目的 为提高儿童先天性拇指发育不良的示指拇指化手术效果提供临床解剖学资料。 方法 解剖正常发育的儿童手标本20只，年龄5~8岁。根据临床示指拇指化手术出现的缺陷，通过裸视和手术显微镜下解剖第1骨间掌、背侧肌的形态和神经分布形式，观测骨间肌止点切取和再固定的位置，外在肌肌腱的切取和再缝合部位。模拟手术，从解剖学角度探讨对掌动力肌的再固定位置、方法和骨间肌神经的保护措施。 结果 解剖学研究发现，第1骨间掌侧肌细小，体积仅为骨间背侧肌的1/2，腱束起于第2掌骨尺侧，主要止于示指近侧指骨间关节囊背侧腱束的尺侧。第1骨间背侧肌桡侧头起于第1掌骨尺侧中部，尺侧头起于第2掌骨桡侧中部，二者会合后形成的腱束大部分止于第2掌指关节囊的桡侧和指背腱膜。尺神经深支肌支从骨间肌的腹侧入肌，走行方向近似垂直于第2掌骨骨膜切开的方向。骨间肌止点的再固定位置在再造“拇指指骨间关节囊”屈侧近两侧处，与原止点距离一致。“拇指”外在肌肌腱近段缩短约2 cm，与远段屈、伸肌腱端端缝合，与原力线一致。 结论 选择第1骨间掌、背侧肌作为“拇指”的内在动力肌，分别固定于拇指指骨间关节囊的屈侧近尺、桡侧；切除第2掌骨体后，把附有第1骨间掌、背侧肌的骨膜固定在新“掌骨”上；外在肌屈、伸指肌腱近段切除约2 cm后与“拇指”相对应的屈、伸指肌腱端端缝合，其力线和肌腱长度符合解剖要求，有利于对掌功能的建立。
Abstract
Objective To provide clinical anatomical evidence to optimize index finger pollicization for congenital thumb hypoplasia in children. Methods Twenty hands from healthy children aged 5-8 years were dissected. Macroscopic and microscopic analyses were performed to study the morphology and innervation of first palmar and dorsal interosseous muscles, focusing on anatomical features associated with common surgical deficiencies. The resection and reattachment points of interosseous muscle and extrinsic muscle tendons were observed. Simulated pollicization procedures were conducted to determine optimal techniques for muscle reattachment and nerve preservation. Results The first palmar interosseous muscle was small, approximately half size of dorsal interosseous muscle, and primarily inserted into the ulnar side of dorsal capsule of proximal interphalangeal joint. The radial bundle of first dorsal interosseous muscle originated from the ulnar side of the first metacarpal, and the ulnar bundle from the radial side of the second metacarpal, converging to insert into the radial side of the second metacarpophalangeal joint capsule and dorsal aponeurosis. The deep branches of ulnar nerve entered the muscles from palmar side, nearly perpendicular to the direction of the incision on second metacarpal periosteum. Optimal reattachment points for interosseous muscles were located adjacent to the flexor aspect of the reconstructed thumb's interphalangeal joint capsule, consistent with their original insertions. The proximal segments of the flexor and extensor tendons were shortened by approximately 2 cm and sutured end-to-end to the corresponding tendons of the reconstructed thumb, preserving the original line of pull. Conclusions Anatomical reconstruction using the first palmar and dorsal interosseous muscles as intrinsic dynamic muscles, fixed near the flexor aspect of the reconstructed thumb's interphalangeal joint capsule, is recommended. Securing the periosteum containing interosseous muscles to the newly created metacarpal and performing proximal tendon shortening with end-to-end repair align force transmission and tendon tension with native anatomy, promoting ideal functional outcomes.
关键词
先天性拇指发育不良 /
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示指拇指化 /
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拇指对掌功能 /
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临床解剖学
Key words
Congenital thumb developmental deformity /
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Index finger pollicization /
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Function of oppenens pollicis /
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Clinical anatomy
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