手指伸肌腱Ⅰ区肌腱末节指骨止点与毗邻组织的应用解剖学研究

doi:10.13418/j.issn.1001-165x.2021.02.002

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中国临床解剖学杂志 ›› 2021, Vol. 39 ›› Issue (2) : 126-129. DOI: 10.13418/j.issn.1001-165x.2021.02.002

应用解剖

手指伸肌腱Ⅰ区肌腱末节指骨止点与毗邻组织的应用解剖学研究

赵文韬¹，　赵民²

作者信息 +

Applied anatomy study of zoneⅠ extensor terminal tendon insertion and its adjacent tissues

Zhao Wentao¹, Zhao Min²

Author information +

文章历史 +

摘要

目的　通过对手指伸肌腱Ⅰ区肌腱末节指骨止点与毗邻组织的解剖研究，为骨性锤状指微型钢板内固定手术提供解剖依据。方法　解剖观测10例成人尸体上肢手标本，观察指甲根部甲基质、甲根与伸肌腱Ⅰ区末节指骨止点的解剖关系，测量伸肌腱Ⅰ区末节指骨止点至甲根、甲基质、关节面距离，测量伸肌腱Ⅰ区末节指骨止点的宽度，测量末节指骨关节面水平的横径及纵径。显微镜下观察伸肌腱Ⅰ区末节指骨止点的形态及其与周围组织之间的联系。结果　甲根近端未能完全覆盖甲基质，甲基质与伸肌腱Ⅰ区末节指骨止点相距（1.21±0.21）mm，两者之间平铺一层疏松结缔组织。伸肌腱Ⅰ区末节指骨止点宽度为（6.27±1.23）mm，在关节水平厚度为（1.02±0.21）mm。伸肌腱Ⅰ区末节指骨止点在肌腱掌侧面至末节指骨关节面（1.22±0.21）mm。末节指骨的关节面水平的横径为（8.00±2.21）mm，纵径为（6.22±1.21）mm。伸肌腱Ⅰ区与远侧指间背侧关节囊联系紧密，显微镜下解剖未见两者之间存在明显的解剖间隙。结论　末节指骨背侧正中皮肤切口可充分显露伸肌腱Ⅰ区末节指骨止点周围组织结构；在应用微型钩状钢板固定骨性锤状指末节撕脱骨折块时，钢板远端与甲基质部分重叠，需要部分切开甲根及甲基质。伸肌腱Ⅰ区与远侧指间背侧关节囊联系紧密，该处伸肌腱终腱存在类似掌板样纤维软骨组织。

Abstract

Objective　To provide anatomical basis for mini plate internal fixation of bony mallet finger by anatomical study of the zoneⅠ terminal extensor tendon and adjacent tissues.　Methods　Ten adult hand cadavers’ upper limb specimens were dissected and the anatomical relationships between nail matrix, nail root and zoneⅠ terminal extensor tendon were observed. Microscopically, the distance from the terminal extensor tendon to nail root, nail matrix, articular surface were measured. The width of zoneⅠ terminal extensor tendon and the transverse and vertical diameters of phalangette joints were measured.　Results　The proximal margin of the nail root did not completely cover the germinal matrix, and the distance between the zoneⅠ terminal extensor tendon and the germinal matrix was（1.21±0.21）mm.There was a loose connective tissue between them. The width of terminal extensor tendon was（6.27±1.23）mm, horizontal thickness was (1.02±0.21) mm. The distance between the zoneⅠ terminal extensor tendon and the articular of the distal interphalanx was （1.22±0.21）mm. The transverse diameter of the distal phalanx articular surface was (8.00±2.21) mm, the longitudinal diameter was （6.22±1.21）mm. ZoneⅠ terminal extensor tendon was closely connected to the dorsal articular capsule of distal interphalangeal joint.　Conclusions　The longitudinal dorsal median skin incision on the distal phalangeal bone can fully reveal the tissue structure around zoneⅠ terminal extensor tendon. In fixing the avulsed fracture fragment of the distal phalanx, the plate is partially overlapped with the nail matrix, and the nail root and nail matrix need to be partially incised. The terminal extensor tendon is closely linked to the dorsal capsule of distal interphalangeal joint, where the zoneⅠterminal extensor tendon has a dorsal fibrous cartilage tissue plate, just like the volar plate.

导出引用

赵文韬, 赵民. 手指伸肌腱Ⅰ区肌腱末节指骨止点与毗邻组织的应用解剖学研究[J]. 中国临床解剖学杂志. 2021, 39(2): 126-129 https://doi.org/10.13418/j.issn.1001-165x.2021.02.002

Zhao Wentao, Zhao Min. Applied anatomy study of zoneⅠ extensor terminal tendon insertion and its adjacent tissues [J]. Chinese Journal of Clinical Anatomy. 2021, 39(2): 126-129 https://doi.org/10.13418/j.issn.1001-165x.2021.02.002

中图分类号： R323.71 R658.2

参考文献

[1] Theivendran K, Mahon A, Rajaratnam V. A novel hook plate fixation technique for the treatment of mallet fractures[J]. Ann Plast Surg, 2007, 58(1): 112-115. DOI: 10. 1097/01. sap. 0000232858. 80450. 27.
[2] Teoh LC, Lee JYL. Mallet fractures: a novel approach to internal fixation using a hook plate[J]. J Hand Surg Eur Vol, 2007, 32(1): 24-30. DOI: 10.1016/j.jhsb.2006.09.007.
[3] Fábio SI, Thiago AL, Rogério SI, et al. Osteosynthesis of mallet finger using plate and screws: evaluation of 25 patients[J]. Rev Bras Ortop 2016, 51(3): 268-273. DOI: 10.1016/j.rboe.2015.09.013.
[4] Toker S, Türkmen F, Pekince O, et al. et al. Extension Block Pinning Versus Hook Plate Fixation for Treatment of Mallet Fractures[J]. J Hand Surg Am, 2015, 40(8): 1591-1596. DOI: 10.1016/j.jhsa. 2015. 04. 027.
[5] Acar MA, Güzel Y, Güleç A, et al. Clinical comparison of hook plate fixation versus extension block pinning for bony mallet finger: a retrospective comparison study[J]. J Hand Surg Eur Vol, 2015, 40(8): 832-839. DOI: 10.1177/1753193415581517.
[6] 吴志鹏, 林大木, 陈星隆, 等. 应用微型钩钢板治疗骨性锤状指的临床研究[J]. 中华手外科杂志, 2015, 31(1): 9-11. DOI: 10.3760/cma.j.issn.1005-054X.2015.01.005.
[7] Slattery D, Aland C, Durbridge G, et al. The connective tissue and ligaments of the distal interphalangeal joint: a review and investigation using ultra-high field 16.4 Tesla magnetic resonance imaging[J]. J Hand Surg Eur, 2014, 39(4): 398-404. DOI: 10.1177/1753193413 496949.
[8] Slattery P. The dorsal plate of the proximal interphalangeal joint[J]. J Hand Surg Br, 1990, 15(1): 68-73. DOI: 10.1016/0266-7681(90)90052-6.
[9] 陆裕朴, 实用骨科学[M]. 北京: 人民军医出版社, 1993: 679.
[10] Tan AL, Benjamin M, Toumi H, et al. The relationship between the extensor tendon enthesis and the nNail in distal interphalangeal joint disease in psoriatic arthritis-a high-resolution MRI and histological study[J]. Rheumatology (Oxford), 2007, 46(2): 253-256. DOI: 10.1093/rheumatology/kel214.
[11] Palomo PL, de Becerro RBV, López DL, et al. Anatomic relationship of the proximal nail matrix to the extensor hallucis longus tendon insertion[J]. J Eur Acad Dermatol Venereol, 2015, 29(10): 1967-1971. DOI: 10.1111/jdv.13108.
[12] Palomo PL, de Becerro RBV, López DL, et al. Anatomic association of the proximal fingernail matrix to the extensor pollicis longus tendon: a morphological and histological study[J]. J Clin Med, 2018, 7(12): 465-475. DOI: 10.3390/jcm7120465.