近侧列腕骨间关节及韧带的应用解剖学观察

中国临床解剖学杂志 ›› 2012, Vol. 30 ›› Issue (1): 22-25.

近侧列腕骨间关节及韧带的应用解剖学观察

李秀忠¹，　蔡锦方¹，　张元信²，　汤海萍²，　侯书健²，　钟世镇³

1. 解放军济南军区总医院创伤骨科，济南 250015； 2.解放军第401医院手外科，青岛 266071；
3.南方医科大学解剖学教研室，广州 510515

收稿日期:2011-03-28 出版日期:2012-01-25 发布日期:2012-02-03
作者简介:李秀忠（1972-），男，山东临沂人，博士，副主任医师，研究方向：腕关节损伤基础及临床，Tel:(0532)51870542
基金资助:
第48批中国博士后科学基金面上资助项目（20100481　520）

The applied anatomy of proximal midcarpal joints and ligaments

LI Xiu-zhong¹, CAI Jin-fang¹, ZHANG Yuan-xin², TANG Hai-ping², HOU Shu-jian², ZHONG Shi-zhen³

1.Department of Traumatic Orthopedics, Jinan Military General Hospital, Jinan 250031, China;2. Department of Hand Surgery, the 401th Hospital of PLA, Qingdao 266071, China; 3. Department of Anatomy, Southern Medical University, Guangzhou 510515, China

Received:2011-03-28 Online:2012-01-25 Published:2012-02-03

摘要/Abstract

摘要：

目的　对近侧列腕骨间关节及部分腕部韧带的解剖组织学特性进行详细观察。方法　对成人腕关节标本的近侧列腕骨间关节及部分韧带进行解剖学观察、测量，并进行组织学观察。结果　舟月及月三角骨间韧带各亚区中，近侧亚区最薄弱，掌、背侧亚区较粗壮。小多角骨－第2掌骨间背侧韧带长(3.13±0.28)mm，宽(9.12±0.35)mm，厚（3.28±0.25）mm，头状骨－第3掌骨间背侧韧带长（3.45±0.15）mm，宽（11.87±0.44）mm，厚（3.03±0.29）mm。舟月骨间韧带（SLIL）掌、背侧亚区韧带纤维间含较多血管神经束，近侧亚区则为乏血管区；SLIL与月三角骨间韧带（LTIL）有较高的穿孔率。结论　小多角骨－第2掌骨间背侧韧带及头状骨－第3掌骨间背侧韧带均可作为舟月骨间韧带背侧亚区重建的供区材料；SLIL及　LTIL按组织结构及形态可分为掌、背、近侧3个亚区；SLIL及LTIL较高的穿孔率表明腕关节造影术不能准确判断关节内韧带是否损伤。

关键词: 近侧列腕骨间关节, 骨间韧带, 应用解剖, 组织学

Abstract:

Objective　To observe and measure the anatomic properties of midcarpal articulation and partial carpal ligaments.　Methods　Sixty upper limb specimens from adult cadavers were used in this investigation. All dissections were carried out under room temperature. Scapholunate interosseous ligament (SLIL) were stained with hematoxylin and eosin and viewed under standard optic microscopy.　Results　The dorsal and palmar subregions of SLIL and lunotriquetral interosseous ligament (LTIL) were stronger than the proximal subregion. The length, width and thickness of the dorsal trapezoid-to-second metacarpal ligaments was about (3.13±0.28) mm, (9.12±0.35) mm and (3.28±0.25)mm averagely, and that of dorsal capitate-to-third metacarpal ligaments was about (3.45±0.15)mm, (11.87±0.44)mm and (3.03±0.29)mm respectively. Both ligaments could match the size of dorsal SLIL by adequate modification. The histological observation showed the different features between proximal SLIL subregion and dorsal (palmar) subregion. The perforation ratio of SLIL and LTIL in formalin-fixed specimens was higher than that in fresh-frozen specimens obviously.　Conclusions　The morphologic features of bone, ligament and joints in wrist are complicated. Anatomically, the SLIL are composed of three discrete regions: dorsal, proximal, and palmar. The SLIL are composed of true ligaments dorsally and palmary, as defined by histological studies. Because of the high perforation ratio of SLIL and LTIL, arthrography cannot give accurate information concerning the ligament tear in some case.

Key words: Midcarpal joints, Interosseous ligament, Applied anatomy, Histology

中图分类号:

R323.7

李秀忠, 蔡锦方, 张元信, 汤海萍, 侯书健, 钟世镇. 近侧列腕骨间关节及韧带的应用解剖学观察[J]. 中国临床解剖学杂志, 2012, 30(1): 22-25.

LI Xiu-Zhong, CA Jin-Fang, ZHANG Yuan-Shen, SHANG Hai-Ping, HOU Shu-Jian, ZHONG Shi-Tian. The applied anatomy of proximal midcarpal joints and ligaments[J]. Chinese Journal Of Clinical Anatomy, 2012, 30(1): 22-25.

参考文献

[1] Landsmeer JM. Studies in the anatomy of articulation, I: the equilibrium of the “intercalated” bone
[J]. Acta Morphol Neerl Scand, 1961, 3: 287-303.

[2] Mitsuyasu H, Patterson RM, Shah MA, et al. The role of the dorsal intercarpal ligament in dynamic and static scapholunate instability
[J]. J Hand Surg, 2004, 29(2): 279-289.

[3] Cooney WP, Linscheid RL, Dobyns JH. Carpal instability: ligament repair and reconstruction
[M]//Neviaser RJ, ed. Controversies in hand surgery. New York: Churchill Livingstone, 1990: 125-145.

[4] Horii E, Garcia-Elias M, An KN, et al. A kinematics study of luno-triquetral dissociations
[J]. J Hand Surg Am, 1991, 16(2): 355-362.

[5] Tang JB, Shi D, Gu YQ, et al. Can cast immobilization successfully treat scapholunate dissociation associated with distal radius fracture
[J]? J Hand Surg Am, 1996, 21(4): 583-591.

[6] Berger RA. The gross and histological anatomy of the scapholunate interosseous ligament
[J]. J Hand Surg Am, 1996, 21(2): 170-178.

[7] 汤锦波，侍德，徐燕．手舟骨月骨间韧带的解剖学及临床意义
[J]．中国临床解剖学杂志，2000, 18(2), 142-143.

[8] Ritt MJ, Bishop AT, Berger RA, et al. Lunotriquetral ligament properties: A comparison of three anatomic subregions
[J]. J Hand Surg, 1998, 23(3): 425-431.

[9] Donald HL, Kent FD, Edwin LB. The incidence of wrist interosseous ligament and triangular fibrocartilage articular disc disruptions: a cadaveric study
[J]. J Hand Surg Am, 2004, 29(4): 676-685.

[10]Kindynis P, Resnick D, Kang HS, et al. Demonstration of the scapholunate space with radiography
[J]. Radiology, 1990, 175(1): 278-280.

[11]Rhee PC, Moran SL, Shin AY, et al. Association between lunate morphology and carpal collapse in cases of scapholunate dissociation
[J]. J Hand Surg Am, 2009, 34(9):1633-1639.

[12]Nakamura K, Beppu M, Patterson RM, et al. Motion analysis in two dimensions of radial-ulnar deviation of type Ⅰ versus type Ⅱ lunates
[J]. J Hand Surg Am, 2000, 25(5): 877-888.

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