目的 通过解剖研究指深屈肌腱及指伸肌腱在远节指骨基底掌侧和背侧止点平面的差别，为西摩骨折发生机制提供解剖学依据。 方法 手部残肢10具，其中左手3例，右手7例，均为男性患者，年龄24~58岁。2~5指分别有10指，全部手指无外伤手术史、无畸形。自远节指间关节水平掌侧及背侧分别切开，于末节指骨水平分离各指的指深屈肌腱及指伸肌腱，记录其与末节指骨掌侧及背侧关节面的距离，比较指深屈肌腱及指伸肌腱在末节指骨掌、背侧的止点水平。 结果 指深屈肌腱止点近端至关节面距离：示指（2.19±0.27）mm，中指（2.50±0.14）mm，环指（2.23±0.16）mm，小指（1.83±0.19）mm；指伸肌腱止点近端至关节面距离：示指（0.12±0.02）mm，中指（0.18±0.02）mm，环指（0.12±0.05）mm，小指（0.06±0.01）mm；各指差异有统计学意义（P＜0.05）。指深屈肌腱止点中点至关节面距离：示指（3.73±0.45）mm，中指（4.33±0.45）mm，环指（3.53±0.46）mm，小指（3.16±0.41）mm；指伸肌腱止点中点至关节面距离：示指（1.77±0.06）mm，中指（1.76±0.20）mm，环指（1.77±0.06）mm，小指（1.47±0.10）mm；各指差异有统计学意义（P＜0.05）。 结论 指伸肌腱在末节指骨基底的止点较指深屈肌腱的止点距关节面更近，为西摩骨折的发生机制提供了解剖依据。
Abstract
Objective To study the differences of the volar and dorsal insertion of flexor digitorum profundus tendon and extensor tendon in the base of the distal phalanx and provide anatomical base for possible mechanism of Seymour fracture. Methods 10 hand specimens were collected from the anatomical laboratory of the hospital, including 3 left hand cases and 7 right hand cases, all of which were male patients，aged 24~58 years old. All 2~5 fingers were 10 fingers respectively, and all fingers had no history of traumatic surgery or deformity. The flexor digitorum profundus tendon and extensor tendon of each finger were cut apart from the level of the volar and dorsal interphalangeal joint and separated at the level of the distal interphalangeal joint. The distances from the insertion of flexor digitorum profundus tendon and extensor tendon to the volar and dorsal articular surfaces of the distal phalanx were recorded, and the insertion levels of the flexor digitorum profundus tendon and the extensor tendon at the volar and dorsal phalanx were compared. Results The distances from the articular surface to the proximal insertion point of the flexor digitorum profundus tendon for each finger were as follows: the index fingers (2.19±0.27) mm, the middle fingers (2.50±0.14) mm, the ring fingers (2.23±0.16) mm, and the little fingers (1.83±0.19) mm. The distances from the proximal extensor tendon insertion point to the articular surface for each finger were as follows: the index fingers (0.12±0.02) mm, the middle fingers (0.18±0.02) mm, the ring fingers (0.12±0.05) mm, and the little fingers (0.06±0.01) mm. The differences of each finger were statistically significant (P<0.05). The distances from the middle point of the insertion of the flexor digitorum profundus tendon to the articular surface for each finger were as follows: the index fingers (3.73±0.45) mm, the middle fingers (4.33±0.45) mm, the ring fingers (3.53±0.46) mm, and the little fingers (3.16±0.41) mm. The distances from the middle point of the insertion of the extensor tendon to the articular surface for each finger were as follows: the index fingers (1.77±0.06) mm, the middle fingers (1.76±0.20) mm, the ring fingers (1.77±0.06) mm, and the little fingers (1.47±0.10) mm. The differences of each finger were statistically significant (P<0.05). Conclusions The insertion point of the extensor tendon at the base of the terminal phalanx is much closer to the articular surface than that of the flexor digitorum profundus tendon, which provides anatomical basis for the mechanism of Seymour fracture.
关键词
指深屈肌腱 /
指伸肌腱 /
西摩骨折 /
甲基质
Key words
Flexor digitorum profundus tendon; /
/
Extensor tendon; /
/
Seymour fracture; /
/
Nail matrix
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参考文献
[1] Seymour N. Juxta-epiphyseal fracture of the terminal phalynx of the finger[J]. J Bone Joint Surg Br, 1966, 48(2): 347-349.
[2] Lin JS, Popp JE, Balch Samora J. Treatment of acute seymour fractures[J]. J Pediatr Orthop, 2019, 39(1): e23-e27.
[3] Lindor RA, Sadosty AT. Images in emergency medicine. A jammed finger and bloody nail. Seymour fracture[J]. Ann Emerg Med, 2014, 63(6): 656, 677.
[4] Kattan AE, AlShomer F, Alhujayri AK, et al. A case series of pediatric seymour fractures related to hoverboards: increasing trend with changing lifestyle[J]. Int J Surg Case Rep, 2017, 38: 57-60.
[5] Krusche-Mandl I, Köttstorfer J, Thalhammer G, et al. Seymour fractures: retrospective analysis and therapeutic considerations[J]. J Hand Surg Am, 2013, 38(2): 258-264.
[6] Ugurlar M, Saka G, Saglam N, et al. Distal phalanx fracture in adults: seymour-type fracture[J]. J Hand Surg Eur Vol, 2014, 39(3): 237-241.
[7] Al-Qattan MM. Extra-articular transverse fractures of the base of the distal phalanx (Seymour's fracture) in children and adults[J]. J Hand Surg Br, 2001, 26(3): 201-206.
[8] Zipoli B, Donon L, Ribeyre D. Surf and Seymour’s fractures[J]. Chir Main, 2010, 29(4): 263-265.
[9] Reardon CM, McArthur PA, Survana SK, et al. The surface anatomy of the germinal matrix of the nail bed in the finger[J]. J Hand Surg Br, 1999, 24(5): 531-533.
[10]Shum C, Bruno RJ, Ristic S, et al. Examination of the anatomic relationship of the proximal germinal nail matrix to the extensor tendon insertion[J]. J Hand Surg Am, 2000, 25(6): 1114-1117.
[11] Palomo-López P, Becerro-de-Bengoa-Vallejo R, López-López D, 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): E465.
[12] 张磊, 左玉明, 王月光, 等. 儿童及青少年西摩骨折的治疗[J]. 中国修复重建外科杂志, 2016, 30(5): 529-531.
[13] Berber O, Singh B. A unique physeal injury of the distal phalanx[J]. Case Reports Plast Surg Hand Surg, 2015, 2(1): 4-6.
[14] Ganayem M, Edelson G. Base of distal phalanx fracture in children: a mallet finger mimic[J]. J Pediatr Orthop, 2005, 25(4): 487-489.
[15] Han C, Naito K, Sugiyama Y, et al. Bony mallet finger without epiphyseal plate injury in childhood[J]. Int J Surg Case Rep, 2015, 14(C): 172-174.
[16] Lee S, Kim M, Jeon SH. Dislocation of the unossified epiphysis of the distal phalanx of a finger[J]. J Hand Surg Eur Vol, 2012, 37(5): 465-466.
[17] Papadonikolakis A, Li Z, Smith BP, et al. Fractures of the phalanges and interphalangeal joints in children[J]. Hand Clin, 2006, 22(1): 11-18.
[18] Reyes BA, Ho CA. The High Risk of Infection With delayed treatment of open seymour fractures: salter-harris I/II or juxta-epiphyseal fractures of the distal phalanx with associated nailbed laceration[J]. J Pediatr Orthop, 2017, 37(4): 247-253.
[19] Abzug JM, Kozin SH. Seymour fractures[J]. J Hand Surg Am, 2013, 38(11): 2267-2270.
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