目的 通过近节指骨滑车损伤实验，探究其对近指间关节侧方稳定性影响，为治疗提供解剖依据。 方法 解剖6具成人双上肢手标本，选择示指、中指、环指共36只手指进行研究。分别测量0 °屈曲位时近指间关节近节指骨滑车未损伤及桡侧损伤10%、20%、30%、40%、50%的桡偏角度。 结果 未损伤时近节指骨滑车两端长度平均为（10.25±1.12）mm，桡偏角度为（0.14±0.10）°，损伤10%时桡偏角度为（5.06±0.53）°，损伤20%时桡偏角度为（8.47±0.42）°，损伤30%时桡偏角度为（12.28±0.71）°，损伤40%时桡偏角度为（16.33±0.76）°，损伤50%时桡偏角度为（20.03±0.75）°。近节指骨滑车损伤程度越重，近指间关节桡偏角度越大，关节稳定性越差（P<0.0001，Wilcoxon检验）。 结论 近节指骨滑车缺损对近指间关节侧方稳定性具有显著影响，损伤达10%时即可发生侧方不稳定。
Abstract
Objective To provide anatomical basis for the treatment of proximal interphalangeal (PIP) joint by the injury experiment of proximal phalanx trochlea. Methods Both of the upper hand specimens from 6 adults were dissected, and 36 fingers including index finger, middle finger and ring finger were selected for the study. The radial angle of PIP joints was measured when the trochlea of proximal phalanx was intacted 10%, 20%, 30%, 40% and 50% of injuries at 0 ° PIP joint flexion. Results The mean length of the two sides of the proximal phalanx was (10.25±1.12) mm, and the radial angle of PIP joints was (0.14±0.10) °. When 10% of injuries, it was (5.06±0.53) °, when 20% of injuries, it was (8.47±0.42) °, when 30% of injuries, it was (12.28±0.71) °, when 40% of injuries, it was (16.33±0.76) °, and when 50% of injuries, it was (20.03±0.75) °. The more severe the injury of the proximal phalanx trochlea, the larger the radial angle of PIP joints, meaning the more unstable the PIP joints (P<0.0001, Wilcoxon test). Conclusions The defect of the proximal phalangeal trochlea has a significant effect on the lateral stability of PIP joints. Lateral instability can occur when the injury reaches 10%.
关键词
近节指骨滑车 /
近指间关节 /
稳定性 /
应用解剖
Key words
Proximal phalangeal trochlea /
Proximal interphalangeal joint /
Stability /
Applied anatomy
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参考文献
[1] Cheah AEJ, Yao J. Hand fractures: indications, the tried and true and new innovations[J]. J Hand Surg Am, 2016, 41(6): 712-722. DOI: 10.1016/j.jhsa.2016.03.007.
[2] 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. DOI: 10.13418/j.issn.1001-165x.2021.02.002.
[3] 汤样华, 黄小华, 曾林如, 等. 矩形钢板固定治疗近节指骨中远段骨折的疗效分析[J]. 中华手外科杂志, 2018, 34(5): 387-388. DOI: 10.3760/cma.j.issn.1005-054X.2018.05.024.
[4] Tyser AR, Tsai MA, Parks BG, et al. Stability of acute dorsal fracture dislocations of the proximal interphalangeal joint: a biomechanical study[J]. J Hand Surg Am, 2014, 39(1): 13-18. DOI: 10.1016/j.jhsa.2013.09.025.
[5] Buncke HJ Jr, Daniler AI, Schulz WP, et al. The fate of autogenous whole joints transplanted by microvascular anastomoses[J]. Plast Reconstr Surg, 1967, 39(4): 333-341. DOI: 10.1097/00006534-196704000-00001.
[6] 谢山洪, 熊革, 郑炜, 等. 半钩骨移植结合伸肌腱松解治疗陈旧性中节指骨掌侧基底骨折合并近指间关节脱位的临床经验[J]. 中华损伤与修复杂志(电子版), 2020, 15(5): 355-358. DOI: 10.3877/cma.j.issn.1673-9450.2020.05.006.
[7] 林东鑫, 何藻鹏, 苏炜炜, 等. 3D打印技术在指关节缺损的应用研究进展[J]. 中国医学物理学杂志, 2021, 38(2): 250-253. DOI: 10.3969/j.issn.1005-202X.2021.02.022.
[8] Trumble TE, Heaton DJ. Outcomes of surface replacement proximal interphalangeal joint arthroplasty through a volar approach: a prospective study[J]. Hand (N Y), 2017, 12(3): 290-296. DOI: 10.1177/1558944716662020.
[9] Van Nuffel M, Degreef I, Willems S, et al. Proximal interphalangeal joint replacement: resurfacing pyrocarbon versus silicone arthroplasty[J]. Acta Orthop Belg, 2014, 80(2): 190-195. DOI: 10.1016/j.jphys.2014.03.003.
[10] Tägil M, Geijer M, Abramo A, et al. Ten years' experience with a pyrocarbon prosthesis replacing the proximal interphalangeal joint. A prospective clinical and radiographic follow-up[J]. J Hand Surg Eur, 2014, 39(6): 587-595. DOI: 10.1177/1753193413479527.
[11] Li C, Cheung TF, Fan VC, et al. Applications of three-dimensional printing in surgery[J]. Surg Innov, 2017, 24(1): 82-88. DOI: 10.1177/1553350616681889.
基金
江苏省博士后科研资助计划（2020Z359）
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