the starting and ending points and attachment sites of the carpometacarpal joint of thumb. The length, width, thickness and maximum length of each ligament in the neutral position were measured. The range of the motion of the joint was also measured. Results There are 5 ligaments around the carpometacarpal joint of thumb. Among these ligaments, the dorsal radial ligament, posterior oblique ligament, and anterior oblique ligament are the joint capsular ligament, while the first inter-metacarpal ligament, and the ulnar ligament are the extra capsular ligament. The dorsal radial ligament is the thickest (2.08±0.27 mm), and the thinnest is the anterior oblique ligament(1.14±0.17 mm).The anterior oblique ligament is the widest(9.33±1.09 mm), and the narrowest is the posterior oblique ligament(7.23±0.88 mm). The longest elongation is the dorsal radial ligament(57.33%±9.21%), and the shortest is the anterior oblique ligament(38.43%±8.26%). Conclusion The carpometacarpal joint of thumb has three stable structures. In the joint capsule and ligaments structure, the dorsal radial ligament is thickest and most tenacious. It is the main ligament to maintain the joint stability. The anterior oblique ligament is thin and loose,making it vulnerable to degenerative change when injured or spontaneously strained, which then should be reconstructed in the first place.
[1] 张波,阚世廉. 应力位影响评估拇指腕掌关节松弛性的研究及意义[J].中国临床解剖学杂志,2013, 31(2):158-160.
[2] 于胜吉,蔡锦方.腕关节外科[M]. 北京:人民卫生出版社,2002:57-58.
[3] Eation RG,Littler JM. Ligament reconstruction for the painful thumb carpometacarpal joint [J]. Clin Orthop Related Res,1987,220:52.
[4] 杨勇,Tien Huey-y,陈山林,等. 韧带重建肌腱团填塞治疗第一腕掌关节骨关节炎的疗效分析[J]. 中华骨科杂志,2014, 34(10):1030-1036.
[5] Nanno M, Buford WL Jr, Patterson RM, et al. Three-dimensional analysis of the ligamentous attachments of the first carpmetacarpal joint[J]. J Hand Surg Am, 2006, 31(7): 1160-1170.
[6] 隋志甫,刘飚,魏壮,等.拇指腕掌关节韧带的解剖和相关力学研究及其对临床指导意义[J]. 中国实验诊断学, 2005, 9(2):265-267.
[7] 沈其孝, 陈振兵, 翁雨雄, 等. 大多角骨切除加桡侧腕屈肌悬吊治疗退行性第一腕掌关节炎[J]. 中华手外科杂志, 2010, 26(2):71-73.
[8] 张发惠,刘凯, 关夷, 等. 桡侧腕屈与腕长伸肌腱部分转位修复手部关节脱位应用解剖[J]. 中国临床解剖学杂志, 2003,21(6): 580-582.
[9] 田青业,刘正津. 拇指腕掌关节囊和韧带的形态特点及其临床意义[J]. 中国临床解剖学杂志,2002, 20(2):117-119.
[10] 张志新,刘志刚,姜德欣.掌、背侧韧带同时重建治疗第一腕掌关节脱位[J].中华手外科杂志,2004,20(1):11-12.
[11] 汤亭亭,裴国献,李旭.骨科生物力学暨力学生物学[M]. 第3版. 济南:山东科学技术出版社,2009:162.
[12]田光磊,蒋学远,陈山林. 格林手外科手术学[M]. 第6版. 北京:人民军医出版社,2012:374.
[13]田青业,刘正津,周军海. 拇指腕掌关节韧带的力学特性及其意义[J].中国临床解剖学杂志,2002, 20(1):68-70.
[14] Imaeda T, Kai NA, Cooney WP, et al. Anatomy of trapeziometacarpal ligaments[J]. J Hand Surg, 1993,18A: 226-231.
北京市科委2015年首都临床特色应用研究 (Z151 100004015053 )
/
〈 |
|
〉 |